A systematic review of sub-national food insecurity research in South Africa: Missed opportunities for policy insights

Patterns and trends in household food security in rural Mpumalanga Province, South Africa

This study examines patterns and trends in household food security in Bushbuckridge, Mpumalanga Province, South Africa, from 2010 to 2019. We use data from a household panel nested in the Agincourt Health and Socio- Demographic Surveillance System. Findings indicate that there have been improvements in household food security in this rural setting over the last decade. By polychoric principal component analysis, an aggregate food security index was constructed and we observed a small, yet important, proportion of households (7.8 %) that remained chronically food insecure. An ordered probit model was used to estimate the determinants of food security. Findings reveal that the observed differences in household food security status are as a result of differences in socioeconomic status. We therefore recommend that focus must be placed on identifying economic opportunities and empowering the chronically food insecure households if universal household food security is to be attained in rural South Africa and beyond.

Household food insecurity in South Africa from 1999 to 2021: a metrics perspective

OBJECTIVE

To review and synthesize studies on household food security in South Africa.

DESIGN

Systematic mapping review of metrics (methodological review).

SETTING

Electronic databases, including EBSCOHost, Scopus and Web of Science, were searched for studies and reports on household food security in South Africa, reporting household food security published between 1999 and 2021. Searching, selecting and reporting were performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement.

PARTICIPANTS

South African households.

RESULTS

Forty-eight articles reporting on six national surveys (one repeated annually since 2002) and forty sub-national studies meeting the inclusion criteria were selected. Various metrics, with different recall periods and ways of categorizing food security levels, were identified. Surveys that used similar metrics showed that the percentage of South African households that have experienced food insecurity and hunger has decreased over the review period yet remains concerning. However, the multitude of metrics used to assess the different components and levels of food security limits the comparability of the results to evaluate the scope and scale of the problem.

CONCLUSIONS

There is growing support for developing multi-variable approaches for food security research in sub-Saharan Africa. Future research should focus on finding the most appropriate combination of complementary metrics that would allow comparable data while holistically capturing food security and providing insight into the causes and consequences.

Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder

Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.

Cognitive performance in a South African cohort of people with HIV and comorbid major depressive disorder

Cognitive performance in people with HIV (PWH) may be affected by brain injury attributable to the infection itself, by other medical and psychiatric comorbidities (including major depressive disorder; MDD), and by psychosocial factors (e.g., education, food insecurity). We investigated effects of these variables on cognitive performance in a South African cohort of PWH with comorbid MDD and incomplete adherence to antiretroviral therapy (ART). We also examined (a) associations of depression severity with cognitive performance, and (b) whether improvement in depression led to improved cognitive performance. Participants (N = 105) completed baseline neuropsychological, psychiatric, and sociodemographic assessments. Subsequently, 33 were assigned to a cognitive-behavioural therapy for ART adherence and depression (CBT-AD) and 72 to standard-of-care treatment. Eight months post-baseline, 81 (nCBT-AD = 29) repeated the assessments. We investigated (a) baseline associations between sociodemographic, medical, and psychiatric variables and cognitive performance, (b) whether, from baseline to follow-up, depression and cognitive performance improved significantly more in CBT-AD participants, and (c) associations between post-intervention improvements in depression and cognitive performance. At baseline, less education (β = 0.62) and greater food insecurity (β = -0.20) predicted poorer overall cognitive performance; more severe depression predicted impairment in the attention/working memory domain only (β = -0.25). From baseline to follow-up, depression decreased significantly more in CBT-AD participants (p = .017). Improvement over time in depression and cognitive performance was not significantly associated except in the attention/working memory domain (p = .026). Overall, factors associated with cognitive performance were unrelated to brain injury. We conclude that clinicians examining PWH presenting with cognitive difficulties must assess depression, and that researchers investigating cognitive impairment in PWH must collect information on psychosocial factors.

