Abstract
Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South African studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%–66% of underweight was reported among children in rural areas compared to a 3.1%–32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents.
Highlights
Malnutrition is both an immediate and a distant risk factor for early mortality and morbidity in children and adolescent [1,2,3]
This review showed that different sex-and-age specific body mass index (BMI) references and charts (WHO 2007 reference, 2006 WHO Growth standards, Cole-International Obesity Task Force (IOTF) 2000/2007, Centre for Disease Control and Prevention (CDC) 2000, WHO, 1995, 1977 WHO/NCHS and NHANES I, II, III) were used to estimate nutritional status in children
Given the variation in reference standards, there is a need to develop a standardised reference standard which will work best for specific settings taking into consideration the social, ethnic, economic and dietary variations in children. It is evident from the reviewed studies that the burden of undernutrition and overnutrition are high among South African children
Summary
Malnutrition is both an immediate and a distant risk factor for early mortality and morbidity in children and adolescent [1,2,3]. Two burdens of malnutrition exist (undernutrition and overnutrition) and both are associated with economic inequalities and social disparities [4]. 2002 National Youth Risk Behaviour survey indicated that the prevalence of underweight in children between 13–19 years was 9% and about 17% were overweight [5]. Overnutrition (expressed as overweight or obesity in children) is associated with sedentary lifestyles and preponderance of energy dense foods over balanced diets following increasing urbanisation and technology [8,9,10]. In line with the health promotion strategies, regional tracking of underweight and overweight distribution in children is used as a stimulus to prioritise government policies and evaluate government feeding scheme for children [11]. It has been recommended that behavioural interventions including promotion of government school feeding scheme, physical activity [12] and dietary interventions [5]
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