Integrated Nutrition Programme

Malnutrition is a serious problem in South Africa and is one of the biggest contributors to childhood illness and death. It's estimated that about 27% of South African children are stunted from a lack of adequate nutrition in the early years of their lives.

Malnutrition includes both under and over nutrition as well as micronutrient deficiency.

What are we doing about malnutrition?

The Integrated Nutrition Programme (INP) aims to improve the nutritional status of all people living in the Western Cape province. There are numerous aspects to this programme.

Nutrition services are focused on the specific health needs of individuals through the different life stages from newborn to old age.

Causes of Malnutrition:

• Inadequate food intake,
• illness, and
• psychosocial stress/trauma are the most significant immediate causes of malnutrition.

Factors that Contribute to Malnutrition:

Poverty and lack of resources are basic factors that contribute to malnutrition.

Insufficient feedings and/or inappropriate feeding practices in the orphanage, particularly for those children with special needs.

Nutrition supplements for children

At primary health care level children who are examined and identified as undernourished (this includes children and adults who are HIV positive and with tuberculosis) will be given food supplements including fortified maize meal and a high-energy drink.

Supplements are given to identified children according to criteria.

Health workers also provide counselling, information and education about healthy diets and the healthiest ways of preparing food.

Dieticians also provide specialised services to the community.

Side by Side Campaign

Side-by-Side is a national campaign working to ensure that all children under 5 receive the nurturing care they need to develop to the best of their abilities.

The Side by Side Campaign relates to the essential components of early childhood development:

• Nutrition
• Early learning through interaction and stimulation.
• Parents and other caregivers form secure and loving relationships with the children they care for.

The Department of Health is identified as a key stakeholder in this campaign and works together with other stakeholders (such as the Department of Social Development) to implement the identified programmes, policies and support structures to achieve the aims and objectives.

Road to Health Booklet 

All children born in the Western Cape are issued with a Road to Health Booklet when discharged from the birthing unit.  The Road to Health Booklet is a patient held record of all medical interventions, care and treatments which must be completed at all contact points with health services (both private and public). 

Breastfeeding

Your child needs the right foods to be healthy and grow well. The right nutrition during the 1 000-day window can have a profound impact on a child’s ability to develop and learn. The First 1000 days campaign is to educate parents on the following:

• Nutrition and health
• Care and support
• Safety and stimulation

The World Health Organization promotes proper feeding for infants and young children.

Recommendations have been refined to also address the needs of infants born to HIV-infected mothers. Antiretroviral drugs now allow these children to exclusively breastfeed until they are 6 months old and continue breastfeeding until at least 12 months of age with a significantly reduced risk of HIV transmission.

Support for non-breastfeeding mothers

A proportion of infant cannot be breastfed due to a variety of reasons including:

• Medical conditions of the infant
• Medical conditions of the mother
• Informed decision made by the mother
• Lack of access to mothers’ milk

In these instances, mothers or caregivers will be supported to provide powdered infant formula by teaching the mother or caregiver to prepare powdered infant formula hygienically, safely and correctly.  The mother or caregiver will also be taught how to cup feed the prepared feeds safely and how to handle prepared feed in the home environment.

Growth monitoring

All children are weighed regularly as part of the growth monitoring programme, a sensitive indicator of whether the child is growing.

The weight is entered onto the Road to Health Card.

Underlying causes for weight loss are investigated such as infectious diseases, shortage of food at home and child neglect.

Infectious diseases play a great part in undernourishment and these illnesses are treated at primary health care level.

Diarrhoeal disease is closely related to poor environmental hygiene (sanitation and water supply) and under- or poor nutrition of an infant, which in turn makes them more vulnerable to serious and prolonged diarrhoea.

Children (0 – 59 months) should be weighed and measured frequently to ensure early detection of suboptimal growth and development.  Caregivers are advised to bring the child for growth monitoring once a month in the first 2 years of life and every 3 months (2 and 5 years old) thereafter where the child will be weighed, length or height measured, the information plotted on the appropriate graph in the RtHB and the interpretations discussed with the caregiver presenting the child.

We will measure:

• Mid upper arm circumference (MUAC) is measure from 6 months to 5 years old during every home visit or health contact visit.
• Weight is measured at every health visit and recorded in the RtHB at least once a month.
• Length or height is measured and recorded every 6 months unless visible differences are seen between the periods.

Vitamin supplements

Vitamins and minerals play an important role in supporting the immune system and body functioning.  Often children are deficient in some of the important vitamins and minerals and this will only show when the deficiency has reached critical levels. 

The INP provides Vitamin A supplementation to targeted children. Children who lack Vitamin A lose weight, fail to grow properly and are more likely to get infections and to die from them. A lack of Vitamin A also damages the eye and is one of the main causes of blindness amongst children.

Children with low birth weights are given Vitamin A capsules, which boost the immune system and help with the child's developmental growth. Infants from 6 -11 months are given a single dose of Vitamin A to prevent severe illness. Children from 12 months to five years old are given a single dose at 12 months then a dose of every 6 months until 5 years of age.

Additional doses of Vitamin A are given to children who are severely malnourished, or who have persistent infectious diseases such as diarrhoea, measles or HIV infection.

Deworming

Weight loss in children can also be due to worm infestation and this can be treated at the clinic with deworming medication.

Worm infestations negatively affect nutritional status when it causes intestinal bleeding, loss of appetite, diarrhoea or dysentery, and reducing the absorption of micronutrients.  All children (from 2 years of age) should receive deworming medication every 6 months.

Disease-specific nutrition support, treatment and counselling

Nutritional education, information and counselling are given at all levels of care to people who have had:

• Strokes
• Hypertension
• Diabetes
• HIV/AIDS and
• Tuberculosis.

Dietetic services

Dieticians are placed within all the districts and sub-districts in the province. Outreach services are provided in communities which include prevention/promotion, treatment and counselling services.

Dietitians interact with various stakeholders in communities including; non-profit organisations, religious groups, other departments and civil society etc. group talks, education and training sessions as well as advisory services on several areas, e.g. food services, adaptation of normal diets, chronic disease management and healthy lifestyles.

Nutrition in Early Childhood Development

Nutrition services in the ECD sector are provided, including; growth monitoring and promotion, case detection, healthy eating, providing guidelines in terms of provision of meals and nutrition rehabilitation of malnourished children in daycare centres.

National Primary School Nutrition Programme

The National Primary School Nutrition Programme is managed by the Department of Education and aims to enhance the learning capacity of learners through the provision of a healthy meal at schools.  The Integrated Nutrition Programme provides technical support to the Department of Education in the implementation of this programme.

Guidelines for tuck-shops in schools have been drafted to improve healthy eating at schools.

Food in institutions

The INP also contributes to the institutional care of clients through food service systems for the provision of balanced nutrition.