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Double-duty solutions for optimising maternal and child nutrition in urban South Africa: a qualitative study

Published online by Cambridge University Press:  24 August 2020

Agnes Erzse
Affiliation:
SAMRC/Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
Susan Goldstein
Affiliation:
SAMRC/Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
Shane A Norris
Affiliation:
SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
Daniella Watson
Affiliation:
School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
Sarah H Kehoe
Affiliation:
MRC Lifecourse Epidemiology Unit, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
Mary Barker
Affiliation:
MRC Lifecourse Epidemiology Unit, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
Emmanuel Cohen
Affiliation:
SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Musée de l’Homme, Muséum National d’Histoire Naturelle, UMR-CNRS 7206 Eco-anthropology, Paris, France
Karen J Hofman
Affiliation:
SAMRC/Centre for Health Economics and Decision Science, PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
Corresponding
E-mail address:

Abstract

Objective:

To obtain a community perspective on key nutrition-specific problems and solutions for mothers and children.

Design:

A qualitative study comprising nine focus group discussions (FGD) following a semi-structured interview guide.

Setting:

The township of Soweto in South Africa with a rising prevalence of double burden of malnutrition.

Participants:

Men and women aged ≥18 years (n 66). Three FGD held with men, six with women.

Results:

Despite participants perceived healthy diet to be important, they felt their ability to maintain a healthy diet was limited. Inexpensive, unhealthy food was easier to access in Soweto than healthier alternatives. Factors such as land use, hygiene and low income played a fundamental role in shaping access to foods and decisions about what to eat. Participants suggested four broad areas for change: health sector, social protection, the food system and food environment. Their solutions ranged from improved nutrition education for women at clinic visits, communal vegetable gardens and government provision of food parcels to regulatory measures to improve the healthiness of their food environment.

Conclusions:

South Africa’s current nutrition policy environment does not adequately address community-level needs that are often linked to structural factors beyond the health sector. Our findings suggest that to successfully address the double burden of malnutrition among women and children, a multifaceted approach is needed combining action on the ground with coherent policies that address upstream factors, including poverty. Further, there is a need for public engagement and integration of community perspectives and priorities in developing and implementing double-duty actions to improve nutrition.