Exploring intimate partner violence among pregnant Eswatini women seeking antenatal care: How agency and food security impact violence-related outcomes

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.

Socio-demographic predictors of food security among rural households in Langai district in Plateau-Nigeria: a cross-sectional study

Introduction

household food insecurity is a critical social determinant of health globally. There is a rising global prevalence of food insecurity which affects households' access to food of adequate quantity and quality. This study assessed the level of food security and its socio-demographic determinants among rural households.

Methods

this is a cross-sectional community survey among 201 rural households in Langai district representing a total population of 1,284. Reported food security was assessed using Food Consumption Scores and Coping Strategy Index. Data were analysed with SPSS 21. Analysis was done to assess the level of food-security associated factors. Multivariable analysis was done to assess determinants of food security. P-value <0.05 is considered significant.

Results

forty-three percent of all households have a total income greater than the national minimum wage. Overall, 21.4% are quality-food insecure (FCS), 6.5% have severe coping behaviour (CSI-food insecure) and 34.8% are highly economically vulnerable to food insecurity. Significant predictors of household food security include women earning than the basic monthly wage (AOR: 4.29 [95%CI: 1.34-13.71]; p=0.014); those without marital partners (AOR: 4.91 [95%CI: 1.01-23.90]; p=0.049); smaller household size (≤ 5) (AOR: 2.69 [95%CI: 1.16-6.24]; p=0.021); and those not receiving financial support (AOR: 2.68 [95%CI: 1.17-6.13]; p=0.020).

Conclusion

almost a quarter of all households' experience food insecurity with more than one-third being highly vulnerable to food insecurity. Efforts should be made to cushion the effect of global food insecurity among vulnerable populations and improve livelihood through improved agricultural practices to have sustainable and equitable food security.

Food insecurity and the risk of HIV acquisition: findings from population-based surveys in six sub-Saharan African countries (2016-2017)

OBJECTIVE

To assess the potential bidirectional relationship between food insecurity and HIV infection in sub-Saharan Africa.

DESIGN

Nationally representative HIV impact assessment household-based surveys.

SETTING

Zambia, Eswatini, Lesotho, Uganda and Tanzania and Namibia.

PARTICIPANTS

112 955 survey participants aged 15-59 years with HIV and recency test results.

MEASURES

Recent HIV infection (within 6 months) classified using the HIV-1 limited antigen avidity assay, in participants with an unsuppressed viral load (>1000 copies/mL) and no detectable antiretrovirals; severe food insecurity (SFI) defined as having no food in the house ≥three times in the past month.

RESULTS

Overall, 10.3% of participants lived in households reporting SFI. SFI was most common in urban, woman-headed households, and in people with chronic HIV infection. Among women, SFI was associated with a twofold increase in risk of recent HIV infection (adjusted relative risk (aRR) 2.08, 95% CI 1.09 to 3.97). SFI was also associated with transactional sex (aRR 1.28, 95% CI 1.17 to 1.41), a history of forced sex (aRR 1.36, 95% CI 1.11 to 1.66) and condom-less sex with a partner of unknown or positive HIV status (aRR 1.08, 95% CI 1.02 to 1.14) in all women, and intergenerational sex (partner ≥10 years older) in women aged 15-24 years (aRR 1.23, 95% CI 1.03 to 1.46). Recent receipt of food support was protective against HIV acquisition (aRR 0.36, 95% CI 0.14 to 0.88).

CONCLUSION

SFI increased risk for HIV acquisition in women by twofold. Heightened food insecurity during climactic extremes could imperil HIV epidemic control, and food support to women with SFI during these events could reduce HIV transmission.

