Determinants of poor nutritional status among school children in Mpumalanga Province, South Africa: A school-based study

Abstract

Investigating the nutritional status of school-age children who may be at risk of faltered growth and development, subsequently impacting on their educational achievement, can never be overemphasised as one of the public health concerns in South Africa. This study assessed the determinants of poor nutritional status among dyads of school-age children and their mothers (n = 400; mean age: children, 9.0±1.9 years; mothers, 31.1±5.1 years) with predominantly poor sociodemographic backgrounds selected through multistage sampling from the six public primary schools in Ehlanzeni District in Mpumalanga province, South Africa. Data collection included socio-demographic information, anthropometric measurements, and dietary diversity based on Food and Agriculture Organization’s (FAO) 12 food groups from a 24-hour recall, classified as low scores (DDS: Dietary diversity ≤4), and medium scores (DDS >4). Poor nutritional status among children was defined by z-scores between -3SD and -2SD for weight-for-age (underweight), height-for-age (stunting), and body mass index-for-age (thinness), while z-scores between +2SD and +3SD defined overweight/obesity. Overweight/obesity among mothers was determined using a BMI ≥ 25kg/m². Data were analysed using STATA 17. About 42% of mothers were overweight/obese, while over half of their children were stunted (53%) underweight (26%), thin (21%), and overweight/obesity (17%). Prevalence of concurrent stunting and overweight/obesity was 22%, while concurrent stunting and underweight (47%) was the most prevalent coexisting undernutrition among children. Mean DDS was 3.45 ± 1.49, with 78% of children on low DDS and 22% on medium DDS. Legumes, nuts, and seeds (52%), cereals (48%), sweets (48%), and beverages (47%) were the mostly consumed food groups in contrast to eggs, fish and other seafoods, vegetables, and tuber and roots. Multiple regression analysis showed that children aged 10-13 years, underweight and living with relatives were more likely to be stunted, while being underweight was associated with children 10-13 years of age, maternal overweight, obesity, and abdominal obesity. Boys had higher odds of thinness, while overweight/obesity among children was significantly associated with a medium DDS. Policies that govern the nutrition of school children to prohibit unregistered vendors from selling unhealthy foods around schools should be instituted and enforced. Such policies should cater for parental involvement working together with educators for the buy-in of the entire school community to boost children’s aspirations, academic performance, and the feeling of belonging to the school. Nutrition education for mothers/caregivers might also contribute to addressing poor nutritional status among school-age children.