Policy analysis of the exacerbated childrens nutrition crisis and - PowerPoint PPT Presentation

Policy analysis of the exacerbated children’s nutrition crisis and interventions that can be made T: +27 51 401 9111 | E: info@ufs.ac.za | www.ufs.ac.za Chantell Witten, RD(SA), PhD Left out of the conversation webinar series 22 July 2020

In short…the buffet of policy options and the piece-meal food and nutrition interventions for children T: +27 51 401 9111 | E: info@ufs.ac.za | www.ufs.ac.za Chantell Witten, RD, PhD Left out of the conversation webinar series 22 July 2020

Acknowledgements This presentation draws heavily on conversations in different spaces and contexts to make sense of the current food (and nutrition) situation. With special thanks and appreciation for: - The insights and sobering conversations with women and men serving food to children and families on the frontlines, mostly in the Western Cape and KZN. - The academic conversations, webinars and the flood of scientific papers and op- eds. Mainstream media has never been so alive with food and hunger issues. - The inspirational social media engagement with like-minded groups trying to find home-grown solutions. - Deep gratitude to the late Prof David Sanders for his teaching and leadership on the social justice in food and nutrition. Hunger and malnutrition is an injustice given that we live in a country that is food secure.

Outline of the presentation • Nutrition is much more than hunger • South African life course nutrition profile and landscape before and during covid-19 • The policy time line against the nutrition profile • Food programming for nutrition outcomes • Possible interventions

Nutrition is more than hunger A – Anthropometry B – Biochemical - Measures in weight, height, - Blood values - Head circumference - Urine analysis - Mid-upper arm circumstances - Breastmilk analysis - Reported changes in any of these - Hair analysis measures, clothes size - Bone density C – Clinical manifestations D – Dietary changes - Head to toe changes - Food choices - Night-blindness - Dietary patterns - Angular cheilitis (sores on corner of - Dietary diversity mouth) - Nutrient density - Fatigue and lethargy - Nutrient cost analysis

Life course nutrition profile before and during covid Before covid-19 During covid-19 (limited in nutrition • High levels of maternal obesity(33%), anemia (29%) and iron information) depletion (15%) 1 with poor birth outcomes (preterm-labour, prematurity, LBW) Decreased access to food 8,9 • • Inadequate food relief in scale and • Increased BF rates (EBF: 8% in 2008 to 32% in 2016) and from 7 months to 12months) 2 – BF rates higher and duration nutrient content 9,10 longer among the poor in LMICs 3 • Increased cost of the food basket 11 • Increase in child stunting (21% in 2008 and 27% in 2016) and • Speculation of increasing severe obesity (4.8% in 2008 and 15% in 2016) 2,4 acute malnutrition 12 • Dietary patterns in children were poor – low in variety and • Increasing and deepening food nutrient-density but adequate in calories 2,4 poverty and hunger 13 • Nutritious basket of food cost more than the child support • Decreased access to routine health grant 5 services 13 (no data on BF, childhood Only ECDs registered with DSD received funding 6. Nutrition • disease or food inventory) adequacy of ECD & NSNP feeding programmes 6,7 ~11 000 Severe Acute Malnut cases (2018/2019 ) •

Malnutrition media debacle 12 UNICEF Conceptual No additional data on framework for disease but malnutrition - Decreased access to PHC services - Lower use of routine Increased dietary services Immunization (EPI), inadequacy Growth Monitoring and - Less food in Promotion, Mid-Upper Arm amount and Circumference (MUAC) frequency screening - Low quality food - Diarrhoea, Acute Respiratory tract Infections (ARI) and SAM top three causes of child death

Stunting for across nutrition policy timelines 21.6 to 18% (1999 vs 2005) # 24% (2012) * 27% (2003, 2016) ^ 1994 2017 2013 # National Food Consumption * SANHANES ^ DHS

Understanding nutrition from a food lens 15 Long term negative impact on children and futures • Poor health • disease • Low cognitive development Covid conversation • Delayed milestones • Low education attainment

Food & nutrition programming in relation to stages of food security 15 In the context of food shortages (poverty), then humanitarian aid is appropriate - Food parcels - School feeding? - ECD feeding?

