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Household characteristics & anthropometric status of child support grant recipients in Avian Park &
Zwelethemba
Mrs H.E. Koornhof, Prof M.H. McLachlan,
Prof M Faber & Prof JH Nel
Stellenbosch University Food Security Initiative
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UNICEF Conceptual Framework on Malnutrition
Malnutrition
Inadequate dietary intake Disease
Inadequate access
to food
Inadequate care for
children
and women
Insufficient health services
&
unhealthy environment Underlying
Causes
Immediate
Causes
Basic
Causes
Manifestation
Human economic and
organisational resources
Potential resources
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CNSP Background
CNSP objectives:
• To gather information regarding the nutritional status of children,0 – 36 months old, and their mothers / primary caregivers
• To assess the household and community food security situation in Zweletemba and Avian Park
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Study Setting of CNSP
Two communities in the Breede Valley, WC
•Zweletemba
– Old established community
– Predominantly isiXhosa speaking
•Avian Park
– Newly established community
– Predominantly Afrikaans speaking
Data collection took place between March- June 2011
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CNSP Study Objectives
• To gather information regarding the nutritional status of children (0 – 36 months) and their mothers / primary caregivers
• To assess the household and community food security situation in Zweletemba and Avian Park
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CNSP Study Design
A cross sectional baseline study including:
• Nutritional status – anthropometry
– biochemical indicators
– dietary intakes
• A household survey – Representative sample of children 0 - 36 months old
and their mothers / primary caregivers in each area
• A community survey – Food availability and access
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Inclusion Criteria
• Households – Households (HHs) with children between the ages 0 - 36
months
• Children – All children between the ages 0 - 36 months who reside in
Zweletemba or Avian Park for at least 27 weeks of the year
– not already participating in another research study
• Mothers / primary caregivers – Mothers / primary caregivers of children included in the
study, residing with the child in Zweletemba or Avian Park;
– Non-pregnant (self-reported).
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Inclusion Criteria
• Biochemical samples for analysis:
– Children 12 months and older
– Weighing 6 kg or more, who meet the other inclusion criteria for the study
– Mothers / primary caregivers of above mentioned children who meet the inclusion criteria for the study
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Sample size
• with power analysis using one way Anova and a 5% significance design to attain 90% power
• Sample size of 170 per group – mothers and children in two areas
– Effect size of δ = 0.25 with 5% significance
• Allowing a response rate of 85%, total sample size of 200 per group per area was calculated.
• Total sample size: – 400 children (0 – 36 months) plus
– 400 mothers / primary caregivers of these children
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Street 1
Street 1
Street 2
Street 3
Street 1
Street 4
Street 1
Stre
et 5
Stre
et 6
Stre
et 7
Stre
et 8
Stre
et 9
Stre
et 1
0
Stre
et 1
1
*
* *
*
* *
*
*
*
Sampling Strategy
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Sampling strategy
• If more than one HH lived at an address with a qualifying mother / primary caregiver & child pair
– Participation was determined through random selection
• If there was more than one qualifying mother / primary caregiver & child pair in a HH
– Participation was determined through random selection
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Screening vs Consenting (all participants)
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Reasons for non- inclusion of HHs
Avian Park n = 162 Zweletemba: n = 70 SATVI = South African Tuberculosis Vaccine Initiative