Food Desert Status of Family Child Care Homes: Relationship to Young Children's Food Quality

Family child care homes (FCCHs) are a favored child care choice for parents of young children in the U.S. Most FCCH providers purchase and prepare foods for the children in their care. Although FCCH providers can receive monetary support from the Child and Adult Care Food Program (CACFP), a federal subsidy program, to purchase nutritious foods, little is known about FCCH providers' access to nutritious foods, especially among FCCH providers serving children from communities that have been historically disinvested and predominantly Black. This study aims to describe the food desert status of FCCHs in Baltimore City, Maryland, and examine the relationship between food desert status and the quality of foods and beverages purchased and provided to children. A proportionate stratified random sample of 91 FCCH providers by CACFP participation status consented. Geographic information system mapping (GIS) was used to determine the food desert status of each participating FCCH. Participants reported on their access to food and beverages through telephone-based surveys. Nearly three-quarters (66/91) of FCCHs were located in a food desert. FCCH providers working and living in a food desert had lower mean sum scores M (SD) for the quality of beverages provided than FCCH providers outside a food desert (2.53 ± 0.81 vs. 2.92 ± 0.70, p = 0.036, respectively). Although the significant difference in scores for beverages provided is small, FCCH providers working in food deserts may need support in providing healthy beverages to the children in their care. More research is needed to understand food purchases among FCCH providers working in neighborhoods situated in food deserts.

Caregivers' Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers’ knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver–child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers’ knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.

Food Insecurity, Safety Nets, and Coping Strategies during the COVID-19 Pandemic: Multi-Country Evidence from Sub-Saharan Africa

The COVID-19 pandemic has affected food security across the world. As governments respond in different ways both with regards to containing the pandemic and addressing food insecurity, in parallel detailed datasets are being collected and analysed. To date, literature addressing food insecurity during the pandemic, using these datasets, has tended to focus on individual countries. By contrast, this paper provides the first detailed multi-country cross-sectional snapshot of the social dimensions of food insecurity during the COVID-19 pandemic across nine African countries (Chad, Djibouti, Ethiopia, Kenya, Malawi, Mali, Nigeria, South Africa, and Uganda). Econometric analysis reveals that female-headed households, the poor, and the less-formally educated, appear to suffer more in terms of food insecurity during this global pandemic. Importantly, our findings show that the negative consequences of the pandemic are disproportionately higher for lower-income households and those who had to borrow to make ends meet rather than relying on savings; impacts are country-specific; and there is considerable spatial heterogeneity within country food insecurity, suggesting that tailored policies will be required. These nine countries employ both food and cash safety nets, with the evidence suggesting that, at least when these data were collected, cash safety nets have been slightly more effective at reducing food insecurity. Our results provide a baseline that can be used by governments to help design and implement tailored policies to address food insecurity. Our findings can also be used as lessons to reshape policies to tackle the heterogeneous impacts of climate change.

Using photography to explore people with diabetes' perspectives on food environments in urban and rural South Africa

Diabetes, a serious disease resulting in significant morbidity and early mortality, is currently on the rise globally. A major contributor to this observed increase in low- and middle-income countries, such as South Africa, has been the observed change in diet at the population level-a shift from a traditional diet, to one consisting of more energy-dense, processed foods, with more added sugar, salt and fat. Implicated in this degradation of diet are changing local food environments. Participant-generated digital photographs and facilitated focus group discussion-style workshops were utilized to better understand diabetic community members' perspectives on their food environments in both an urban and rural setting in South Africa, and what (and how) aspects of these physical environments influence their food acquisition behaviours and diet. Qualitative data were analysed using a deductive thematic analysis approach. The resulting predominant themes of accessibility, availability and affordability are outlined and discussed. Findings from this study have implications beyond the self-management of diabetes and extend to the self-management and reduction of all diet-related non-communicable diseases.

Evidence for factors associated with diet and physical activity in African and Caribbean countries

Objective

To identify and describe summarized evidence on factors associated with diet and physical activity in low- and middle-income countries in Africa and the Caribbean by performing a scoping review of reviews.

Methods

We searched the Medline®, LILACS, Scopus, Global Health and Web of Science databases for reviews of factors associated with diet or physical activity published between 1998 and 2019. At least 25% of studies in reviews had to come from African or Caribbean countries. Factors were categorized using Dahlgren and Whitehead's social model of health. There was no quality appraisal.

