A recent headline in the Daily Maverick read as follows, “Child malnutrition in the Eastern Cape qualifies as a disaster” quoting from a South African Human Rights Commission report on child malnutrition in the Eastern Cape province. The article cited the fact that 25% of the provinces’s children have stunted growth and over the period of one year over 1000 children were diagnosed with severe malnutrition of whom 120 died.
Juxtapose this with a more recent media headline in a Afrikaans National Sunday Newspaper which reads translated from the Afrikaans, “You cough up R24 000 per head so that Cyril’s (the State President) guests can feast while they fly”. The latter article referring to the fact that on a flight from London to South Africa after the funeral of Queen Elizabeth in 2022, the VIP’s were provided with catering that cost a total of R569 000 amounting to around R24 000 per head.
Not surprisingly the latter article resulted in public outrage while the former article went almost unnoticed by the main stream media. There were, and rightly so, expressions of outrage at the profligate spending on the Presidential jet for a group of privileged individuals many of whom probably suffered rather from over and not under nutrition. In contrast child malnutrition described in the Eastern Cape media article remains, largely outside of the public consciousness. A recent retrospective study at an Eastern Cape hospital found a 7.2% prevalence of Severe Acute Malnutrition (SAM) in children with an inpatient mortality of 6.5%.1 Child malnutrition has been described as a form of “slow violence”2 occurring out of sight and not viewed as violence at all but with long term severe implications.
An interesting phenomenon is what is termed as the “double burden of malnutrition” which implies the coexistence of undernutrition and over nutrition both at individual, household and community levels. On the household level, the double burden may manifest as different forms of malnutrition in multiple family members with for example a mother being over weight and her child being under weight. In a 2019 study conducted in rural Limpopo, while the prevalence of underweight or thin children was similar to that reported recently in the Eastern Cape, the mothers of the children in the Limpopo study had a high rate of overweight and obesity.3 This illustrates the vulnerability of young children to the ravages of under nutrition which diminishes if they survive into adulthood.
20 years of my professional life were spent as a doctor and paediatrician until the mid-1990’s working in the South African public health sector. During this time I witnessed at first hand the impact of malnutrition on young children from poor communities. In 1976-1977 I worked at a rural mission hospital in the then Transkei in what is now the Eastern Cape and at that time many young children were admitted with severe acute malnutrition, in particular with what was termed Kwashiorkor due to a diet which lacked adequate protein consisting of diluted milk and mealie meal porridge. These children unfortunately often died despite our best efforts and if they survived the “treatment” was an adequate nutritious diet. Again while working at the Bloemfontein Pelonomi Hospital in the 1980’s I encountered many children admitted with the consequences of severe malnutrition, a fact that precipitated me into the world of political activism as I describe in my book.4. As a doctor and paediatrician the plight of hungry children suffering for malnutrition angered me then and still does, as does the fact that so many resources of this country have been plundered by those without a conscience and only a greedy desire to literally and figuratively become “fat cats” at the expense of many including children.
Nutrition has been demonstrated to have a profound effect on mental and physical development particularly in early childhood and later in life on productivity which in turn impacts on the economic potential of a country.5 Similarly there is a complex interrelationship between the poverty related causes and consequences of malnutrition.6 As evidenced by numerous studies poverty, a potent cause of child malnutrition in South African communities, remains a challenge that should feature high on the priorities for the government of this country.
In 1994 to address this challenge, the new government introduced the Primary School Nutrition Programme (PSNP) initially the responsibility of Government Departments of Health but later transferred to Basic Education which aimed initially to provide a nutritious daily meal to primary school children. The program has been extended to become the National School Nutrition Programme (NSNP) with the aim to ensure that all children have the benefit of adequate nutrition and to promote learning. The program has however been dogged with funding, implementation and administrative challenges. The implementation of social grants such as the Child Support Grant (CSG) and most recently in response to the COVID-19 epidemic the Social Relief Distress Grant (SRDG) introduced to provide financial support to families in distress should, if appropriately managed and allocated, serve to relieve the poverty that challenges food security. Pressure has increased on government to replace the SRDG with what is termed a Basic Income Grant (BIG) although concerns have been expressed about the affordability of doing so. Questions must be asked about the administration and management of these grants as it is troubling, given the recent data from provinces such as the Eastern Cape and Limpopo, that child malnutrition as a marker of poverty remains at the level that it is.
From a developmental perspective, given the impact of child malnutrition on future generations, it is troubling that the President and his guests saw fit to dine royally on an international flight, while children during the most sensitive and critical period of their growth and development go hungry. What this seems to indicate is either disregard or a dissociation between those in senior positions of power and privilege and the plight of many of the people that they purport to serve. I am reminded of the phrase translated from the French attributed to an 18th Century French princess, “Let them eat cake” when told the peasants had no bread and were hungry. The phrase can be interpreted alternatively to reflect either a disregard for the starving peasants or a poor understanding of their plight. Could the same possibly be said of the passengers on that presidential jet?
How can it be in the South Africa of 2023 with a Constitution that ostensibly protects the rights of its citizens to sufficient food and children to basic nutrition, that children can still suffer chronic malnutrition and die of severe acute malnutrition? Is this something that crossed the minds of those privileged individuals aboard the presidential jet? I fear not. But if nothing else, it would be reassuring if after the moral indignation expressed by many about their actions that those in positions of power now reflect seriously on what must be done to ensure that children do not go hungry in this country.
- Mandla N, Mackay C and Mad S Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa. South African Journal Clinical Nutrition 2022; 35(40:149-154
- May J, Witten C and Lake L (eds) South African Health Gauge 2020. Cape Town: Children’s Health Institute, University of Cape Town
- Modjadji P and Madiba S The double burden of malnutrition in a rural health and demographic surveillance study site in South Africa; a study of primary school children and their mothers. (2019) 19:1087 https://doi.org/10.1186/s12889-019-7412-y
- Walking the Road of Healthcare in South Africa My 40-year Journey Dr Craig Househam Quickfox Publishing 2021
- Alan Berg The nutrition factor: Its role in national development. The Brooking Institution, Washington
- Vorster, HH, The link between poverty and malnutrition: A South African perspective. Health SA Gesondheid 15(1), Art435, 6 pages, DOI;10.4102/hsag.v1511.435
