Stellenbosch University Food Security Initiative · Inclusion Criteria • Households ... Focus of this presentation • To describe the relationships between the anthropometric status

Household characteristics & anthropometric status of child support grant recipients in Avian Park &

Zwelethemba

Mrs H.E. Koornhof, Prof M.H. McLachlan,

Prof M Faber & Prof JH Nel

Stellenbosch University Food Security Initiative

UNICEF Conceptual Framework on Malnutrition

Malnutrition

Inadequate dietary intake Disease

Inadequate access

to food

Inadequate care for

children

and women

Insufficient health services

&

unhealthy environment Underlying

Causes

Immediate

Causes

Basic

Causes

Manifestation

Human economic and

organisational resources

Potential resources

CNSP Background

CNSP objectives:

• To gather information regarding the nutritional status of children,0 – 36 months old, and their mothers / primary caregivers

• To assess the household and community food security situation in Zweletemba and Avian Park

Study Setting of CNSP

Two communities in the Breede Valley, WC

•Zweletemba

– Old established community

– Predominantly isiXhosa speaking

•Avian Park

– Newly established community

– Predominantly Afrikaans speaking

Data collection took place between March- June 2011

CNSP Study Objectives

• To gather information regarding the nutritional status of children (0 – 36 months) and their mothers / primary caregivers

• To assess the household and community food security situation in Zweletemba and Avian Park

CNSP Study Design

A cross sectional baseline study including:

• Nutritional status – anthropometry

– biochemical indicators

– dietary intakes

• A household survey – Representative sample of children 0 - 36 months old

and their mothers / primary caregivers in each area

• A community survey – Food availability and access

Inclusion Criteria

• Households – Households (HHs) with children between the ages 0 - 36

months

• Children – All children between the ages 0 - 36 months who reside in

Zweletemba or Avian Park for at least 27 weeks of the year

– not already participating in another research study

• Mothers / primary caregivers – Mothers / primary caregivers of children included in the

study, residing with the child in Zweletemba or Avian Park;

– Non-pregnant (self-reported).

Inclusion Criteria

• Biochemical samples for analysis:

– Children 12 months and older

– Weighing 6 kg or more, who meet the other inclusion criteria for the study

– Mothers / primary caregivers of above mentioned children who meet the inclusion criteria for the study

Sample size

• with power analysis using one way Anova and a 5% significance design to attain 90% power

• Sample size of 170 per group – mothers and children in two areas

– Effect size of δ = 0.25 with 5% significance

• Allowing a response rate of 85%, total sample size of 200 per group per area was calculated.

• Total sample size: – 400 children (0 – 36 months) plus

– 400 mothers / primary caregivers of these children

Street 1

Street 1

Street 2

Street 3

Street 1

Street 4

Street 1

Stre

et 5

Stre

et 6

Stre

et 7

Stre

et 8

Stre

et 9

Stre

et 1

0

Stre

et 1

1

*

* *

*

* *

*

*

*

Sampling Strategy

Sampling strategy

• If more than one HH lived at an address with a qualifying mother / primary caregiver & child pair

– Participation was determined through random selection

• If there was more than one qualifying mother / primary caregiver & child pair in a HH

– Participation was determined through random selection

Screening vs Consenting (all participants)

Reasons for non- inclusion of HHs

Avian Park n = 162 Zweletemba: n = 70 SATVI = South African Tuberculosis Vaccine Initiative

Methodology: Interviews by fieldworkers using the following questionnaires

1. Socio demographic questionnaire

2. Household Food Insecurity Access Scale

3. Food Procurement and Food Inventory

4. Dietary diversity questionnaire

5. Food frequency questionnaire

6. 24-hour recalls

7. Infant and young child feeding practices questionnaire

8. Mother & child health information

Focus of this presentation

• To describe the relationships between the anthropometric status and food security of children receiving and not receiving a Child Support Grant