Findings

We identified 25 reviews: 13 on diet, four on physical activity and eight on both. Eighteen articles were quantitative systematic reviews. In 12 reviews, 25-50% of studies were from Africa or the Caribbean. Only three included evidence from the Caribbean. Together, the 25 reviews included primary evidence published between 1926 and 2018. Little of the summarized evidence concerned associations between international health or political factors and diet or associations between any factor and physical activity across all categories of the social model of health.

Conclusion

The scoping review found a wide range of factors reported to be associated with diet and physical activity in Africa and the Caribbean, but summarized evidence that could help inform policies encouraging behaviours linked to healthy diets and physical activity in these regions were lacking. Further reviews are needed to inform policy where the evidence exists, and to establish whether additional primary research is needed.

Food insecurity and depression: a cross-sectional study of a multi-site urban youth cohort in Durban and Soweto, South Africa

OBJECTIVE

To assess the prevalence of food insecurity and the independent association between depression and food insecurity among youth living in two urban settings in South Africa.

METHODS

Baseline cross-sectional survey data was analysed from a prospective cohort study conducted between 2014 and 2016 among youth (aged 16-24 years) in Soweto and Durban. Interviewer-administered questionnaires collecting socio-demographic, sexual and reproductive health and mental health data were conducted. Household food insecurity was measured using the 3-item Household Hunger Scale, with food insecure participants defined as having 'moderate' or 'severe hunger' compared to 'no hunger'. Depression was assessed using the 10-item Center for Epidemiological Studies Depression (CES-D 10) Scale (range 0-30, probable depression ≥ 10). Multivariable logistic regression models were used to estimate the association between depression and food insecurity.

RESULTS

There were 422 participants. Median age was 19 years (interquartile range [IQR] 18-21) and 60% were women. Overall, 18% were food insecure and 42% had probable depression. After adjustment for socio-demographic variables (age, gender, female-headed household, household size and school enrolment), participants with probable depression had higher odds of being food insecure than non-depressed participants (2.79, 95%CI 1.57-4.94).

CONCLUSION

Nearly one-fifth of youth in this study were food insecure. Those with probable depression had increased odds of food insecurity. Interventions are needed to address food insecurity among urban youth in South Africa, combining nutritional support and better access to quality food with mental health support.

Considerations for the design of nutrition-sensitive production programmes in rural South Africa

Background

Very little has been researched about the efficacy, effectiveness, feasibility, sustainability and impact of food-based approaches on the diets and nutritional status of populations at risk of hunger and food insecurity. This study contributes knowledge about the impact of food-based approaches on the diets of populations at risk of hunger and food insecurity in four of the poorest rural communities in South Africa. The study investigated the consumption and production patterns of rural households (278 in summer and 280 in winter) in four sites in the poorest municipalities in South Africa.

Methods

A multistage stratified random sampling technique was applied to identify the communities and sample households for the quantitative survey and qualitative assessments. Qualitative and quantitative data were collected between 2013 and 2015 through focus group discussions (FGDs), key informant interviews and the two-round panel survey to cover both the summer and winter seasons at each site.

Results

Home gardening led to a significant positive increase in the consumption of white roots and tubers, dark green leafy vegetables, orange-coloured fruit and other fruit in the 24 h prior to the survey. Participation in a community garden led to significant increases in the consumption of dark green leafy vegetables and other vegetables. School gardening did not demonstrate any statistical relationships with the consumption of foods from the crop-related food groups. Crop production improved dietary diversity. Selling produce and irrigation showed a stronger improvement in dietary diversity. Seasonality affected the availability of fresh fruit and vegetables for home consumption in winter.