Key proven practices, services and policy interventions for the prevention and treatment of malnutrition 16

Staples and non-staples (eggs, vegetables) consumption on underweight 17 Microeconomic food policies that keep the price of food staples low can contribute toward reducing child underweight

This is should not be an option

Proposed interventions (nothing new) just better In addition to the call for Universal Basic Income Grant • Macro economic food policies to control food prices and introduce a fixed priced child-focused food basket in addition to the Child Support Grant • Strengthen and scale-up Infant and Young Child feeding support in the home, in communities and at workplaces • Scale up and intensify household food production and small scale farming supported by nutrition education

What is needed • Immediate activation and engagement of civil society on South Africa’s National Food and Nutrition Security Plan (2018-2023) • Build nutrition capacity across different sectors (DSD, DBE, Agri/Rural Development) • Inclusion of sound nutrition data elements in the next NIDS-CRAM wave or similar survey inclusion of Nutrition researchers • Civil society organizations to engage nutrition expertise to strengthen their food relief and food support efforts to mainstream nutrition in all programming (ECD, GBV, HIV/TB, enterprise development etc)

References 1. Symmington et al (2019). Maternal iron-deficiency is associated with premature birth and higher birth weight despite routine antenatal iron supplementation in an urban South African setting: The NuPED prospective study. y. PLoS ONE 14(9): e0221299 2. National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. 2018. South Africa Demographic and Health Survey 2016 Key Findings. Pretoria, South Africa, and Rockville, Maryland, USA: NDoH, Stats SA, SAMRC, and ICF Breastfeeding in the 21 st century. https://www.who.int/pmnch/media/news/2016/breastfeeding_brief.pdf 3. 4. Shisana et al(2013) South African National Health and Nutrition Examination Survey (SANHANES-1). Cape Town: HSRC Press. 5. National Agriculture Marketing Council (2019). https://www.namc.co.za/wp-content/uploads/2019/04/NAMC-Food-Basket-Price-Monthly-Apr-2019.pdf 6. KIDS (2019). South African Early Childhood Review 2019. file:///C:/Users/witte/Downloads/SA-ECR_2019_12_09_2019_online_pages.pdf 7. Hazell E. JET Education Services. 2016. Report on the Implementation Evaluation of the National School Nutrition Programme. Pretoria. Department Basic education; Department Planning, Monitoring and Evaluation. https://www.education.gov.za/Portals/0/Documents/Publications/NSNP%20Documents/1.%20NSNP_report%20final_17092016.pdf?ver=2018-11-09-083250- 753 8. InSession (2020) https://www.parliament.gov.za/storage/app/media/Publications/InSession/2020-09/final.pdf 9. Heneck, S (2020) https://www.dailymaverick.co.za/article/2020-04-23-covid-19-informal-traders-will-need-support-after-the-lockdown/#gsc.tab=0 10. BBC News (2020). https://www.bbc.com/news/av/world-africa-52701571/coronavirus-south-africans-in-massive-queues-for-food-parcels) 11. Pietermaritzburg Economic Justice and Dignity Group (2020). https://businesstech.co.za/news/finance/410141/heres-how-much-the-average-price-for-a- household-food-basket-has-increased-in-south-africa/#:~:text=The%20group%20found%20that%20the,R3%2C486.23%20in%20June%202020. 12. Vermeulen et al (2020). https://theconversation.com/food-aid-parcels-in-south-africa-could-do-with-a-better-nutritional-balance-136417 13. Evans S and Cowan (2020). https://www.news24.com/news24/analysis/analysis-gray-vs-mkhize-child-malnutrition-surge-is-coming-was-gray-or-mkhize-right- 20200528 14. van den Berg et al (2020) https://cramsurvey.org/wp-content/uploads/2020/07/Van-der-Berg-Coronavirus-Lockdown-and-Children-1.pdf 15. Gross et al (2000). https://www.semanticscholar.org/paper/Four-dimensions-of-food-and-nutrition-security%3A-and-Gross- Sch%C3%B6neberger/de6300535f6cc2904f623588db79a5cb6418d017 16. Bhuta et al (2008) What works? Interventions for maternal and child undernutrition and survival. The Lancet, DOI:10.1016/S0140-6736 17. Torless et al (2003). Association of household rice expenditure with child nutrition states indicates a role for macro-economic food policy to combat malnutrition. Journal of Nutrition 13:1320-25

Thank you