Category: Resourceful Young Children | Comprehensive ECD package | 19 January, 2014 - 16:00← BACK
BACKGROUND TO MALNUTRITION IN SOUTH AFRICA
Of the 18.5 million children in South Africa a disproportionate number (68%) live in poverty and in households with a per capita income below R350. Over 2.6 million children live in backyard dwellings or shacks in informal settlements and 42% of these children are aged between 0 and 5 years old. Moreover, malnutrition and childhood infections, including HIV, are the biggest killers of children. One-third of children who die are severely malnourished and over 60% are underweight for their age. In 2007, 2.7 million children in South Africa (15% of the child population) lived in households where there was child hunger. When these children miss meals it affects their energy and concentration levels and reduces their capacity to learn. This deeply impacts every aspect of their lives.
Babies and children living in poor households are at an increased risk of illness and face more challenges in accessing timely, high quality care – with the result that they are four times more likely to die than those from wealthier families. Under-nutrition magnifies the effect of every disease, including measles and malaria. In South Africa one in ten children suffers from severe malnutrition, 50% of these are pre-school children. Nearly one in five children have stunted growth caused by inadequate nutrition.
Malnutrition inhibits the normal growth of the brain from birth to six years old. The malnourished child can never cope with a normal education as a result of his or her inadequate diet. The lack of proper childhood education then results in the adult not being in a position to one-day support a family of his/her own – perpetuating a cycle of poverty and unemployment.
National statistical data released in February 2012 by the Department of Health regarding malnutrition rates of children under the age of 5 years showed that Kwazulu-Natal was the worst performing area in South Africa in this regard. KZN has 7 districts in the country’s top 10 worst performing districts. These include: Umkhanyakude, Zululand, Umgungundlovu, Ethekwini, Uthukela, Umzinyathi and Ugu.
OUR APPROACH TO ADDRESSING THE MALNUTRITION CHALLENGE
The challenges that we faced in fighting malnutrition were clear. We needed a four-step approach:
Our overall vision of Feed the Babies is to eliminate malnutrition, and promote and maintain good health amongst babies. This is done through the provision of at least one nutritious meal a day to children under the age of 5 years. Our work is focused on the province of KZN. We have found that to simply provide basic mealie-meal or porridge to the children fills their bellies but without substantial other sources of food, the daily dietary requirements for a developing child are not satisfied. We needed to source a product that was formulated and contained the majority of nutrients and proteins in sufficient quantities to satisfy a high percentage of the DRI (Daily Recommended Intake) for pre-school children. The product also needed to be suitable to the living conditions of the marginalised children and easy to prepare.
After testing various specialised products, Feed the Babies Fund finally settled on a Durban-based manufacturer who could provide a concentrated, formulated cereal. The nutrients and proteins in the cereal are sufficient to satisfy an average of 60% of the DRI of a pre-school child in a single serving. The product does not need to be cooked and is simply mixed with hot or cold water before serving. It is packaged to ensure minimum wastage occurs with daily use.
We want to ensure that the food reaches the children and is not consumed by the entire household. Providing a bag of cereal or an entire month’s supply to a poor household does not guarantee that the target child receives sufficient servings of the cereal to satisfy their daily needs. This was a lesson we learnt from previous experience of distributing via welfare organisations and clinics.
To find a better way of distributing the cereal we looked to where children were spending the bulk of their day. This was in crèches. We considered the methodology of the School Nutrition Programme, which feeds six million learners in 18 039 schools. Unfortunately no such scheme exists for pre-schools or crèches. Current government assistance to crèches is only in the form of an Early Childhood subsidy and the majority of crèches in rural areas do not qualify for this subsidy because they are not registered. Whilst statistically, only 30% of pre-school children attend crèches, these statistics do not account for unregistered crèches.
Consequently, we are focussing our food distribution on unregistered crèches and those that are registered but don’t receive an ECD subsidy. We believe that this strategy helps us feed a high percentage of marginalised children in a controlled environment.
Distribution partners: crèches and caregivers as food conduits
Crèches in rural KZN may be humble structures with inadequate facilities but they provide children with a safe and controlled environment in which to learn, interact and play. By adding the dimension of a healthy nutritious breakfast to the daily crèche routine they also become a nutritious haven for the children from poor backgrounds. Local families send their children to the crèche knowing that they will receive a healthy breakfast every morning. This increases crèche enrolment and consequently, more children are exposed to an early learning environment.
Before beginning any food distribution, Feed the Babies Fund undertakes an initial assessment of each crèche through an on-site visit. The purpose of the visit is to capture pertinent information about key indicators in respect to the health of children, such as: hygiene, sanitary issues, and access to water facilities. The information gleaned from this survey is an indicator of need and vulnerability.
We train the crèche caregivers on the importance of correct nutrition and on the preparation and serving of the cereal we provide. The caregivers maintain a daily Food Register that records the amount and frequency of food that each child receives. This is assessed monthly at the time of delivery.
We train caregivers in Early Childhood Development and Crèche Management courses, equipping them with the necessary tools to teach a syllabus that will aid the children's development and further education. We facilitate First Aid training and provide crèches with First Aid Kits and regularly dispense soap to crèches to encourage the creation of hygienic surroundings, especially at feeding times. Feed the Babies Fund also provides our crèches with educational posters, stationery and other educational material.
It is not practical to distribute food to over 250 crèches throughout Kwazulu-Natal by driving to each one. This is too cost and time inefficient. Our past experience also indicated that representatives from the crèches would not travel to our depot to collect the cereal. Instead, we learnt that the most cost-effective and realistically reliable way of delivering to each crèche was to recruit delivery partners to assist us. As such, Feed the Babies Fund sourced ‘distribution’ partners in major local centres.
Partnership relations: We developed a good working relationship with the Department of Social Welfare and a number of other like-minded NPOs and community organisations situated in the major hubs of the various districts in which we operate. These organisational partners not only distribute the cereal for us but also help identify needy crèches and provide information about the communities in which we work. Other than DSD, our distribution partners are non-profit organisations that assist our crèches with other matters. They also hold monthly networking meetings with the crèches.
Partner benefits: In turn, we give feedback to the Department of Social Development about crèches in need. For instance we alert them to crèches where children have not been immunised or are suffering from health issues; and we support them with registering the NPO status of crèches.
Delivery schedule: The crèches are grouped by geographical area and the distribution partner in the area-hub delivers the cereal to the crèches. We deliver directly to each distribution partner on the day of their monthly network meeting with the crèches so that the crèche supervisors can collect their allocation of cereal on a one-day trip to town.
Having overcome the challenge of distributing food to the marginalised children, we need to ensure that our project is having the necessary impact on the children we feed. We monitor the project by visiting every crèche four times a year. We collect feedback on the condition and health of the children. We also ensure that feeding is still being done correctly and that they are adhering to all necessary administration issues.
In order to find a scientific method of monitoring our feeding impact, we are currently piloting a process of weighing and measuring children at regular intervals and comparing growth and development patterns against World Health Organisation standards. This involves, at the start of our feeding project, collecting baseline data on the weight-for-age and height/length-for-age of all children attending crèches in our beneficiary communities. From this we get a starting-point snapshot of the nutritional status of the children. We then provide the children in the target crèches with the nutritional porridge and repeat the measurement process after a 6-9 months period. However, verbal confirmation from caregivers and the joy seen on the faces of the children on our regular visits, are confirmation enough of the success of this project.
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This Feed the Babies Learning Brief describes how to implement and track the progress of an infant feeding programme in South African crèches. Other organisations rolling out similar feeding projects can benefit from this suggested programme strategy.