Longer breastfeeding could help underfed South African infants
"Generally speaking, in the third world children in rural areas are better off than those living in shifting urban settlements," says Oelofse's supervisor Dr Jules Tolboom, paediatrician at the Sint Radboud Hospital in Nijmegen. "In rural areas people still have plots where they can grow vegetables." This could well explain why Oelofse, who works for the Medical Research Council in Cape Town, found no stunted growth in a group of pre-school children in the rural area of KwaZulu Natal. This does not necessarily mean that the food they eat is good. Oelofse found that almost all of the children had a vitamin A deficiency, and about a quarter suffered from anaemia.
In Cape Town, Oelofse examined a group of breastfed infants between 6 and 12 months old. The group as a whole had more nutrient deficiencies than the rural group, which meant that their growth was also stunted. The children of coloured parents were most at risk: 18 percent had stunted growth. The rate was only 8 percent among black South African babies, while surprisingly the food that this group received was of a lower nutritional value. The black children did however show a slower rate of mental development than the coloured children. Oelofse believes that this is primarily due to a zinc deficiency.
An important cause of the problem of nutrient deficiencies is that South African mothers are breastfeeding their babies for a shorter amount of time. The advice from the WHO is to only give babies breast milk for the first six months, and until their second year both breast and supplemental feeding. The reality is different however. "Most mothers start their babies on some solids when they are only a few months old," says Dr Joop van Raaij, researcher in the Human Nutrition and Epidemiology group at Wageningen University, and also supervisor of Oelofse. " Usually they are fed some kind of porridge." This usually contains too few micronutrients such as iron, iodine and zinc.
Oelofse has two suggestions to improve the situation: women should be encouraged to breastfeed more and longer, and more should be done to improve the complementary foods for babies, such as supplementing them with micronutrients. Another idea is to use fermented foods. These products are already partly digested by micro-organisms, which means it is easier for babies to absorb the nutrients from them.
Not all bad
Despite the problems encountered, when compared with the situation in neighbouring African countries, the health of South African children is good. Tolboom worked for nine years in Africa: "In the rural areas of Zambia we discovered that about 60 percent of the children had stunted growth," he explains. "But if you compare the results in this PhD with the health of the upper layer of society in South Africa then these data are also pretty grim," Tolboom adds.
Andr? Oelofse will receive his PhD on 6 November for his thesis 'Micronutrient deficiencies in South African infants and the effect of a micronutrient-fortified complementary food on their nutritional status, growth and development'. His promoter is Professor Hautvast, Professor of Nutrition and Health at Wageningen University.