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Methodology: Interviews by fieldworkers using the following questionnaires
1. Socio demographic questionnaire
2. Household Food Insecurity Access Scale
3. Food Procurement and Food Inventory
4. Dietary diversity questionnaire
5. Food frequency questionnaire
6. 24-hour recalls
7. Infant and young child feeding practices questionnaire
8. Mother & child health information
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Focus of this presentation
• To describe the relationships between the anthropometric status and food security of children receiving and not receiving a Child Support Grant
• a secondary analysis of selected quantitative data
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Questionnaires & methods used to collect data of this presentation
• Socio demographic questionnaire
• Dietary Diversity (DD) Questionnaire
• Household Food Insecurity Access Scale (HFIAS)
• Anthropometry
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Dietary Diversity (DD) Questionnaire
• Validated tool, FAO recommended
• 16 questions assess food intake
• HHDD or Individual DD scores ( > 3 years old)
• DD is the no. of individual foods/food groups consumed in past 24 hr
• Individual DD Score (IDDS) is a proxy of the nutrient adequacy of an individual’s diet
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Household Food Insecurity Access Scale
• Acronym: HFIAS
• Validated tool ; FAO recommended
• 9 questions assess respondents’ feelings & perceptions re. the access domain of food insecurity
• Describes HFIAS-related conditions and domains
• Estimates prevalence of HH food insecurity and HFIAS scores
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Anthropometry
• Children (0 – 36 months): – Height / Length (cm)
– Weight (kg)
– Mid-upper arm circumference (cm)
• Mothers / primary caregivers of children participating in the study: – Height (cm)
– Weight (kg)
– Waist circumference (cm)
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Results- Type of housing
Total = 453 HHs in Avian Park & Zweletemba
71% (n= 319)
29%
(n=133)
Formal
Informal
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Results- Type of housing
69.5%
30.5% Formal HH
Informal HH
Type of housing in which CSG children live (n=312)
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Results: Social grant recipients
• 441 of 453 (97% ) HHs received at least one grant; not necessarily a CSG
• 69% (n=312) of all HHs received one or more CSG
• 5.3% HHs received disability grants
• 16.4% HHs received old age pensions • 115 children were < 6 months old • 61% children < 6 months old received CSG
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Results- No. of people per HH
Total = 453 HH in Avian Park & Zweletemba
Total CGs n = 451
CSG HHs n = 312
Non-CSG HHs n = 139
p-value
No people in HH
n=447 n=308 n=139
X2-test: P <
0.0001
1-2 persons 4.7 3.6 7.2
3-4 persons 45.9 39.0 61.2
5-6 persons 33.1 38.2 21.5
> 6 persons 16.3 19.2 10.1
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Results- HH income
Total CGs n = 451
CSG HHs n = 312
Non-CSG HHs n = 139
p-value
% % %
R1-500 10.6 12.7 5.5
X2-test:
p=0.00
06
R501-R1000 11.7 13.0 8.6
R1001-R3000 42.8 43.7 40.6
R3001-R5000 19.8 19.9 19.5
Over R5000 15.1 10.7 25.8
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Results – Average HH size
Total CGs
n = 451
CSG HHs
n = 312
Non-CSG HHs
n = 139 p-value
HH size (no
of persons) 4 (2-12) 5 (2-12) 4 (2- 12)
*t-test:
p <
0.0001
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Results - Monthly HH income
n=435 n=307 n=128
Mean total income (SD)
R3,252 (R4,535) R2,723 (R3,298 ) R4,520 (R6,464)
t-test: p=0.00
33
Median income Median = R2,260 Median = R2,060 Median= R2,695
Minimum income Min. = R250 Min.= R250 Min. =R300
Maximum income Max. = R60,000 Max. = R40,260 Max. = R60,000
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Results - Employment & Education
• 60,1% of all CGs were unemployed
• No significant difference in employment status of CSG & non-CSG recipients
• No difference in level of education of CSG and non-CSG caregivers
• 43% of CSG vs. 46 % of non-CSG caregivers had completed Grade 10
