Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-18T00:16:35.426Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a nutrition supplementation programme in the Northern Cape Province of South Africa

Published online by Cambridge University Press:  22 December 2006

MK Hendricks ,
M le Roux ,
M Fernandes  and
J Irlam
MK Hendricks*
Affiliation:
Child Health Unit, School of Child and Adolescent Health, University of Cape Town, 46 Sawkins Road, Rondebosch 7700, Cape Town, South Africa
M le Roux
Affiliation:
Nutrition Sub-directorate, Department of Health, Northern Cape, South Africa
M Fernandes
Affiliation:
Nutrition Sub-directorate, Department of Health, Northern Cape, South Africa
J Irlam
Affiliation:
Child Health Unit, School of Child and Adolescent Health, University of Cape Town, 46 Sawkins Road, Rondebosch 7700, Cape Town, South Africa
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Aim:

This study aimed at assessing the effectiveness regarding implementation and impact of a take-home nutrition supplementation programme, the Protein Energy Malnutrition (PEM) Scheme, that targets malnourished pre-school children and pregnant and lactating women in the Northern Cape Province of South Africa.

Methodology:

In assessing implementation of the PEM Scheme, a cross-sectional descriptive study was undertaken over a 6-month period in the six regions of the Northern Cape Province. Interviews were conducted with programme managers and health personnel at clinics who were responsible for implementing the PEM Scheme. In assessing the impact of the PEM Scheme on growth, a retrospective review was done of the clinic records (including anthropometric data) of children enrolled in the PEM Scheme over a 1-year period.

Results:

About 76% of the budget allocated to the PEM Scheme had been utilised over the 1-year period. The budget for the following financial year was based solely on food supplements purchased in the previous year. Coverage of malnourished pre-school children and eligible pregnant and lactating women for enrolment was estimated to be 50% and 60%, respectively. Eighty-five per cent of health facilities in the province participated in the PEM Scheme. Some of the main problems identified included: lack of training, inappropriate targeting of certain groups, incorrect application especially of discharge criteria for pregnant and lactating women, inadequate assessment for nutrition-related disease, inadequate nutrition counselling and no standardised monitoring. Of the 319 children enrolled over a year, the mean age was 16.2 (standard deviation 16.2) months, 41% had been low-birth-weight and 18% had been diagnosed with tuberculosis. Ten per cent of the children with a weight-for-age Z-score of <−2 moved into the normal Z-score range after being on the PEM Scheme for a mean duration of 8 months. There was an overall improvement in the weight-for-age Z-scores of 25% of the sample, with a significant difference between the mean weight-for-age Z-scores at enrolment and follow-up (t = 4.8, P < 0.001). This was mainly related to significant improvement in the mean weight-for-age Z-scores of children <2 years.

Conclusions:

Numerous problems with the PEM Scheme have been identified which could have limited its impact. Recommendations are proposed for improving the effectiveness and impact of the PEM Scheme in the province.

Keywords

Nutrition programmeSupplementationProtein energy malnutritionEvaluationSouth Africa
Type
Research Article
Information
Public Health Nutrition , Volume 6 , Issue 5 , August 2003 , pp. 431 - 437
Copyright
Copyright © The Authors 2003

