Despite being a critical component of interventions to reduce child mortality, exclusive breastfeeding practice is extremely low in South Africa. This paper investigates why. The authors conducted a sub-group analysis of a community-based cluster-randomised trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites between 2006 and 2008. By 12 weeks postpartum, results showed that 20% of HIV-negative women and 40% of HIV-positive women had stopped breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first three days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks. Self-reported breast health problems were also associated with a three-fold risk of stopping breastfeeding. The authors conclude that early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.
Poverty and health
Speaking at the World Congress of Rural Sociology, the Director-General of the Food and Agricultural Organisation (FAO) José Graziano da Silva challenged academics to get involved in essential and politically important research into rural poverty and the food and agriculture business as it pertains to small-scale producers. He identified the most pressing issues in the fight against hunger and rural underdevelopment as food insecurity, nutrient deficiencies and unsafe food, as well as unequal competition between small-scale and large food producers. He singled out large-scale investments in agriculture or ‘land-grabbing’ as a politically important area where universities could conduct research into principles for responsible agricultural investments. Such research could feed into the work of the Committee on World Food Security, the leading global forum for discussions on food security issues, he said. How to integrate small-scale farmers into the agricultural and food chains should be another area of academic concern. Academics should look into the issue of governance of the food and agriculture sector, both at global and local levels, and how to achieve a fair distribution of benefits.
With the world's highest population growth rate, the East African highlands have historically undergone extensive transformation to feed a poor population largely dependent on subsistence farming. Most available land has been adapted for agricultural use as dairy pastures or croplands. The lost of forest areas, mainly due to subsistence agriculture, between 1990 and 2010 ranged between 8,000 ha in Rwanda and 2,838,000 ha in Ethiopia. These unmitigated environmental changes in the highlands have led to a rise in temperature and a correlated increase in numbers of malarial mosquitoes, with several epidemics observed in the late 1980s and early 2000s. Although malaria has decreased through intensified interventions from the mid-2000s onwards, the authors of this study argue that environmental changes might further increase the risk of malaria in the region, particularly if the current interventions are not sustained.
The authors of this paper argue that the effects of relative deprivation, shame and social exclusion call for a reconsideration of how we assess global poverty. However, the authors do not support use of standard measures of relative poverty. Instead they call for using a weakly relative measure as the upper-bound complement to the lower-bound provided by a standard absolute measure. New estimates of global poverty are presented, drawing on 850 household surveys spanning 125 countries over 1981–2008. The absolute line is US$1.25 a day at 2005 prices, while the relative line rises with the mean, at a gradient of 1:2 above $1.25 a day. The authors show that these parameter choices are consistent with cross-country data on national poverty lines. The results indicate that the incidence of both absolute and weakly relative poverty in the developing world has been falling since the 1990s, but more slowly for the relative measure. While the number of absolutely poor has fallen, the number of relatively poor has changed little since the 1990s, and is higher in 2008 than 1981.
In the context of increased food prices in Ethiopia, the authors of this study hypothesised that adolescents in low income urban households are more likely to suffer from chronic food insecurity than those in the rural areas who may have direct access to agricultural products. They gathered data from the first two rounds of the Jimma Longitudinal Family Survey of Youth (JLFSY) and interviewed a total of 1,911 adolescents aged 13-17 years on their personal experiences of food insecurity both at baseline and at year two. Overall, 20.5% of adolescents were food insecure in the first round survey, while the proportion of adolescents with food insecurity increased to 48.4% one year later. Female sex of adolescents, high dependency ratio and household food insecurity were independent predictors of chronic adolescent food insecurity. The fact that the prevalence of chronic food insecurity increased among adolescents who are members of chronically food insecure urban households as income tertiles decreased suggests that the resilience of buffering is eroded when purchasing power diminishes and food resources are dwindling. Food security interventions should target urban low income households to reduce the level of chronic food insecurity and its consequences, the authors argue.
The objective of this study was to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. The authors drew on General Household Surveys from 2002-2009, which included a question about perceived drinking water safety. Trends in responses to this question were examined from 2002-2009 in relation to reported cholera cases. The results suggest that perceptions of drinking water safety have remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000-2002 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. This suggest that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.
This WBTI (World Breastfeeding Trends Initiative) report assesses infant and young child feeding (IYCF) policies and programmes in 33 countries located in Asia, Africa and South and Central America. The authors highlight the fact that universalising the coverage of infant and young child feeding practices is one of the most effective interventions to reduce infant and young child mortality, morbidity and malnutrition. Yet their research points to major gaps in both policies and programmes in all 33 countries, with limited support for breastfeeding women. They argue that the United Nations and external funders should commit substantial financial resources in order to universalise key interventions related to breastfeeding and complementary feeding. This calls for a coordination mechanism for planning and supervising the implementation of relevant policy in an integrated manner at all levels, from policy making to service delivery at the grassroots level. Key breastfeeding and complementary feeding indicators will need to be regularly monitored and the results may be used to make policy and programmes more effective. The authors also call for integration of infant feeding in related comprehensive national policies, as well as building human resources and social welfare for exclusively breastfeeding women.
The 2012 Africa Human Development Report argues that sustainable increases in agricultural productivity protect food entitlements—
the ability of people to access food. Furthering human development
requires nutrition policies that unleash the potential of today’s and future generations. Also, communities must be resilient enough to absorb
shocks and have the power to make decisions about their own lives. The Report shows that the basic right to food and the right to life itself is
being violated in sub-Saharan Africa to an intolerable degree. Building
a food secure continent requires transformative change— change that will be most effective if accompanied by a shift of resources, capacities and
decisions to smallholder farmers, poor communities and women. When women and other vulnerable groups gain a voice in the decisions affecting their lives and livelihoods, their capacity to produce,trade and use food is materially enhanced.
Uganda’s Indigenous Batwa people are among the most vulnerable populations in the world and have limited access to key social determinants of health, including health care, education, clean water, employment and adequate clothing, food, and security. The Batwa people were evicted from their native forests following an environmental policy enacted in 1991 and are now considered conservation refugees undergoing a drastic transition from forest dwellers to agriculturalists. The shift has negatively affected people’s health. The report argues that coordinated action among public and private sectors is required to improve Batwa health through the enforcement of their rights and increased participation in policies and programs affecting their well-being.
Angola has made vast progress since the end of the civil war in 2002 according to this report. Despite being one of Africa’s wealthiest nations in terms of natural resources, particularly oil, and recording impressive gross domestic product growth rates of 7% per year, poverty among the country’s citizens is rampant. Angola has ranked near the bottom of the bottom of the United Nations’ Human Development Index and Angola has high inequality and urban poverty. Government is reported to have made various commitments to address these issues, including investment in jobs and houses, decentralisation of government services and development of the agricultural sector.