• 2.3% of CSG vs. 7.2% of non-CSG caregivers had completed at least a one year tertiary qualification
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Results – Household characteristics
Total n = 451
CSG households
n = 312
Non-CSG households
n = 139
p-value
Household size (no of persons)
4 (2-12) 5 (2-12) 4 (2- 12) *t-test:
p < 0.0001
Number of people per room
2.6 (1.4) 2.7 (1.5) 2.3 (1.2) *t-test:
p = 0.0037
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Results – Household characteristics
No of people in
household
Total
n=447
CSG HHs
n=308
Non-CSG HHs
n=139
X2-test:
P < 0.0001
1-2 persons 4.7 3.6 7.2
3-4 persons 45.9 39.0 61.2
5-6 persons 33.1 38.2 21.5
More than 6
persons 16.3 19.2 10.1
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Anthropometric status of children
0
5
10
15
20
25
30
35
Underweight Wasted Stunted Overweight (BAZ ≥2)
All Children
CSG Children
Non CSG Children
*
%
* Chi-square test: P = 0.012
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Anthropometric status of caregivers
Mothers/primary
caregivers
All
(n = 446)
CSG
(n = 308)
Non-CSG
(n = 138) p-value
BMI < 18. 5 kg/m2 3.8 3.3 5.1
X2-test:
P = 0.215
BMI 18.5– 25 kg/m2 32.5 33.4 30.4
BMI 25–30 kg/m2 26.5 24.0 31.9
BMI > 30 kg/m2 37.2 39.3 32.6
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Caregivers Diet Diversity Scores (DDS)
Dietary Diversity
Score: Mother/
primary caregiver
All HHs
n = 451
CSG HHs
n = 312
non-CSG HHs
n = 139 p-value
% % %
X2-test:
p = 0.4894 DDS: 0–4 56.0 54.9 58.4
DDS: 5–9 44.0 45.1 41.6
Mean DDS:
Mother/primary
caregiver
4.4 (1.6)
n = 445
4.4 (1.6)
n = 308
4.34 (1.72)
n = 137
t-test:
p =0.6993
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HH Food Security
All HHs
n = 451
CSG HHs
n = 312
Non-CSG HHs
n = 139 p-value
% % %
Food secure 63.1 59.9 70.5
X2-test:
p = 0.1193
Mildly Food Insecure
Access 4.4 4.2 5.0
Moderately Food
Insecure Access 21.7 24.4 15.8
Severely Food
insecure access 10.6 11.5 8.6
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HH Food Security Access
All HHs
n = 451
CSG HHs
n = 312
non-CSG HHs
n = 139 p-value
HH Food Security Access-related domains % % %
1. Anxiety and uncertainty about household food supply 32.2 35.9 23.7
X2-test: p =0.0107
2. Insufficient food quality 34.2 37.5 26.6 X2-test: p=0.024
3. Insufficient food intake and its physical consequences
34.4 37.8 26.6 X2-test: p=0.0207
HFIAS score 3.2 (5.2) 3.6 (5.5) 2.4 (4.6) t-test:
p =0.0178
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DISCUSSION
• 63% food secure HHs higher than 2013 SA data
• 37.8% of CSG HHs experience hunger
• Higher income associated with food security
• Significantly higher HFIAS score in CSG HHs indicates the role of income in the ability to access food
• Similarly, the probability of experiencing any of the three HFIAS access related conditions was also significantly higher in CSG HHs
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DISCUSSION • Prevalence of stunting, associated with food
insecurity, was significantly higher in CSG children
• Social determinants of health – food & health
care
• DDS ≤ 4 indicating poor nutritional quality diet found in 56 % of caregivers
• No significant difference in the IDDS of CSG and non-CSG caregivers
• Diet diversity a problem in CSG & non-CSG HHs
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CONCLUSION
• CSG HHs experienced more HH food & nutrition insecurity than non-CSG HHs
• Despite receiving CSGs vulnerable children in poor families were exposed to diets of insufficient quality and quantity
• There is a need for intervention programmes to improve diet diversity in all HHs, not only CSG HHs
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Acknowledgements
• The local groups who allowed the study to be conducted in a professional way:
Breede Valley Municipality & Department of Health
• Community leaders
• Fieldworkers
• Participants
• Franklin van Wyk and our colleagues for support with additional work load
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Acknowledgements
The financial support of the Stellenbosch University Hope Project is gratefully
acknowledged.