Type
Research paper
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Vorster, H (2010) The link between poverty and malnutrition: a South African perspective. Health SA Gesondheid 15, 6.CrossRefGoogle Scholar
Bourne, LT, Lambert, EV & Steyn, K (2002) Where does the black population of South Africa stand on the nutrition transition? Public Health Nutr 5, 157162.CrossRefGoogle ScholarPubMed
Hawkes, C, Ruel, MT, Salm, Let al. (2020) Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. Lancet 395, 142155.CrossRefGoogle ScholarPubMed
Mamabolo, RL, Alberts, M, Steyn, NPet al. (2005) Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central region of Limpopo province, South Africa. Public Health Nutr 8, 501508.CrossRefGoogle ScholarPubMed
Statistics South Africa (2017) South Africa Demographic and Health Survey 2016. Pretoria: Statistics South Africa. http://www.mrc.ac.za/bod/SADHS2016.pdf (accessed November 2019).Google Scholar
Kimani-Murage, EW (2013) Exploring the paradox: double burden of malnutrition in rural South Africa. Global Health Action 6, 19249.CrossRefGoogle ScholarPubMed
Maimela, E, Alberts, M, Modjadji, SEPet al. (2016) The prevalence and determinants of chronic non-communicable disease risk factors amongst adults in the Dikgale health demographic and surveillance system (HDSS) site, Limpopo province of South Africa. PLOS ONE 11, e0147926.CrossRefGoogle Scholar
Afshin, A, Sur, PJ, Fay, KAet al. (2019) Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet 393, 19581972.CrossRefGoogle Scholar
Victora, CG, Adair, L, Fall, Cet al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.CrossRefGoogle ScholarPubMed
Godfrey, KM, Gluckman, PD & Hanson, MA (2010) Developmental origins of metabolic disease: life course and intergenerational perspectives. Trends Endocrinol Metab 21, 199205.CrossRefGoogle ScholarPubMed
National Department of Health (2013) Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2013–17. Pretoria: National Department of Health. http://www.hsrc.ac.za/uploads/pageContent/3893/NCDs%20STRAT%20PLAN%20%20CONTENT%208%20april%20proof.pdf (accessed October 2019).Google Scholar
National Planning Commission (2012) Our Future – Make it Work: National Development Plan 2030. Cape Town: Department of The Presidency, South Africa. https://www.gov.za/sites/default/files/NDP-2030-Our-future-make-it-work_r.pdf (accessed October 2019).Google Scholar
United Nations (2015) Transforming Our World: The 2030 Agenda for Sustainable Development. United Nation. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E (accessed October 2019).Google Scholar
World Health Organization (2017) The Double Burden of Malnutrition: Policy Brief. Geneva: World Health Organization. Report No.: WHO/NMH/NHD/17.3. https://apps.who.int/iris/bitstream/handle/10665/255413/WHO-NMH-NHD-17.3-eng.pdf?ua=1 (accessed May 2019).Google Scholar
Compaoré, A, Ouedraogo, K, Boua, Ret al. (2020) ‘Men are no more playing their roles’, maternal and child nutrition in Nanoro, Burkina Faso. Public Health Nutr.Google Scholar
Debpuur, C, Nonterah, EA, Chatio, STet al. (2020) Supporting maternal and child nutrition: views from community members in rural Northern Ghana. Public Health Nutr.Google Scholar
Watson, D, Kehoe, SH, Erzse, Aet al. (2020) Community perspectives of maternal and child health during nutrition and economic transition in sub-Saharan Africa. Public Health Nutr.Google Scholar
Nyati, LH, Pettifor, JM & Norris, SA (2019) The prevalence of malnutrition and growth percentiles for urban South African children. BMC Public Health 19, 492.CrossRefGoogle ScholarPubMed
Ware, LJ, Prioreschi, A, Bosire, Eet al. (2019) Environmental, social, and structural constraints for health behavior: perceptions of young Urban black women during the preconception period: a healthy life trajectories initiative. J Nutr Educ Behav 51, 946957.CrossRefGoogle ScholarPubMed
Macaulay, S, Ngobeni, M, Dunger, DBet al. (2018) The prevalence of gestational diabetes mellitus amongst black South African women is a public health concern. Diabetes Res Clin Pract 139, 278287.CrossRefGoogle ScholarPubMed
Prioreschi, A, Wrottesley, S, Draper, CEet al. (2017) Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children. Glob Health Action 10, 1301085.CrossRefGoogle ScholarPubMed
Krueger, RA & Casey, MA (2000) Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, California: SAGE Publications.Google Scholar
Baragwanath Transport Interchange and Traders Market, Johannesburg (2019) Ludwig Hansen Architects Urban designers. http://www.ludwighansen.co.za (accessed June 2019).Google Scholar
QSR International (2020) NVivo Qualitative Data Analysis Software. https://www.qsrinternational.com/nvivo/home (accessed January 2020).Google Scholar
Virginia, B, Victoria, C & Nikki, H (2018) Thematic analysis. In Handbook of Research Methods in HealthSocial Sciences [Liamputtong, P, editor]. Singapore: Springer.Google Scholar
Tong, A, Sainsbury, P & Craig, J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19, 349357.CrossRefGoogle ScholarPubMed
Greyling, L & Mears, R (2014) Demographic characteristics of Soweto: a comparison of 1993 and 2008. JEIEFB 3, 20.Google Scholar
United Nations System Standing Committee On Nutrition (2016) Investments for Healthy Food Systems, Implementing the Framework for Action of the Second International Conference on Nutrition, Executive Summary. https://www.unscn.org/files/ICN2_TPM/EN_final_Investments_for_Healthy_Food_Systems_UNSCN.pdf (accessed March 2020).Google Scholar
Swinburn, B, Sacks, G, Vandevijvere, Set al. (2013) INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): overview and key principles. Obes Rev 1, 112.CrossRefGoogle Scholar
Popkin, BM, Adair, LS & Ng, SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70, 321.CrossRefGoogle ScholarPubMed
Ndlovu, N, Sartorius, B, Hofman, Ket al. (2018) Assessment of food environments in obesity reduction: a tool for public health action. In South African Health Review 2018 Durban: Health Systems Trust. http://www.hst.org.za/publications/Pages/SAHR2018 (accessed July 2019).Google Scholar
Wrottesley, SV, Pisa, PT & Norris, SA (2017) The influence of maternal dietary patterns on body mass index and gestational weight gain in Urban black South African women. Nutrients 9, 732.CrossRefGoogle ScholarPubMed
Wrottesley, SV, Prioreschi, A, Kehoe, SHet al. (2019) A maternal ‘mixed, high sugar’ dietary pattern is associated with fetal growth. Maternal Child Nutr. doi: 10.1111/mcn.12912.Google Scholar
National Department of Health (2013) Roadmap for Nutrition in South Africa 2013–2017. Pretoria, South Africa: National Department of Health. http://www.adsa.org.za/Portals/14/Documents/DOH/Nutrition%20Road%20Map%202013–2017.pdf (accessed July 2019).Google Scholar
National Department of Health (2013) South Africa Infant and Young Child Feeding Policy. Pretoria, South Africa: National Department of Health. https://www.health-e.org.za/wp-content/uploads/2013/09/IYCF_Policy_2013.pdf (accessed July 2019).Google Scholar
Richter, LM, Mathews, S & Kagura, J (2018) A longitudinal perspective on violence in the lives of South African children from the Birth to Twenty Plus cohort study in Johannesburg-Soweto. South Afr Med J 108, 181186.CrossRefGoogle ScholarPubMed
Ramsoomar, L, Morojele, NK & Norris, SA (2013) Alcohol use in early and late adolescence among the Birth to Twenty cohort in Soweto, South Africa. Glob Health Action 6, 5766. doi: 10.3402/gha.v6i0.19274.CrossRefGoogle ScholarPubMed
Ruel, MT & Alderman, H (2013) Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 382, 536551.CrossRefGoogle ScholarPubMed
World Health Organization (2012) Population-Based Approaches to Childhood Obesity: Prevention. Geneva, Switzerland: World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/80149/9789241504782_eng.pdf?sequence=1 (accessed January 2020).Google Scholar
Tugendhaft, A, Danis, M, Christofides, Net al. (2020) CHAT SA: modification of a public engagement tool for priority setting for a South African Rural Context. Int J Health Policy x, 113. doi: 10.34172/IJHPM.2020.110.Google Scholar
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