Free State infants are still dying from a lack of healthy food, with 21 having died from severe acute malnutrition (SAM) between April and June, and one having died from moderate acute malnutrition, according to provincial Health spokesperson Mondli Mvambi.
Between April 2022 and March 2023, 17 under-fives died from moderate acute malnutrition and 98 children succumbed to SAM – but numbers refer only to deaths in health facilities, writes Refilwe Mochoari for Spotlight.
Meanwhile, a third-quarter performance report in March showed that six of 37 patients (children under five) admitted to tertiary hospitals in the province for severe acute malnutrition (SAM) had died.
“Included in the deaths were SAM with oedema, SAM admitted with diarrhoea, and SAM with congenital cyanotic heart lesion as well as pulmonary HPT,” the report states.
The Free State Health Department had missed several of its targets meant to address malnutrition in the province in the third quarter of the 2022/2023 financial year. Last year, Spotlight reported that there was an increase in deaths of children under five – mostly from severe acute malnutrition from 2020/21 to 2021/22.
At the time, Mvambi said: “Of all the children admitted to the province’s hospitals for acute malnutrition, 48 died in 2020/21 and 86 in 2021/22.”
Additionally, results from a survey by the Grow Great Campaign – an organisation committed to reducing the number of children suffering from stunting – released last month showed that two out of every 10 children in the Thabo Mofutsanyana District suffered from stunting.
Dr Chantell Witten, dietician and researcher in the Community Paediatrics Division at the University of the Witwatersrand, called this and the number of children with malnutrition a national crisis. Often, stunting was an indicator of chronic malnutrition, she said.
The survey results were released last month at an imbizo on stunting in Bethlehem held by the Grow Great Campaign.
Professor Corina Walsh, who specialises in nutrition and dietetics at the University of the Free State, said malnutrition takes many forms, including underweight, stunting (low height for age), wasting (low weight for height) and hidden hunger (micronutrient deficiencies). Wasting is an indicator of recent severe malnutrition and is referred to as severe acute malnutrition (SAM), while stunting is an indicator of long-term chronic malnutrition.
Dying of hunger
The Grow Great Campaign survey looked at children under five from 455 households in the rural Thabo Mofutsanyana District and found that 17% of them suffered from stunting. The district has a population of around 700 000, with 52% of the community living below the lower poverty line and 32% unemployed.
Of the surveyed children, 15% were obese, 3% underweight, 6% wasted, and 1% had acute malnutrition.
Grow Great also found that 13% of them had a low birth weight (under 2.5kg), 62% had Vitamin A supplements on track, 61% had deworming on track, 39% had adequate dietary diversity, and 65% were exclusively breastfed. Only 27% have access to early learning centres and 84% rely on child support grants.
Small reflection of the burden
The Thabo Mofutsanyana district nutrition manager for the Department of Health, Dineo Mopeli, said the results were just a small reflection of the area’s burden of acute malnutrition.
“I would say 1% suffers from severe acute malnutrition and 6% from moderate acute malnutrition – but remember, we conduct surveys differently. Also, we measure what is coming to the clinic, so there is a possibility our statistics will differ. But the facts are we have a high rate of severe acute malnutrition and infant deaths are high.”
“Daily, I deal with children suffering from malnutrition,” said Majabulile Mapoteng, a professional nurse specialising in child health at Mphohadi Clinic in Bethlehem.
"We see about 30 children under five every day and I will get (about) five who are either underweight or too short. When we see this, we refer the mothers to a dietician so they can receive education on the types of nutritious food a child needs. We also give them a nutritional supplement of soft porridge likes Jikelele, and if the child is still an infant, we give them baby formula.”
Numbers increasing
When Spotlight spoke to Mvambi about the survey results, he said the recorded number of children with malnutrition in the province increased from 3 284 to 3 754 from April 2022 to April 2023.
He said the department runs educational programmes for pregnant mothers, encouraging them to follow exclusive breastfeeding for infants up to six months.
But Witten said the underlying causes of malnutrition are the high levels of poverty and unemployment. “This means many households depend on a child support grant and the pension grant. Free State has more than 700 000 beneficiaries of the child support grant, which was increased from R480 in 2022 to R500 this year. But it’s not sufficient to buy good quality food for children.”
Nationally, 27% of children are thought to be stunted, according to Statistics South Africa. The numbers from the Thabo Mofutsanyana district are lower than that, but they are still high, she said.
“The low birth weight is in line with the national statistics of 15%, and that researchers involved in the annual Child Gauge, a University of Cape Town publication, have made several recommendations to address the child nutrition crisis.
“Among these were for a subsidised food basket or micro policy interventions where we control the prices of important products for children – like eggs, full cream milk, soya products, and VAT-free meat products, especially for children on the child support grant.”
Meanwhile, in response to a question on under-five deaths in health facilities in the provincial legislature by the DA’s MPL and spokesperson for health in the Free State, Mariette Pittaway, numbers provided by Health MEC Mmathabo Leeto showed that more than 10 000 children had died in health facilities from 2013 to 2022. These were due to acute malnutrition, pneumonia, diarrhoea and preterm birth complications.
“Child malnutrition in the province is a severe problem and limited access to adequate healthcare like prenatal and paediatric care, and poor water and sanitation infrastructure, makes it difficult for poor households to meet basic needs,” Pittaway said.
Reasons and planned interventions
Several interventions are listed in the department’s third quarter report to tackle the severe acute malnutrition in-facility fatality rate and explain why the department could not reach its own targets.
In tertiary hospitals, for example, the department said SAM fatalities were recorded due “to late referral from lower levels of care”, and “some children were critically ill and had other medical conditions”. The plan is to, among others, “strengthen early detection and referral to high levels of care” and persist with “continuous health education and promotion as a preventative measure”.
In regional hospitals, however, which also missed the target for the severe acute malnutrition fatality rate, the department blamed caregivers’ “delay seeking healthcare”.
Other reasons were late referrals from lower levels of care and mobile services often being unable to reach some areas because of poor roads.
The department plans to “improve outreach services with social workers and dieticians”, health promotion on the “early danger signs and detection of malnutrition” and to “advocate for caregivers to present earlier for intervention”.
The department reported that it would train community healthcare workers to identify vulnerable children early and refer them to care timeously. It would also provide nutrition supplements and strengthen infant and young child feeding.
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