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Updated 09 July 2013

South Africa's 'hidden hunger'

As food prices increase, South Africans find it exceedingly difficult to afford healthy nutrient-rich foods.

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South Africa has enough food to feed its entire population, and yet many people, especially the poor in the rural areas, remain vulnerable to hunger and malnutrition.

What many people don't realise, is that even more people suffer from "hidden hunger" – a chronic lack of vitamins and minerals, without which the body cannot function properly. These deficiencies often go unnoticed (they remain "hidden") but have far-reaching consequences. As food prices increase, South Africans find it exceedingly difficult to afford healthy nutrient-rich foods.

A person may not be going to bed hungry, but the quality of their food intake may be so low that they suffer from nutrient deficiencies that can have a serious impact on their health. This deficit is especially detrimental to growing children.

Food security

A multi-disciplinary South African research team recently undertook a scoping study to identify the current food intake in rural communities, in order to identify ways to improve food security and tackle malnutrition.

"We need to understand people's current practices related to food – including the food environment. People get their food from various sources and for different reasons," Dr Friede Wenhold, study project leader and senior lecturer of the UP's Department of Human Nutrition, and Dr Mieke Faber, chief specialist scientist of the Medical Research Council (MRC) Nutritional Intervention Research Unit, explain.

The study, sponsored by the SA Water Research Commission (WRC), was a joint effort by the departments of Human Nutrition and Plant Production and Soil Science at the University of Pretoria, the Nutritional Intervention Research Unit at the MRC, and the Human Sciences Research Council.

While several food- and nutrition-related studies have been undertaken in South Africa in the past, the reasons for the food intake were not considered in many cases.

"None of the national food surveys reviewed considered seasonal difference in food availability and accessibility and how this may have an impact on food choices. In addition, despite the importance of basic services, factors such as access to basic water, sanitation and healthcare were not generally considered in any detail in the studies reviewed," the research team reports.

Natural resources under-utilised

According to Dr Gerhard Backeberg, WRC Executive Manager (Water Utilisation in Agriculture), a better understanding of the links between agriculture, nutrition and health is a high priority.

"Although not conclusive, it seems that most poor people are buying and not growing the food that they are eating. At the same time it is of major concern that available natural resources (such as water, soil and plants) are under-utilised. This despite the fact that at least 40% of the population (i.e. 20 million people of which approximately 70% live in rural villages) are hungry and under-nourished,” Backeberg warns in a WRC press release.

"It is absolutely essential that poor people gain secure access to available resources and have practical skills for beneficial food production."

Since most of the food in poor, rural areas is bought, rather than produced, the regularity and quality of food intake is directly related to cost and availability.

For example, studies of inland villages in the Eastern Cape found children only consumed meat once a month at the time of the monthly pension pay-out.

The study also found less variety in the rural areas. Access to electricity and refrigerators is also a factor when it comes to storing food.

Vitamin A, iron and zinc

Though the study was unable to identify a typical basket of foods that is currently consumed by the rural poor, it did find a high prevalence of malnutrition - both under-nutrition (hunger and starvation) and over-nutrition (overweight and obesity).

On a national level, South Africans mainly buy maize, wheat, bread and salt. For this reason it has been legislated that all maize meal and bread flour produced by commercial mills in South Africa must be fortified with a whole micronutrient mix; and all salt must be iodised.

Among rural poor people, the key micronutrient deficiencies are Vitamin A, iron and zinc, found mainly in foods of animal origin, fruit and vegetables.

"While there is a high prevalence of overweight and obesity amongst adult females, there is a medium prevalence of stunting (low height for age) and underweight (low weight for age) amongst young children," says Wenhold.

"Overall there is a high prevalence of micronutrient malnutrition. This unseen or 'hidden' hunger is mainly due to an insufficient intake of fruit, vegetables and animal-source foods."

According to Wenhold the most common nutrient deficiency in South Africa is Vitamin A, a nutrient that is needed for maintaining vision and eye health, healthy embryonic development and the maintenance of the immune system - critical for resistance against disease.

"Only animal source foods, including liver and milk (as well as breast-milk), contain pre-formed vitamin A (retinol). Since these foods tend to be expensive (and also high in fat which could lead to obesity), it is a good idea to opt for foods that are rich in beta-carotene (which is a pre-cursor of vitamin A), such as dark green leafy vegetables (spinach), and orange and deep-yellow fruit (apricots, mango) and vegetables (carrots, pumpkin, orange sweet potato). The use of wild green leaves (‘morogo’ or ‘imifino’) can also play an important role in addressing the vitamin A deficit."

Stunted growth and learning problems

Other major deficits in micronutrients include the minerals iron and zinc, which are also mainly found in animal-source foods (especially "red" meats), which are costly.

Iron is needed to carry oxygen throughout the body and to help tissues, muscles and other bodily systems function properly. It is also important for the immune system and for healthy foetal development. Children who do not get enough iron risk stunted growth and other developmental problems. A lack of iron can also cause fatigue, poor attention and learning problems because the brain is not receiving enough oxygen. Furthermore, iron-deficiency during pregnancy can lead to birth defects.

Says Wenhold: "The iron in red meat is better absorbed than that in plant sources, such as green leafy vegetables and enriched breakfast cereals. The reason for this is that the absorption of plant-sourced iron is inhibited by 'roughage' and other dietary constituents. Vitamin C (such as oranges), however, promotes the absorption of iron. Education around this is therefore very important."

Zinc is equally important for healthy muscles and bones, growth in childhood and adolescence and a healthy strong immune system.

Home-grown food

Educating people on the importance of fresh produce for their health and giving them the skills and means to produce these foods at home (dark green leafy vegetables and orange sweet potatoes, for example, are cheap and easy to grow), could play an important role in improved nutrition in the rural communities.

"Dietary variety, balance and moderation remain the basic recommendations for good nutritional health," Wenhold advises. "To achieve this, many inputs are necessary, ranging from food supplementation and fortification to empowerment through nutrition education and home-production.

"Since food insecurity drives malnutrition in South Africa, this must be a key concern; thus a multi-sectoral approach is needed. On a national level South Africa has enough food to feed its population, but the problem is distribution; resulting in many households being food insecure."

(The full report of the study "Water use and nutrient content of crop and animal food products for improved household food security: A scoping study" is available on the SA Water Research Commission's website.)

- (Health24, April 2013)

 
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