Conclusions

Producing beyond that solely for home consumption has greater benefits for dietary diversity and a consumption-smoothing effect during the post-harvest period. Politicians and the scientific community should recognise the role that household and small-scale crop production plays in supporting household consumption and the provision of essential micronutrients despite constraints and disincentives. Production and education programmes should focus on strengthening existing good consumption patterns and promoting the consumption of foods that can improve dietary diversity.

A qualitative analysis of perceptions of various stakeholders on nutrition-sensitive agricultural interventions, including the taxation on sugar-sweetened beverages (SSBs), to improve overall health and nutrition in South Africa

BACKGROUND

As a low-middle income country, South Africa has seen an upsurge in the double burden of malnutrition (DBM). Owing to the rising costs of obesity on healthcare in South Africa, the National Treasury implemented a fiscal policy for the taxation of SSBs, known as the Health Promotion Levy, in line with the WHO recommendation. Potential negative impacts of the policy on the sugar cane industry and economic and rural development have been voiced by different sectors. By including a subsection in the SSBs fiscal policy and aligning the goals with existing policies, government could have made provisions for sugar cane farms to substitute crops with alternatives, including nutritional alternatives where possible, while supporting existing small-scale farms to produce nutrient-dense, local and culturally acceptable crops. Thus, the purpose of the study is to understand the perceptions of the various stakeholders on combining nutrition-sensitive agricultural interventions with the taxation on sugar-sweetened beverages (SSBs) to improve overall health and nutrition in South Africa.

METHODS

Semi-structured, in-depth interviews were conducted with each participant. The interviews were audio-recorded, transcribed intelligent verbatim, and cross-checked against the audio-recordings by the principal researcher. ATLAS.ti 8 software was used to navigate the data and assist with thematic analysis.

RESULTS

Perceptions of combining SSB taxation with agricultural policies to improve food and nutrition security were positive. The participants found it to be an innovative idea in theory but questioned the feasibility of combining policies. Participants highlighted education as an essential element for successfully changing behaviour to ensure a positive impact of the combined policy approach. Participants believed that before government could scale up nutrition-sensitive agricultural interventions, basic services and government functions would first need to run optimally.

CONCLUSION

Overall, perceptions with regard to combining the taxation on SSBs with nutrition-sensitive agricultural policies to improve overall health and nutrition in South Africa were positive. Although participants questioned the feasibility of combining these policies, it was viewed as a way to combat alleged collateral damage linked to the tax, with a specific focus on developing small-scale farmers. More research into these combined policy approaches in a South African context is required.

The Role of Agriculture in Ensuring Food Security in Developing Countries: Considerations in the Context of the Problem of Sustainable Food Production

Ensuring food security has become an issue of key importance to countries with different degrees of economic development, while the agricultural sector plays a strategic role in improving food availability. The aim of this paper is to identify relationships between the undernourishment scale and selected characteristics describing the agricultural sector within identified clusters of developing countries. Typological groups of countries were separated using Ward’s method. It results from the analyses that the greatest problems with maintaining food security are observed in the developing countries with a high share of agriculture in their Gross Domestic Product (GDP), adverse conditions hindering agricultural production and deficient infrastructure. Based on research results desirable and tailored strategies for food security improvement in individual clusters were developed. Promoting investments in agricultural infrastructure and extension services along with adopting measures aimed at increasing the households’ purchasing power, especially those in rural areas, appear to be key drivers for improving both food availability and food access. The paper focuses not only on identifying the reasons of undernourishment, but also contributes to recognition of the most effective ways to solve the hunger problem under a country’s unique conditions. It offers a comprehensive perspective for the policy formulation in various areas world-wide, which may be of interest to scholars and policy makers.

