Sunday Times (Johannesburg) - Sunday 28 July, 2002
Michael Schmidt, Andre Jurgens and Bobby Jordan

In Alexandra, Johannesburg - a mere 5km from the Sandton Convention Centre where the World Summit on Sustainable Development will start on August 26 - children like Siphiwe are suffering from chronic diseases usually associated with the famine-plagued Horn of Africa.

Siphiwe is the human face of a hidden epidemic. The facts are that:

One in 10 infants in the former Transkei region die during their first 12 months, chiefly due to starvation, according to a Health Systems Trust study conducted last year;

One in five South African children suffer from chronic malnutrition, according to Social Development Minister Dr Zola Skweyiya;

Around 12 cases of marasmus or of kwashiorkor have been seen every month by one feeding scheme in Alexandra township;

One in 10 children admitted to Africa's largest hospital, Soweto's Chris Hani Baragwanath, suffers from severe malnutrition, according to the head of community paediatrics, Dr Haroon Saloojee;

Half of the 3 120 children surveyed in a national food consumption survey were found to have less than half the recommended level of nutrients such as calcium, iron and zinc; and

About 75% of South Africans have inadequate access to food, according to a government estimation.

HIV/Aids and job losses have contributed massively to the number of starving children being admitted to hospitals.

The gaunt faces of Siphiwe, his four-year-old sister, Zandile, and baby sister, Nthombizodwa, are painful reminders of a losing battle against hunger.

Their father, Phakathi, 38, is employed as a part-time gardener, but with a household income of only R700 a month, seven mouths to feed and a 12-year-old to put through school, the children came down with marasmus.

A year after they started to receive food from the African Children's Feeding Scheme, the youngsters have picked up some weight, thanks to a diet of maize porridge and fruit. But they are mostly still skin and bones.

Betty Sithole, of the scheme's Alexandra branch, which feeds 317 children, said she had seen perhaps 10 cases of marasmus and one or two of kwashiorkor a month.

A recent study showed that only 20% of Alexandra's residents eligible for welfare grants, including child support grants, had signed up for them.

Saloojee said one in 10 children admitted to his hospital was suffering from severe malnutrition. He said the HIV/Aids epidemic was largely to blame for the problem, which had been virtually eliminated from urban areas in the early 1990s. "It has returned with a vengeance," he said.

Said Skweyiya: "Undernutrition among young children in our country is of major concern. It affects the growth, development and learning capacity of children, and hence the development of the country. There is no magic vaccine or tablet which can reduce malnutrition."

Meanwhile, the UN's World Food Programme has set up a regional logistical office in Johannesburg to co-ordinate efforts to combat the famine that is expected to affect more than 12 million people in Southern Africa - and escalate by December.

National food consumption figures contained in a joint report published last week by the Medical Research Council, the Health Department and the World Health Organisation show that more than one in five South African children are physically stunted due to malnutrition. Worst affected are younger children (one to three years of age) living in rural areas.

The findings of the survey have prompted the government to set up a committee to investigate fortifying staple foods such as maize.

A national food consumption survey, one of several studies contained in the report, found that only one out of four South African households were food-secure. In contrast, half of all households experienced hunger.

Researchers have recommended that the government modify existing supplementary food programmes to concentrate on providing more nutrient-rich food.

Malnutrition stunts many

A 1999 Health Department survey showed that 21.6% of all SA children between the ages of one and nine were stunted because of malnutrition, with acute wasting running at 3.7% in the same age group.

MARASMUS is caused by a severe lack of protein and calories. Its effects are:

Children look like pot-bellied skeletons; and

They have virtually no fat and little muscle on their bodies.

KWASHIORKOR is caused by a severe lack of protein and nutrients. Its effects are:

Children are sometimes mistaken for healthy as they are chubby, but they are, in fact, bloated;

They lose appetite, often suffer diarrhoea and lose weight; and

Their skin is dry and cracked and their hair is brittle and loses colour.

Both conditions are potentially fatal. Short-term effects include:

Listlessness and a short attention span;

Dehydration;

Hypothermia;

Low blood-sugar levels;

Potassium and magnesium deficiencies; and

A susceptibility to bacterial infections.

Long-term effects in survivors include:

Stunted growth, making them susceptible to disease and early death;

Learning and cognitive disabilities; and

Delayed motor-skills development.
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