References

1Health Systems Trust and Department of Health. Health Care in the Northern Cape: Implications for Planning. Technical Report. Durban: Health Systems Trust and Department of Health, 1996.Google Scholar
2Labadarios, D, ed. Supported by Steyn, N, Maunder, E, MacIntyre, U, Swart, R, Gericke, G, Huskisson, J, Dannhauser, A, Vorster, HH and Nesamvuni, AE. The National Food Consumption survey (NFCS): Children aged 1–9 years, South Africa, 1999. Technical Report. The National Food Consumption Survey (NFCS), Stellenbosch, 2000.Google Scholar
3The South African Vitamin A Consultative Group (SAVACG). Children aged 6 to 71 months in South Africa, 1994: Their Anthropometric, Vitamin A, Iron and Immunisation Coverage Status. Isando: SAVACG, 1995.Google Scholar
4Dhansay, A, Hendricks, M. A Literature Review and Technical Perspective of Protein Energy Malnutrition in SA and International and Local Nutrition Intervention Studies. National Research Programme for Nutritional Intervention of the Community Health Research Group. Cape Town: Medical Research Council, 1994.Google Scholar
5Department of Health, Nutrition Directorate. Integrated Nutrition Programme for South Africa: Broad Guidelines for Implementation. Pretoria: Department of Health, 1998.Google Scholar
6Louw, HH, Khan, MBM, Woods, DL, Power, M, Thompson, MC. Perinatal mortality in the Cape Province 1989–1991. South African Medical Journal 1995; 85: 325.Google ScholarPubMed
7Jennings, J, Gillespie, S, Mason, J, Lotfi, M, Scialfa, T, eds. Managing Successful Nutrition Programmes. United Nations Administrative Committee on Co-ordination/Sub-Committee on Nutrition (ACC/SCN) State-of-the-art Series Nutrition Policy Discussion Paper No. 8. A report based on the ACC/SCN workshop at the 14th IUNS International Nutrition Congress on Nutrition, Seoul, South Korea 20–25 August 1989. Geneva: ACC/SCN, September, 1992.Google Scholar
8Mora, JO, de Paredes, B, Wagner, M, de Navarro, L, Suescuan, J, Christiansen, N, et al. Nutritional supplementation and the outcome of pregnancy. I Birth weight. American Journal of Clinical Nutrition 1979; 32: 455–62.CrossRefGoogle ScholarPubMed
9Mora, JO, Herrera, MG, Suescun, J, de Navarro, L, Wagner, M. The effects of nutritional supplementation on the physical growth of children at risk of malnutrition. American Journal of Clinical Nutrition 1981; 34: 1885–92.CrossRefGoogle ScholarPubMed
10Stefanak, MA, Jarjoura, D. Weight gain in supervised and take-home feeding programmes in Chad. Journal of Tropical Pediatrics 1989; 35: 214–7.CrossRefGoogle ScholarPubMed
11Hendricks, M, Perez, E, Roberts, M, Weight, M. A Prospective study of the growth of children under five years receiving a nutrition supplement at a malnutrition clinic. South African Journal of Epidemiology and Infection 2000; 15(2): 32–5.Google Scholar
12Malek, E. An Evaluation of the Protein Energy Malnutrition Scheme for Children under 6 years of age in the Mitchell's Plain District of the Western Cape Province. Unpublished report, 1997.Google Scholar
13Rivera, JA, Habicht, JP, Robson, DS. Effect of supplementary feeding on recovery from mild to moderate wasting in pre-school children. American Journal of Clinical Nutrition 1991; 54: 62–8.CrossRefGoogle Scholar
14 Beaton G. Which age groups should be targeted for supplementary feeding? In: Nutritional Issues in Food Aid. United Nations Administrative Committee on Co-ordination/Sub-Committee on Nutrition (ACC/SCN) Nutrition Policy Discussion Paper No. 12. Papers from a Symposium held at ACC/SCN 19th Session hosted by the World Food Programme, Rome, 24–25 February 1992. Geneva: ACC/SCN.Google Scholar
15Uauy, R, Kain, J. The epidemiological transition: need to incorporate obesity prevention into nutrition programmes. Public Health Nutrition 2002; 5(1A): 223–9.CrossRefGoogle ScholarPubMed
16Gayle, HD, Dibley, MJ, Marks, JS, Trowbridge, FL. Malnutrition in the first two years of life. American Journal of Diseases in Childhood 1987; 141: 531–4.CrossRefGoogle ScholarPubMed
17Lechtig, A, Habicht, JP, Delgado, H, Klein, RE, Yarbrough, C, Martorell, R. Effect of food supplementation during pregnancy on birth weight. Pediatrics 1975; 56(4): 508–20.CrossRefGoogle Scholar
18Kusin, JA, Kardjatis, S, Houtkooper, JM, Renqvist, UH. Energy supplementation during pregnancy and postnatal growth. Lancet 1992; 340: 623–6.CrossRefGoogle ScholarPubMed
19Gonzalez-Cossio, T, Habicht, JP, Delgado, H, Rasmussen, KM. Food supplementation during lactation increases milk intake and the proportion of exclusive breastfeeding. FASEB Journal 1991; 5: A917.Google Scholar
20Allen, LH, Gillespie, SR, eds. What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions. United Nations Administrative Committee on Co-ordination/Sub-Committee on Nutrition (ACC/SCN) Nutrition Policy Discussion Paper No. 19/Asian Development Bank (ADB) Nutrition and Development Series No. 5. Geneva-Manila: ACC/SCN in collaboration with the ADB, 2001.Google Scholar