Socio-economic Determinants of Increasing Household Food Insecurity during and after a Drought in the District of iLembe, South Africa

In 2015 and 2016, South Africa experienced a severe drought resulting in water restrictions and food price inflation. A year later, while the proportion of food secure households remained constant, the proportion of those experiencing severe food insecurity increased. This paper investigates the socio-economic determinants of increasing food insecurity during and after the drought. Two cross-sectional household surveys were carried out in the district of iLembe in November 2016 and 2017. Household food insecurity was measured using the Coping Strategies Index. The results indicated changes in socio-economic determinants of food insecurity over time, with the poorest households experiencing the worst levels of food insecurity. After the drought, having a child under-five years was positively associated with food insecurity, while being located in a rural area was negatively associated. Policies that limit household vulnerability to price inflation, and interventions that protect poorer households from the effects of drought should be considered.

Stunting Is Preceded by Intestinal Mucosal Damage and Microbiome Changes and Is Associated with Systemic Inflammation in a Cohort of Peruvian Infants

Stunting, defined as height-for-age Z score equal to or lower than -2, is associated with increased childhood mortality, cognitive impairment, and chronic diseases. The aim of the study was to investigate the relationship between linear growth, intestinal damage, and systemic inflammation in infants at risk of stunting. We followed up 78 infants aged 5-12 months living in rural areas of Peru for 6 months. Blood samples for biomarkers of intestinal damage (intestinal fatty-acid-binding protein [I-FABP] and zonulin) and systemic inflammation (interleukin-1β, interleukin-6, tumor necrosis factor α [TNF-α], soluble CD14, and lipopolysaccharide-binding protein [LBP]) and fecal samples for microbiome analysis were collected at baseline and closure of the study. The children's growth and health status were monitored through biweekly home visits by trained staff. Twenty-one percent of the children became stunted: compared with non-stunted children, they had worse nutritional parameters and higher levels of serum I-FABP at baseline. The likelihood of becoming stunted was strongly associated with an increase in sCD14 over time; LBP and TNF-α showed a trend toward increase in stunted children but not in controls. The fecal microbiota composition of stunted children had an increased beta diversity compared with that of healthy controls throughout the study. The relative abundance of Ruminococcus 1 and 2, Clostridium sensu stricto, and Collinsella increased in children becoming stunted but not in controls, whereas Providencia abundance decreased. In conclusion, stunting in our population was preceded by an increase in markers of enterocyte turnover and differences in the fecal microbiota and was associated with increasing levels of systemic inflammation markers.

Assessment of Nutritional Status and Dietary Intake of Pregnant Women in Rural Area of Vhembe District, Limpopo Province

Poor consumption of balanced diet could result in poor weight gain during pregnancy increasing the risk of premature delivery, low birth weight, and birth defects. To assess the nutritional status and dietary intake of pregnant women in rural areas of Vhembe district. A cross-sectional descriptive study was carried out among 240pregnant women who were selected conveniently from 16 clinics in Vhembe District. An interviewer-administered questionnaire was used for data collection. Anthropometric measurements were measured following standard techniques. Data on dietary intake were collected using Food Frequency Questionnaire (FFQ). Permission and clearance were obtained and participant's rights were respected. Majority (78%) had secondary educational level while 19.5% had tertiary educational level. The mean energy and carbohydrate intake was 2248 Kcal and 372.1 g, respectively. Prevalence of underweight, overweight and obese using BMI was 16.3%, 24.2%, and 8.7% respectively. Dietary intake of the study participants showed that the intake of energy, fats, carbohydrates and vitamin C met the Recommended Dietary Allowance (RDA) values. The mean intake of protein was 30.2 ± 18.2 g. However, micronutrients like zinc, iron, magnesium, calcium including Vitamin A, B1 and B2 did not meet the RDA values in the current study. Despite government's programs to ensure adequate consumption of micronutrients and proper weight gain during pregnancy, malnutrition and insufficient consumption of micronutrients remains a major public health problem in South Africa. Improving nutritional status during pregnancy should follow an integrated approach tackling both malnutrition and micronutrient deficiencies at the same time considering the behavioral approach which will improve child survival and maternal health.

Nutritional status and dietary diversity of pregnant women in rural KwaZulu-Natal, South Africa

BACKGROUND

Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child.

