A stunting profile of children younger than five years in selected vulnerable communities in Worcester, Breede Valley, Western Cape

Lenhoff, Annemie (2020-03)

Thesis (MNutr)--Stellenbosch University, 2020.

Thesis

ENGLISH SUMMARY: INTRODUCTION: Stunting is defined as a height for age z-score below minus two standard deviation, measured against the World Health Organisation (WHO) growth charts and is a significant public health priority associated with various economic consequences. In 2018 it was estimated that 150.8 million children worldwide were stunted. The WHO set a target to reduce childhood stunting with 40% by 2025 however, the prevalence of stunting in Africa continues to rise. AIM: The study aimed to create a stunting profile of children below the age of five, living in the following vulnerable communities of Worcester, Breede Valley sub-district: Avian Park, Riverview, Roodewal and Zwelethemba. METHODOLOGY: A descriptive, cross-sectional survey was conducted and consecutive sampling with randomised starting points was used. The data collection period spanned from 26 July 2018 to 30 October 2018, where a fieldworker-administered questionnaire was completed, and anthropometrical measurements of the mothers and their children below the age of five were taken. The main factors of stunting, determined according to the WHO conceptual framework on context, causes and consequences of childhood stunting were investigated. RESULTS: In this study the overall prevalence of stunting was 26.27% (n=232/883). The childhood underweight, wasting, overweight and obesity prevalence was 10.18% (n=90/885), 4.11% (n=36/876), 11.41% (n=100/876) and 4.34% (n=38/876), respectively. In addition, the maternal nutritional profile was determined to be poor. A high burden of 53.23% (n=470/851) in overweight and obesity was found while 11.63% (n=99/851) of the participants were identified as underweight. The odds of stunting were higher in male children (AOR=1.58; 95% CI: 1.07, 2.35) and those born with a birthweight below 2500g (AOR=2.21; 95% CI: 1.38, 3.52). Maternal waist circumference above 88cm cut-off showed a protective effect against childhood stunting in these vulnerable communities (AOR=0.46; 95% CI: 0.30, 0.71). Lastly, a low overall dietary diversity score was significantly associated (p=0.016) with stunting in the children that formed part of this study. CONCLUSION: Child and maternal under- and overnutrition was found to be a significant problem in the study area. The double burden of malnutrition was evident within the same households and the following key drivers of stunting were identified: being of male gender, lower weight at birth, low dietary diversity and poor maternal nutritional status. Interventions focused on improving maternal nutritional status during pregnancy and improved dietary diversity in children are essential in order to combat the prevailing stunting levels in the Breede Valley sub-district.

AFRIKAANSE OPSOMMING: INLEIDING: Ingekortelengtegroei word gedefinieer as die lengte vir ouderdom z-telling onder minus twee standaard afwyking, gemeet op die Wereldgesondheidsorganisasie (WGO) groeikaarte, en is ‘n beduidende publieke gesondeheids prioriteit wat met verskeie ekonomiese gevolge assosieer word. In 2018 was dit beraam dat ongeveer 150.8 miljoen kinders wereldwyd ingekortelengtegroei het, en die WGO het ‘n doelwit gestel om ingekortelengtegroei met 40% te verminder teen die jaar 2025, alhoewel die voorkoms in hiervan Afrika is steeds besig om te styg. DOEL: Die studie het beaam om ‘n ingekortelengtegroei- profiel van kinders onder die ouderdom van vyf jaar te skep, wat in die volgende selekteerde kwesbare gemeenskappe in Worcester, Breede Vallei sub-distrik woon: Avian Park, Riverview, Roodewal en Zwelethemba. METODES: ‘n Beskrywende, deursnit opname was gedoen en opeenvolgende steekproefneming met ewekansige beginpunte gebruik. Die data opname het tussen 26 Julie 2018 tot 30 Oktober 2018 plaasgevind, waartydens veldwerker geadministreerde vraelyste voltooi was en antropometriese metings van moeders en hul kinders onder die ouderdom van vyf jaar, geneem was. Die hoof oorsake van ingekortelengtegroei was vasgestel deur die WGO se konseptuele raamwerk insluitende konteks, oorsake en gevolge van ingekortelengtegroei onder kinders. RESULTATE: In die studie was die algehele verskyning van ingekortelengtegroei 26.27% (n=232/883). Kinder ondergewig, uitering, oorgewig en vetsig se voorkoms was 10.18% (n=90/885), 4.11% (n=36/876), 11.41% (n=100/876) en 4.34% (n=38/876) ondererskeidelik. Daarbenewens die antropometriese status van moeders was swak bevind. ’n Hoe las van 55.23% (n=470/851) oorgewig en vetsig was bevind, terwyl 11.63% (n=99/851) van die deelnemers ondergewig was. Die kans van ingekortelengtegroei was hoer in seuns (AOR=1.58; 95% CI: 1.07,2.35) en die wat gebore is met ‘n gewig onder 2500g (AOR=2.21; 95% CI: 1.38, 3.52). Die moeders met ‘n middelyfomtrek oor die 88cm afsny punt het ‘n beskermende effek teenoor ingekortelengtegroei getoon in die kwesbare gemeenskappe (AOR=0.46; 95% CI: 0.30, 0.71). Laastens ‘n lae dieetdiversiteitstelling was betekenisvol geassosieer (p=0.016) met ingekortelengtegroei in die kinders wat deelgeneem het in die navorsings projek. SAMEVATTING: Kinder- en moeder ondervoeding en oorvoeding was ‘n beduidende probleem in die studie areas. Die dubbele las van wanvoeding was duidelik in dieselfde huishoudings en die volgende faktore van ingekortelengtegroei was geindentifiseer: manlike geslag, laer gewig by geboorte, lae dieetdiversiteit en die swak voedingstatus van moeders. Intervensieprogramme gefokus om moeders se voedingstatus tydens swangerskap te verbeter, asook om die dieetdiversiteit van kinders te verbeter, is noodsaaklik om die heersende ingekortelengtegroei voorkoms te bekamp in die Breede Vallei sub-distrik.

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