• a secondary analysis of selected quantitative data

Questionnaires & methods used to collect data of this presentation

• Socio demographic questionnaire

• Dietary Diversity (DD) Questionnaire

• Household Food Insecurity Access Scale (HFIAS)

• Anthropometry

Dietary Diversity (DD) Questionnaire

• Validated tool, FAO recommended

• 16 questions assess food intake

• HHDD or Individual DD scores ( > 3 years old)

• DD is the no. of individual foods/food groups consumed in past 24 hr

• Individual DD Score (IDDS) is a proxy of the nutrient adequacy of an individual’s diet

Household Food Insecurity Access Scale

• Acronym: HFIAS

• Validated tool ; FAO recommended

• 9 questions assess respondents’ feelings & perceptions re. the access domain of food insecurity

• Describes HFIAS-related conditions and domains

• Estimates prevalence of HH food insecurity and HFIAS scores

Anthropometry

• Children (0 – 36 months): – Height / Length (cm)

– Weight (kg)

– Mid-upper arm circumference (cm)

• Mothers / primary caregivers of children participating in the study: – Height (cm)

– Weight (kg)

– Waist circumference (cm)

Results- Type of housing

Total = 453 HHs in Avian Park & Zweletemba

71% (n= 319)

29%

(n=133)

Formal

Informal

Results- Type of housing

69.5%

30.5% Formal HH

Informal HH

Type of housing in which CSG children live (n=312)

Results: Social grant recipients

• 441 of 453 (97% ) HHs received at least one grant; not necessarily a CSG

• 69% (n=312) of all HHs received one or more CSG

• 5.3% HHs received disability grants

• 16.4% HHs received old age pensions • 115 children were < 6 months old • 61% children < 6 months old received CSG

Results- No. of people per HH

Total = 453 HH in Avian Park & Zweletemba

Total CGs n = 451

CSG HHs n = 312

Non-CSG HHs n = 139

p-value

No people in HH

n=447 n=308 n=139

X2-test: P <

0.0001

1-2 persons 4.7 3.6 7.2

3-4 persons 45.9 39.0 61.2

5-6 persons 33.1 38.2 21.5

> 6 persons 16.3 19.2 10.1

Results- HH income

Total CGs n = 451

CSG HHs n = 312

Non-CSG HHs n = 139

p-value

% % %

R1-500 10.6 12.7 5.5

X2-test:

p=0.00

06

R501-R1000 11.7 13.0 8.6

R1001-R3000 42.8 43.7 40.6

R3001-R5000 19.8 19.9 19.5

Over R5000 15.1 10.7 25.8

Results – Average HH size

Total CGs

n = 451

CSG HHs

n = 312

Non-CSG HHs

n = 139 p-value

HH size (no

of persons) 4 (2-12) 5 (2-12) 4 (2- 12)

*t-test:

p <

0.0001

Results - Monthly HH income

n=435 n=307 n=128

Mean total income (SD)

R3,252 (R4,535) R2,723 (R3,298 ) R4,520 (R6,464)

t-test: p=0.00

33

Median income Median = R2,260 Median = R2,060 Median= R2,695

Minimum income Min. = R250 Min.= R250 Min. =R300

Maximum income Max. = R60,000 Max. = R40,260 Max. = R60,000

Results - Employment & Education

• 60,1% of all CGs were unemployed

• No significant difference in employment status of CSG & non-CSG recipients

• No difference in level of education of CSG and non-CSG caregivers

• 43% of CSG vs. 46 % of non-CSG caregivers had completed Grade 10

• 2.3% of CSG vs. 7.2% of non-CSG caregivers had completed at least a one year tertiary qualification

Results – Household characteristics

Total n = 451

CSG households

n = 312

Non-CSG households

n = 139

p-value

Household size (no of persons)

4 (2-12) 5 (2-12) 4 (2- 12) *t-test:

p < 0.0001

Number of people per room

2.6 (1.4) 2.7 (1.5) 2.3 (1.2) *t-test:

p = 0.0037

Results – Household characteristics

No of people in

household

Total

n=447

CSG HHs

n=308

Non-CSG HHs

n=139

X2-test:

P < 0.0001

1-2 persons 4.7 3.6 7.2

3-4 persons 45.9 39.0 61.2

5-6 persons 33.1 38.2 21.5

More than 6

persons 16.3 19.2 10.1

Anthropometric status of children

0

5

10

15

20

25

30

35

Underweight Wasted Stunted Overweight (BAZ ≥2)

All Children

CSG Children

Non CSG Children

*

%

* Chi-square test: P = 0.012

Anthropometric status of caregivers

Mothers/primary

caregivers

All

(n = 446)

CSG

(n = 308)

Non-CSG

(n = 138) p-value

BMI < 18. 5 kg/m2 3.8 3.3 5.1

X2-test:

P = 0.215

BMI 18.5– 25 kg/m2 32.5 33.4 30.4

BMI 25–30 kg/m2 26.5 24.0 31.9

BMI > 30 kg/m2 37.2 39.3 32.6

Caregivers Diet Diversity Scores (DDS)

Dietary Diversity

Score: Mother/

primary caregiver

All HHs

n = 451

CSG HHs

n = 312

non-CSG HHs

n = 139 p-value

% % %

X2-test:

p = 0.4894 DDS: 0–4 56.0 54.9 58.4

DDS: 5–9 44.0 45.1 41.6

Mean DDS:

Mother/primary

caregiver

4.4 (1.6)

n = 445

4.4 (1.6)

n = 308

4.34 (1.72)

n = 137

t-test:

p =0.6993

HH Food Security

All HHs

n = 451

CSG HHs

n = 312

Non-CSG HHs

n = 139 p-value

% % %

Food secure 63.1 59.9 70.5

X2-test:

p = 0.1193

Mildly Food Insecure

Access 4.4 4.2 5.0

Moderately Food

Insecure Access 21.7 24.4 15.8

Severely Food

insecure access 10.6 11.5 8.6

HH Food Security Access

All HHs

n = 451

CSG HHs

n = 312

non-CSG HHs

n = 139 p-value

HH Food Security Access-related domains % % %

1. Anxiety and uncertainty about household food supply 32.2 35.9 23.7

X2-test: p =0.0107

2. Insufficient food quality 34.2 37.5 26.6 X2-test: p=0.024

3. Insufficient food intake and its physical consequences

34.4 37.8 26.6 X2-test: p=0.0207

HFIAS score 3.2 (5.2) 3.6 (5.5) 2.4 (4.6) t-test:

p =0.0178

DISCUSSION

• 63% food secure HHs higher than 2013 SA data

• 37.8% of CSG HHs experience hunger

• Higher income associated with food security

• Significantly higher HFIAS score in CSG HHs indicates the role of income in the ability to access food

• Similarly, the probability of experiencing any of the three HFIAS access related conditions was also significantly higher in CSG HHs

DISCUSSION • Prevalence of stunting, associated with food

insecurity, was significantly higher in CSG children

• Social determinants of health – food & health

care

• DDS ≤ 4 indicating poor nutritional quality diet found in 56 % of caregivers

• No significant difference in the IDDS of CSG and non-CSG caregivers

• Diet diversity a problem in CSG & non-CSG HHs

CONCLUSION

• CSG HHs experienced more HH food & nutrition insecurity than non-CSG HHs

• Despite receiving CSGs vulnerable children in poor families were exposed to diets of insufficient quality and quantity

• There is a need for intervention programmes to improve diet diversity in all HHs, not only CSG HHs

Acknowledgements

• The local groups who allowed the study to be conducted in a professional way:

Breede Valley Municipality & Department of Health

• Community leaders

• Fieldworkers

• Participants

• Franklin van Wyk and our colleagues for support with additional work load

Acknowledgements

The financial support of the Stellenbosch University Hope Project is gratefully

acknowledged.