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Abstract
Background : This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries.
Objective : To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country.
Methods : A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 1–20 years. In addition, HIV testing was carried out on children aged 1–5 years and Tanner pubertal assessment among adolescents aged 9–20 years.
Results : The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child's HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child's age, sex, and pubertal development, household-level food security, socio-economic status, and household head's highest education level.
Conclusions : The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive.
Acknowledgements
The value of this work is greatly owed to the PhD thesis supervisors Prof Kathleen Kahn and Prof Shane Norris. We also acknowledge technical support from Prof Stephen Tollman, Prof John Pettifor, Prof Kerstin Klipstein-Grobusch, Prof Lenore Manderson, Prof David Dunger, Dr. Mark Collinson and Dr. Xavier Gómez-Olivé and Edmore Marinda. We acknowledge Dr. Paula Griffiths for reviewing the PhD thesis and giving constructive comments. We also acknowledge constructive comments on the manuscript from Prof Sharon Fonn and Prof Laetitia Rispel. We acknowledge funding from the National Research Foundation (NRF) and the Medical Research Council (MRC), South Africa, and the Faculty of Health Sciences (Faculty Endowment Fund), University of the Witwatersrand, South Africa. The Agincourt health and socio-demographic surveillance system is funded by the Wellcome Trust, UK (Grant # WT069683 & WT085477), and is a member of the INDEPTH Network. Elizabeth Kimani-Murage had a PhD fellowship funded by the Flora and William Hewlett Foundation, USA, and is currently a Wellcome Trust Fellow (Grant # 097146/Z/11/Z). We acknowledge the data collection team and the LinC office team at the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) for their role in community mobilisation. We also acknowledge the training team and the data entry team from the Birth to Twenty program, University of the Witwatersrand, South Africa, funded by the Wellcome Trust, UK (077210/Z/05/Z). We also greatly appreciate the involvement of the study participants.