AIM

The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women (N = 100) in early pregnancy (up to 24 weeks gestation).

SETTING

The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa.

METHODS

This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy.

RESULTS

Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category.

CONCLUSION

Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome.

Extended composite index of anthropometric failure in Argentinean preschool and school children

OBJECTIVE

The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces.

DESIGN

ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess.

SETTING

Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina).

PARTICIPANTS

10 879 children of both sexes aged between 3 and 13·99.

RESULTS

ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight.

CONCLUSIONS

The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

The Winning Weaning Food (WWF): The Development of a Complementary Food for Food-Insecure Infants and Young Children in Malawi

Growing evidence exists for the benefits of adequate infant and young children feeding (IYCF) practices at the weaning stage (≥ 6 months), including optimal growth, building the immune system, cognitive development, healthy food preferences, and reduced mortality and morbidity rates. However, these outcomes are not universally experienced. To ensure that a developing country such as Malawi, where recent studies have shown high rates of food insecurity and malnutrition benefits from adequate IYCF, five nutrient-dense complementary foods (Recipes 1 to 5) were developed. Standardized food processing techniques were used in the preparation and combination of Malawian indigenous food samples. The developed food recipes were assessed for nutrient density and cultural acceptability through sensory evaluations. Recipe 5 emerged as the winning weaning food (WWF), with an overall acceptability rate of 65% (mean score of 5.82 ± 0.87). Unlike theoretical analysis with the ESHA Food Processor, statistical analysis did not show that Recipe 5 met the Codex Alimentarius recommendations for macro- and micronutrients. However, it showed that the micronutrient recommendations for iron (p = 0.0001; 95%CI) and zinc (p = 1.00; 95%CI) were partially met, but not those for calcium and vitamins A and D. The prototype and outcome of this pilot study will be invaluable for interventions aimed at combating food insecurity and malnutrition in Malawi.

'When you take pills you must eat': Food (in)security and ART adherence among older people living with HIV

South Africa has increasing numbers of persons living with HIV on antiretroviral treatment (ART). There is evidence for a relationship between food, food security and HIV. Despite increasing rates of people older than 50 living with HIV coinciding with greater levels of co-morbidity, the existing research is largely limited to those aged 15-49 years. In this paper, we therefore explore how older people living with HIV (OPLWH) in two urban communities within South Africa negotiate and ensure they have sufficient access to food and how food insecurity may affect their retention in care and ART adherence. This study used exploratory qualitative semi-structured in-depth interviews with 23 OPLWH to collect data in isiXhosa. Data were analysed using thematic content analysis. Factors at the community, household and individual levels influence (a) access to sufficient and quality food, and (b) beliefs about ART and food based on (mis)understandings of messaging from health care providers. The results demonstrate the need to explore further and clarify the nutritional guidelines that OPLWH receive from providers to ensure this does not result in reduced adherence or retention in care. They also demonstrate the role that social welfare and family or kin obligations plays in ensuring the food security of OPLWH.

Pathways From Food Insecurity to Intimate Partner Violence Perpetration Among Peri-Urban Men in South Africa

INTRODUCTION

Although poverty is sometimes seen as a driver of intimate partner violence victimization, less is known about how it intersects with men's violence perpetration. Food insecurity is a sensitive marker of poverty that may have unique mechanisms leading to men's intimate partner violence perpetration given its association with gender roles and men "providing for the family."

METHODS

Using cluster-based sampling, the team conducted an audio-assisted questionnaire in 2016 among men living in a peri-urban settlement near Johannesburg, South Africa. The aim was to examine the relationship between men's food insecurity and their use of past-year intimate partner violence, and to explore the pathways linking these two conditions.

