The rate of severe acute malnutrition (SAM) in children under the age of five in SA has risen 26% in the past five years, with the sharpest increase reported in the Eastern Cape, health minister Joe Phaahla has told parliament.
Severe malnourishment is a major killer of children under five, increasing their mortality risk to up to 20 times that of a well-fed child, according to Unicef. Children who weigh less than 60% of their recommended weight are considered to have SAM.
Experts said the figures reported by provincial health departments to the minister are just the tip of the iceberg, as many critically ill children admitted to public healthcare facilities with underlying malnutrition are diagnosed with other conditions such as pneumonia or diarrhoea, and are not recorded as having SAM.
The incidence of SAM rose from 1.9 per 1,000 children under the age of five in 2018/19 to 2.4 per 1,000 children under the age of five in 2022/23, Phaahla said in a written response to questions posed by EFF MP Laetitia Arries.
The Eastern Cape recorded the sharpest five-year increase, with SAM almost tripling between 2018/19 and 2022/23, from 0.7 per 1,000 children to 2.7 per 1,000. In 2022/23, the recorded incidence of SAM was highest in the Free State (6.4 per 1,000 children under five) and the Northern Cape (6.2), and lowest in Mpumalanga (1.3) and the Western Cape (1.5).
The minister said the increase in the reported incidence of SAM might represent a real increase in malnutrition, but it could also be due to better case detection. Experts disagreed, saying the data underrepresent the true scale of severe malnutrition in SA.
The most recent report from the health department’s committee for the morbidity and mortality of children under five found one in three children who had died had underlying malnutrition, said Chantelle Witten, a registered dietician.
“The absolute number of children [reported] with SAM is just the tip of the malnutrition iceberg. There are far more children dying outside health facilities who could very well be dying from malnutrition.”
Even so, the reported incidence of SAM is high, given that SA is a middle-income country that provides free healthcare and welfare grants to eligible children, she said.
DG Murray Trust CEO David Harrison said there are 6-million children under the age of five in SA, implying 15,000 children had SAM in 2022/23.
“This is unacceptably high. I don’t buy the argument about better case detection: severe malnutrition is exactly that — severe — and severe cases will end up in the health services,” Harrison said.
The rising incidence of SAM suggests that Covid-19 and the subsequent spike in food prices sent an extra 6,000 children a year over the edge, he said.
While state interventions such as the temporary increase in the child support grant during the pandemic provided some protection, chronic malnutrition remains a problem across SA.
“In general there is a 20%-30% gap in the adequacy of nutrition. Our children are 30% underpowered physically and mentally from malnutrition — they can function but they can’t achieve their full potential.
“We need both targeted and generalised approaches to increase food access and affordability.
“We can’t ignore the children who don’t have [access to] grants, neither can we ignore the 30% gap between the value of the child support grant and the food poverty line,” Harrison said.
SA needs to introduce a maternal support grant for pregnant women, all babies with a low birth weight should be followed up monthly to gauge their progress, and provinces should reintroduce food supplementation for children under two who are failing to thrive, he said.
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