Nutrition

After months of negotiation, a deal has been struck between the San Council and the Council for Scientific and Industrial Research (CSIR) on how to share the potential benefits arising from a local cactus that is tipped to yield a blockbuster obesity drug. The CSIR made international headlines two years ago with news that it had successfully isolated and patented the active ingredient in the hoodia plant, traditionally used by the San people to stave of hunger and thirst. The CSIR licensed the patent on what it called P57 to a UK based company called Phytopharm, which in turn sold the rights to the world's biggest pharmaceutical company, Pfizer. The deal with Phytopharm raised concerns of how, if at all, the San would benefit from the commercialisation of P57. According to the Guardian newspaper, early clinical trials in the UK suggested P57 could reduce appetite by 2 000 calories a day, offering hope of a lucrative foray into the multibillion dollar obesity drug market. Now both sides have agreed on how to divide the expected royalties. The CSIR's lead negotiator and head of its Biochemtek division, Petro Terblanche, declined to provide specifics on the royalty split, saying that the CSIR would make public the details of the agreement next month, once the deal had been signed formally. She did, however, confirm reports that the money accruing to the San would be shared equally amongst all the San. Science and technology director-general Rob Adam said an agreement would hopefully be a model of engagement between holders of indigenous knowledge and hi-tech institutions. (Source: Tamar Kahn: Business Day, 13 January 2002)

Nineteen-year-old Khethelwa Msebe had no idea why her eight-month-old daughter, Andisiwe, was suffering from broken skin and an enlarged abdomen when she took her to Mount Ayliff Hospital in the Eastern Cape. Now she knows. Her daughter is one of more than 700 children in the area who have been admitted to hospital with malnutrition. Andisiwe is one of the lucky ones. Two weeks ago in nearby Lusikisiki, Honjiswa Mgeduzo lost her 11-month-old son. He died of marasmus - a condition caused by lack of calories and protein. In the first six months of this year, 166 children - virtually all of them under the age of six - have died of malnutrition in 11 hospitals in the northern reaches of the Eastern Cape. The horrific figure was calculated by the University of the Western Cape, the Department of Health and the Health Systems Trust. Experts blamed malnutrition on: - People being unable to get child-support grants because of problems obtaining identity documents; - Extreme poverty and lack of food; and - High unemployment. Commenting on the deaths, Social Development Minister Zola Skweyiya said: I am very embarrassed. That children should die of malnutrition in a democratic South Africa is something that should not happen. Skweyiya said one of the problems in the Eastern Cape was the need to outsource the distribution of pensions, which had already been done in all the other provinces. Referring to the northern part of the Eastern Cape, he said: I don't think we have really done enough in terms of making children able to access the child-support grant. Skweyiya said that on a visit to the area last year, he saw horrifying examples of malnourished children. We found out that the grave problem there had been the scarcity and unavailability of identity documents, he said. The chief executive of the SA Congress for Early Childhood Development, Leonard Saul - who conducted a recent study in seven towns in the northern part of the Eastern Cape - said almost 71% of the 1.7 million people living in the region were unemployed. People don't have access to a well-balanced diet. Malnutrition is a very serious problem, with most families having just one meal a day of pap and potato, he said. Msebe, who left school in Grade 6, said she could not get the R130 child-support grant because she did not have an identity document. The unemployed mother from Ntabankulu, near Mount Ayliff, said she depended on her grandmother's old-age pension to support her child. Many times there is no money to buy milk for my daughter and I am left with no choice but to feed her plain soft porridge made from mealie meal. I know it is not adequate but there is nothing else I can do, she said. Dr Thandi Puoane, a health scientist based at the University of the Western Cape, said nurses were trained to deal with malnutrition, but the attraction of overseas posts meant many of them left the country - taking their expertise with them. We trained about 75 nurses in the Eastern Cape to help prevent children who were admitted to hospital with malnutrition from dying. But the problem is that nurses are leaving to find work in the UK, she said. Puoane said a meeting to improve hospitals' management of malnutrition in the Eastern Cape was being held later this month. Nzwaki Sogaula, who is involved in community nutrition in the area, said research done in 2000 showed that at least two of 30 children who were monitored at home after being treated for malnutrition had died. Even if you win the battle against malnutrition in the hospital, the child goes back to the same home environment. There's no food at home; the cupboards are bare. The province's district health director, Dr Thobekile Mjekevu, admitted this week that malnutrition was a serious problem . It is a social problem and mainly serious in the former homeland areas. The problem of malnutrition is made more difficult by other underlying factors such as HIV. Qaqamba Msweli, director of the Umtata-based Masikhule Project, which provides early childhood development training, said many children were unable to concentrate in class because of hunger. Most kids in the Eastern Cape do not even attend school because their parents can't afford to send them. They are not being reached and they are dying in silence, she said.

