Infant growth in the KwaZulu-Natal province, South Africa: Results from the KwaZulu-Natal initiative for breastfeeding support (KIBS) survey II at 13-15 weeks and 6 months of age
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Background: Today, 155 million children under the age of five years are stunted in the world, 52 million are wasted, while 41 million are overweight. When these conditions exist at the same time, within an individual, household or community, it is referred to as the double burden of malnutrition. Malnutrition is on the world’s agenda with several organizations such as UNICEF and WHO working towards a reduction in both over- and undernutrition. Anthropometrical measurements are regarded as the most feasible way of assessing the nutritional status of children. Stunting, wasting, and underweight are measured using length-for-age, weight-for-length, and weight-for-age, respectively. South Africa has experienced rapid nutrition and lifestyle transition the last 20 years. The prevalence of overweight has gone up among children, with 13% of children under the age of five years being overweight in 2016. At the same time, the stunting prevalence continues to be high, applying to one in three boys and one in four girls under the age of five years. The country is facing both lifestyle related chronic disease and at the same time a high burden of infectious diseases. This thesis will focus on infant growth and possible factors associated with growth, in the KwaZulu-Natal province, South Africa. The aim is to report the attained growth and nutritional status expressed among children aged 13-15 weeks and 6 months, and furthermore to assess factors associated with growth and risk factors for over- and undernutrition. Method: The data for this thesis was based on the second cross-sectional survey from the KwaZulu-Natal Initiative for Breastfeeding Support (KIBS), conducted in 2017. The data was so-called end data in the three-year KIBS project undertaken by the KwaZulu-Natal (KZN) Department of Health in partnership with the University of KwaZulu-Natal. The KZN Department of Health aimed to improve infant feeding practices through an intervention divided in three components, with a planned survey at the beginning and at the end of the intervention period. Data was collected in conjunction with routine vaccination by an independent team of data collectors. Two groups of mother-infant pairs were recruited in two sub-surveys in KIBS II: KIBS 2a (13-15 weeks) and KIBS 2b (6 months). These infants are not related and are analysed in the two separate groups, respectively. Descriptive statistical analysis and risk factor analysis was performed. Results: The rate of malnutrition is high in KwaZulu-Natal, with 42.9% being stunted and 28.0% being overweight in KIBS 2a. In KIBS 2b these rates were 21.7% and 21.9% respectively. The risk analysis suggested male sex, low birthweight, mother’s positive HIV status and socioeconomic factors as potential risk factors affecting the linear growth of children negatively in both KIBS 2a and 2b. Only birthweight was recognised as a potential factor affecting the rate of overweight among children in KIBS 2b. Conclusion: The double burden of malnutrition is present in KwaZulu-Natal. The analysis shows how potential factors such as sex, birthweight and HIV affects the possibility of becoming malnourished. Furthermore, through the use of a hierarchical framework, the analysis illustrates how these factors work through different levels to contribute to malnutrition. These risk factors are coherent with other studies in Africa. There is a need for interventions to stop the increase in overweight among children and at the same time decrease the rate of stunting. In addition, there is a need for improved performance of anthropometrical measurements, as this is a prerequisite for identifying and handling children at risk of becoming malnourished.