RESULTS

Among 2,006 currently partnered men, nearly half (48.4%) perpetrated intimate partner violence and more than half (61.4%) were food insecure. Food insecurity was associated with doubled odds of intimate partner violence (OR=2.15, 95% CI=1.73, 2.66). This association persisted after controlling for sociodemographics, relationship characteristics, and neighborhood clustering. In a structural equation model, food insecurity retained a direct relationship with men's violence perpetration and worked through indirect pathways of mental health and relationship quality.

CONCLUSIONS

Addressing men's perpetration of intimate partner violence may require examination of broader structural challenges, such as food insecurity. Future interventions should consider livelihood strategies alongside relationship and mental health approaches.

Food Insecurity Is Associated with Mild Cognitive Impairment among Middle-Aged and Older Adults in South Africa: Findings from a Nationally Representative Survey

There are no studies on the association between food insecurity and mild cognitive impairment (MCI). Thus, cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization’s Study on Global AGEing and Adult Health (SAGE) conducted in South Africa (2007–2008) were analyzed to assess this association. The definition of MCI was based on the National Institute on Ageing-Alzheimer’s Association criteria. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The sample consisted of 3,672 individuals aged ≥50 years [mean (SD) age 61.4 (18.3); 56% females]. The prevalence of MCI was 8.5%, while 11.0% and 20.8% experienced moderate and severe food insecurity, respectively. After adjustment for potential confounders, moderate and severe food insecurity were associated with 2.82 (95%CI = 1.65–4.84) and 2.51 (95%CI = 1.63–3.87) times higher odds for MCI compared with no food insecurity, respectively. The OR for those aged ≥65 years with severe food insecurity was particularly high (OR = 3.87; 95%CI = 2.20–6.81). In conclusion, food insecurity was strongly associated with MCI among South African older adults. Future longitudinal research is required to assess whether addressing food insecurity may reduce risk of MCI and subsequent dementia.

Nutritional status and dietary diversity of pregnant women in rural KwaZulu-Natal, South Africa

BACKGROUND

Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child.

AIM

The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women (N = 100) in early pregnancy (up to 24 weeks gestation).

SETTING

The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa.

METHODS

This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy.

RESULTS

Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category.

CONCLUSION

Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome.

Household Food Security Status and Its Determinants in Maphumulo Local Municipality, South Africa

Food security at the household level remains a major issue in South Africa and for many other developing countries, particularly those in Africa. As a means of ensuring food security in KwaZulu-Natal province, various food security intervention programmes were launched. Nonetheless, food security remains an issue among households in the province. This paper estimates the household food security status of the “One Home One Garden” (OHOG) beneficiaries against that of non-beneficiaries and assesses the determinants of household food security status in Maphumulo. A stratified random sampling technique was used to sample 495 households (including 330 OHOG beneficiaries and 165 non-beneficiaries). The status of household food security was estimated by means of a “Household Dietary Diversity Score” (HDDS). Additionally, a Household Food Consumption Score” (HFCS) tool was employed to supplement the HDDS. The results showed that food consumption patterns were characterized by medium (4.89) and average (4.22) HDDS for the OHOG beneficiaries and non-beneficiaries, respectively. Taking HDDS as a proxy for household food security, an independent samples t-test (Levene’s test—equal variances assumed) reveals a significant (p < 0.001) relationship between the sample means of the two groups. A greater proportion (65%) of the OHOG beneficiaries had an acceptable (≥35) HFCS level, whereas just over half (54%) of the non-beneficiaries fell in the borderline (21.5 to 35) HFCS level. The determinants of household food security status were elicited by means of a binary logistic regression model. The results revealed that education (p = 0.036), receiving infrastructural support (irrigation) (p = 0.001), and participation in the OHOG programme (p = 0.000) positively influenced the food security status of households, yet household income (p = 0.000) and access to credit (p = 0.002) showed a negative correlation. This paper proposes that government and developmental agencies, in their efforts to enhance food security through food security intervention programmes, should support households by investing in education and agricultural infrastructure, as well as giving priority to smallholder infrastructural irrigation support for households that largely rely on rain-fed systems.