Strategies to reduce stunting in South Africa and the case of KwaZulu-Natal

Muller, Anna-Marie (2015-12)

Thesis (MPhil)--Stellenbosch University, 2015

Thesis

ENGLISH SUMMARY : The aim of this thesis is to frame nutrition as a key driver for sustainable development. Since malnutrition, and specifically the disorder ‘stunting’, has ranging detrimental implications for development, the argument was made that optimal foetal and child nutrition and development must be rigorously pursued with collective efforts. Stunting can have both physiological and cognitive effects on an individual. The persistently high prevalence of this disorder has been a long-time feature of child health profiles in developing countries, including Sub-Saharan Africa. Hence the issue transcends the individual to include communities and national levels with a global nutrition target set to reduce stunting by 40% in children under five by 2025. Intervention strategies aimed at the most significant window of opportunity during the first 1000 days of life (the period from conception to a child’s second birthday) should be prioritised. Nutrition specific and nutrition sensitive interventions are multi-sectoral in nature. To facilitate the success of implementation, an enabling environment (political and policy processes that shape and sustain momentum for intervention implementation), is fundamentally important. Two sets of questions emerged from this problem statement. Firstly, developing a clear understanding of stunting magnitude and trends in South Africa, contextualised the question: which strategies are in place to reduce the prevalence of stunting? Documented strategies in the form of national policies were summarised and the approaches to stunting were highlighted. These policies are implemented in a range of sectors: The Roadmap for Nutrition, the Infant and Young Child Feeding Policy and the Strategic Plan for Maternal, Newborn, Child and Women’s Health and Nutrition are the main responsibility of the National Department of Health; the National Policy on Food and Nutrition Security is the joint effort of the National Department of Social Development and the Department of Agriculture, Forestry and Fisheries; the Draft Early Childhood Development Policy will be coordinated by the Department of Social Development and the National Development Plan, the current comprehensive national strategy, was developed by the National Planning Commission situated in the Presidency. The second question explored the Nutrition Director’s role in reducing stunting in the Provincial Department of Health in KwaZulu-Natal. The Nutrition Programme is responsible for the development of policy and the implementation thereof in the province. Due to early indications that KwaZulu-Natal has been successfully reducing the prevalence of stunting, this individual’s leadership approach was qualitatively investigated. The key findings were that access to high-level decision-making processes is important to programmatic success and advocacy was identified as a key method to secure commitment to reducing child undernutrition. This research responded to a call to identify nutrition leaders and describe their work - an emerging field in public health nutrition. It is concluded that optimal nutrition is central to the creation of sustainable communities which should be adequately reflected in relevant policies and pursued by inspiring leadership.

AFRIKAANSE OPSOMMING : Die doel van hierdie tesis is om voeding aan te voer as ‘n belangrike drywer vir volhoubare ontwikkeling. Aangesien wanvoeding, en spesifiek die stoornis ‘dwerggroei’ (stunting), vele nadelige gevolge vir ontwikkeling inhou, word die argument aangevoer dat optimale fetale- en kindervoeding en ontwikkeling met ywer en gesamentlike pogings nagejaag moet word. Dwerggroei kan beide ‘n fisiologiese en kognitiewe effek op die individu se ontwikkeling hê. Volgehoue hoë voorkomsvlakke van dwerggroei is ‘n langtermyn eienskap van die kindergesondheidsprofiel in ontwikkelende lande, insluitend sub-Sahara Afrika. Daarom lê die kwessie dieper as op ‘n individuele vlak. Dit behoort aksies op gemeenskap en op nasionale vlakke in te sluit. ‘n Globale teiken is gestel om teen 2025 dwerggroei se voorkomsvlakke in kinders jonger as vyf met 40% te verminder. Ingrypingstrategieë gemik op die mees beduidende geleentheid tydens die eerste 1000 dae van ‘n kind se lewe (die periode tussen verwekking en ‘n kind se tweede verjaardag) moet as prioriteit beskou word. Voedingspesifieke en voedingsensitiewe intervensies is multi-sektoraal van aard. Om ingrypings se sukses te fasiliteer, is die ‘ondersteunende omgewing’ (politieke en beleidsprosesse wat volhoubaarheid verseker en vorm bied wanneer ingrypings geïmplimenteer word) van kardinale belang. Twee stelle vrae het gespruit uit hierdie probleemstelling. Eerstens, om duidelike insig te ontwikkel oor die omvang en tendens van dwerggroei in Suid-Afrika, is die vraag: watter strategieë is in plek om die voorkomsvlakke van dwerggroei te verminder? gekontekstualiseer. Gedokumenteerde strategieë in die vorm van nasionale beleide is opgesom en die benadering tot dwerggroei is uitgelig. Die betrokke beleide word vanuit vele sektore geïmplimenteer: Die Padkaart vir Voeding, die Baba en Jong Kind Voedingsbeleid en die Strategiese Plan vir Moeder-, Pasgeborene-, Kinder- en Vrouegesondheid en –voeding is die hoofverantwoordelikheid van die Nasionale Departement van Gesondheid; die Nasionale Beleid oor Voedsel- en Voedingsekerheid is die gesamentlike poging van die Departement van Maatskaplike Ontwikkeling en die Departement van Landbou, Bosbou en Visserye; die voorlopige konsep vir die Jong Kind Ontwikkelingsbeleid sal deur die Departement van Maatskaplike Ontwikkeling gekoördineer word; en die Nasionale Ontwikkelingsplan, die nuutste omvattende nasionale strategie, is deur die Nasionale Beplanningskommissie vanuit die Presidensie ontwikkel. Die tweede vraag het die rol van die Voedingsdirekteur in die Provinsiale Departement van Gesondheid in KwaZulu-Natal in die verlaging van dwerggroei ondersoek. Die ontwikkeling en implementering van beleid in die provinsie is die Voedingsprogram se verantwoordelik. Vanweë vroeë aanduidings dat KwaZulu-Natal die voorkomsvlakke van dwerggroei suksesvol verminder het, is hierdie persoon se leierskapsbenadering kwalitatief ondersoek. Die vernaamste bevindinge is dat toegang tot hoë-vlak besluitnemingsprosesse belangrik is vir programsukses en dat voorspraak as ‘n sleutelmetode vir die versekering van verbintenis tot die vermindering van kinderwanvoeding geïdentifiseer is. Hierdie navorsing is gedoen om gehoor te gee aan ‘n behoefte aan die identifisering en toepassing van goeie leierskap op die gebied van voeding en aan die beskrywing van hul werk - ‘n ontwikkelende veld binne openbare voedingsgesondheid. Ten slotte: ten einde volhoubare gemeenskappe te kan vestig, behoort voeding sentraal te wees in die toepaslike beleide wat deur inspirerende leierskap uitgevoer moet word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/97729
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