Exploring the paradox: double burden of malnutrition in rural South Africa

Figures & data

Fig. 1.  Conceptual framework on nutrition transition and hierarchical organisation of factors influencing a child's nutritional status.

Note: The framework is adapted from Popkin's (2003) model of nutrition transition (2), and Griffiths (2004) framework of interpreting community, family and individual effects on child weight status 24. It is also informed by the Food and Agriculture Organization's (FAO)'s (2004) model on changes in food systems 25, and Davison's (2001) ecological model for childhood obesity 26.

Fig. 2.  Prevalence of stunting and underweight for children aged 1–17 years (n=3,070) and wasting for children aged 1–9 years (n=1,641) by sex, Agincourt sub-district, South Africa, 2007. Significant difference by sex: *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Source: Kimani-Murage et al. 2010 20.

Fig. 3.  Prevalence of overweight, obesity & combined overweight and obesity for children aged 2–20 years (n=3,358) by age and sex, Agincourt sub-district, South Africa, 2007. Significant difference by sex: *p-value < 0.05, **p-value < 0.01, ***p-value <0.001. Source: Kimani-Murage et al. 2010 20.

Table 1. Predictors of weight status and central obesity among adolescents 10–20 years (n=1,848), Agincourt sub-district, rural South Africa, 2007

	BMI z-scores^2	Overweight and obesity^3	WHtR z-scores^2	Central obesity^3
Variable^1	Coeff [95% CI]	OR [95% CI]	Coeff [95% CI]	OR [95% CI]
Child-level factors
Child age	−0.0 [−0.0, 0.0]	1.0 [0.9, 1.1]	−0.2 [−0.0, 0.0]	1.1 [1.0, 1.2]*
Child sex
Boys (ref)	0	1	1	1
Girls	0.6 [0.5, 0.7]***	4.2 [2.8, 6.4]***	−0.0 [−0.1, 0.1]	7.2 [3.7, 14.2]***
Pubertal status
Pre-pubertal	0	1	1
Pubertal	0.3 [0.1, 0.5]***	1.4 [0.7, 2.8]	0.1 [−0.1, 0.2]	1
Post-pubertal	1.1 [0.8, 1.4]***	4.4 [1.9, 10.1]***	0.4 [0.2, 0.7]***	2.9 [1.8, 4.6]***
Household-level factors
Maternal factors
Mother's age category
35–49 (ref)		1		1
15–34		1.4 [0.8, 2.3]		1.9 [0.9, 4.0]
50 +		1.5 [1.0, 2.2]		1.8 [1.1, 2.8]*
Other household factors
HHH education
No education (ref)	0
<Secondary level	−0.1 [−0.3, −0.0]*	0.6 [0.4, 0.9]*
Secondary level and higher	0.1 [−0.1, 0.4]	1.1 [0.6, 2.0]
Food security
Not enough (ref)	0	1	1	1
Enough	0.2 [−0.0, 0.3]	1.4 [0.8, 2.2]	0.1 [0.0, 0.2]*	1.7 [0.9, 3.2]
Wealth index tertiles
Lowest (ref)	0	1	0	1
Medium	0.3 [0.1, 0.4]**	1.4 [0.9, 2.2]	0.0 [−0.3, 0.2]	1.3 [0.7, 2.2]
Highest	0.3 [0.1, 0.4]***	2.0 [1.3, 3.1]**	0.1 [0.0, 0.3]*	1.9 [1.1, 3.3]*

¹Only variables with significant association at 10% level of significance are shown.

²Linear regression.

³Logistic regression.

*p<0.05; **p<0.01; ***p<0.001.

Table 2. Linear regression analysis for predictors of height-for-age, weight-for-age, and weight-for-height z-scores among children aged 12–59 months (n=671), Agincourt, South Africa (2007)

	HAZ	WAZ	WHZ
Variable^1	Coeff [95% CI]	Coeff [95% CI]	Coeff [95% CI]
Child-level factors
HIV status
Negative (ref)	0	0	0
Positive	−0.8 [−1.2, −0.3]**	−0.7 [−1.2, −0.3]**	−0.5 [−1.0, 0.1]
Unknown status	0.2 [−0.2, 0.6]	0.2 [−0.2, 0.6]	0.2 [−0.3, 0.7]
Child age	0.2 [0.1, 0.3]***		−0.2 [−0.3, −0.1]**
Birth weight
≥ 2.5 kg (ref)	0	0	0
< 2.5 kg	−0.6 [−0.9, −0.3]***	−0.7 [−1.1, −0.4]***	−0.7 [−1.0, −0.3]***
Household-level factors
Maternal Factors
Mother's age
25–34 (ref)	0	0
15–24	−0.3 [−0.5, −0.1]**	−0.3 [−0.5, −0.1]*
35 +	−0.1 [−0.3, 0.2]	−0.1 [−0.3, 0.2]
Mother's education
None (ref)		0	0
< Secondary		0.2 [−0.1, 0.5]	0.2 [−0.2, 0.5]
Secondary and tertiary		0.3 [−0.0, 0.6]	0.2 [−0.2, 0.6]
Mother co-residence
Co-residing (ref)	0
Not co-residing	0.6 [−0.1, 1.2]
Other household factors
Household head age
35–49 (ref)		0	0
15–34		−0.3 [−0.6, −0.0]*	−0.3 [−0.7, −0.0]
50+ years		−0.1 [−0.3, 0.7]	−0.2 [−0.4, −0.0]
Community-level factors
Area of residence
Predominantly South African (ref)	0	0
Predominantly Mozambican	−0.3 [−0.7, −0.0]	−0.3 [−0.7, 0.0]

¹Only variables with significant association at 10% level of significance are shown.

*p<0.05; **p<0.01; ***p<0.001.

Table 3. Logistic regression analysis for predictors of stunting, underweight, and wasting among children aged 12–59 months (n=671), Agincourt, South Africa (2007) Variable¹

	Stunting	Underweight	Wasted
	OR [95% CI]	OR [95% CI]	OR [95% CI]
Child-level factors
HIV status
Negative (ref)	1	1	1
Positive	2.3 [0.9, 5.6]	1.5 [0.5, 4.4]	1.9 [0.5, 6.5]
Unknown status	0.4 [0.1, 1.6]	0.3 [0.0, 2.2]	0.5 [0.07, 4.1]
Child age	0.6 [0.5, 0.7]***
Birth weight
≥ 2.5 kg (ref)	1	1
< 2.5 kg	1.9 [0.9, 3.8]	3.1 [1.5, 6.4]**
Household-level factors
Maternal factors
Mother's age
25–34 (ref)	1
15–24	1.6 [1.0, 2.6]
35 +	1.1 [0.6, 1.9]
Delivery place
Health facility (ref)			1
Home			2.0 [1.0, 4.1]
Community-level factors
Area of residence
Predominantly South African (ref)	1	1	1
Predominantly Mozambican	2.2 [1.1, 4.3]*	2.0 [0.9, 4.4]	2.3 [0.9, 5.5]

¹Only variables with significant association at 10% level of significance are shown.

*p < 0.05; **p < 0.01; ***p < 0.001.

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