Infant and young child feeding practices of caregivers in Copesville, Pietermaritzburg, KwaZulu-Natal
Malnutrition encompasses undernutrition (wasting, stunting, underweight), micronutrient deficiencies, overweight, obesity and non-communicable diseases. All forms of malnutrition remain unacceptably high across all regions of the world. Globally, 20.5 million children are born with low birthweight, 149.2 million are stunted, 45.4 million children are wasted, while 38.9 million are overweight. In South Africa (SA), children under five years of age are most affected by malnutrition compared with other age groups; 27% are stunted, 3% are wasted, 6% are underweight, and 13% are overweight. Inappropriate infant and young child feeding (IYCF) practices are recognised as a cause of stunting and underweight in children. Protecting, promoting and supporting appropriate IYCF is crucial to ensuring that children grow well, are protected from preventable illness and develop to their full potential.
Paving the way to detect adult malnourished patients in resource-limited settings: the first step to the right to nutritional care
Freedom from hunger and malnutrition is a fundamental right, yet is often disregarded when it comes to disease-related malnutrition (DRM). The recent International Position Paper on clinical nutrition and human rights1 and the adopted International Declaration on the Human Right to Nutritional Care state that all hospitalised patients should have access to malnutrition screening and diagnosis, followed by optimal and timely evidence-based medical nutrition therapy to combat DRM. The Declaration, which was signed in September 2022 by 75 national societies, including the South African Society of Enteral and Parenteral Nutrition (SASPEN), asserts that access to nutrition care is as much a human right as is the right to food and the right to health. It represents a watershed global agreement that aims to increase awareness of the significance of DRM and draws attention to the lack of nutritional support for those with both acute and chronic illnesses. As stated in Sections 27, 28 and 35 of the South African Constitution, the right to access food must be respected in all contexts. By implication, this right should also include the clinical setting, in which the ill person has a fundamental right to food, including appropriate nutritional care. However, this often does not translate into action by governments and other responsible entities, in particular healthcare institutions. Consequently, optimal nutritional care is often overlooked in clinical practice. This leads to increased morbidity, mortality and costs.1 In South Africa, where the majority of the population access health services through resource-constrained public clinics and hospitals, both screening and subsequent diagnosis of malnutrition have been reported to be sub-optimal, partly due to a lack of resources, but not limited to this reason only.5,6 In 2019, the Global Leadership Initiative on Malnutrition (GLIM) proposed a diagnostic framework for diagnosing protein–energy malnutrition (PEM), with the purpose of building a global consensus in the criteria required for diagnosing PEM in the clinical setting. This opinion paper highlights current challenges and proposes strategies to improve the identification of malnutrition in resource-limited healthcare settings, with an emphasis on South Africa. By framing DRM as a human rights and ethical issue in the clinical setting, the article underscores the imperative for timely and equitable access to nutritional care for all individuals in need thereof.