Brown bread and mielie meal, the staple food of the country’s poorest citizens, will soon be fortified with vitamins to help combat malnutrition. According to draft regulations published by the Department of Health on Friday (October 18), it will soon be compulsory for the milling industry to add a range of micro-nutrients to their products or face legal action. The regulations will have important implications for children, old people and those whose immune systems are compromised by diseases such as AIDS and TB, said Health Department spokesperson Jo-Anne Collinge. It is estimated that about 30% of South African children are stunted from a lack adequate nutrition in the early years of their lives. Interested parties have three months to respond to the draft regulations (Source Kerry Cullinan, Health-e, 22 October 2002)

One third of South African children have low levels of vitamin A in the blood, a quarter suffer from malnutrition-related stunted growth, one in 10 are deficient in iron and one in eight are underweight. But there is little that parents on low to middle incomes can do to rectify their children's nutrition problems. To provide a completely healthy and balanced diet to three children aged 15, 10 and six years is costly, at current prices, almost R800 a month.This is equivalent to the entire monthly wage of some domestic workers and 66 percent of the official minimum wage. A survey by Professor Johan Potgieter of Port Elizabeth shows that keeping children healthy is expensive. He estimates that one to three-year-olds cost R162 per month, four to six-year-olds R213 monthly while seven to 10-year-olds will cost parents R246 every four weeks. The price of keeping a child healthy rises with their age.( Source : The Mercury, 15 October 2002)

Nineteen-year-old Khethelwa Msebe had no idea why her eight-month-old daughter, Andisiwe, was suffering from broken skin and an enlarged abdomen when she took her to Mount Ayliff Hospital in the Eastern Cape. Now she knows. Her daughter is one of more than 700 children in the area who have been admitted to hospital with malnutrition.Andisiwe is one of the lucky ones. Two weeks ago in nearby Lusikisiki, Honjiswa Mgeduzo lost her 11-month-old son. He died of marasmus - a condition caused by lack of calories and protein. In the first six months of this year, 166 children - virtually all of them under the age of six - have died of malnutrition in 11 hospitals in the northern reaches of the Eastern Cape. The horrific figure was calculated by the University of the Western Cape, the Department of Health and the Health Systems Trust. Experts blamed malnutrition on: People being unable to get child-support grants because of problems obtaining identity documents; Extreme poverty and lack of food; and High unemployment. The chief executive of the SA Congress for Early Childhood Development, Leonard Saul - who conducted a recent study in seven towns in the northern part of the Eastern Cape - said almost 71% of the 1.7 million people living in the region were unemployed. People don't have access to a well-balanced diet. Malnutrition is a very serious problem, with most families having just one meal a day of pap and potato, he said. Dr Thandi Puoane, a health scientist based at the University of the Western Cape, said nurses were trained to deal with malnutrition, but the attraction of overseas posts meant many of them left the country - taking their expertise with them. We trained about 75 nurses in the Eastern Cape to help prevent children who were admitted to hospital with malnutrition from dying. But the problem is that nurses are leaving to find work in the UK, she said. Puoane said a meeting to improve hospitals' management of malnutrition in the Eastern Cape was being held later this month. Nzwaki Sogaula, who is involved in community nutrition in the area, said research done in 2000 showed that at least two of 30 children who were monitored at home after being treated for malnutrition had died. The province's district health director, Dr Thobekile Mjekevu, admitted this week that malnutrition was a serious problem . It is a social problem and mainly serious in the former homeland areas. The problem of malnutrition is made more difficult by other underlying factors such as HIV. Qaqamba Msweli, director of the Umtata-based Masikhule Project, which provides early childhood development training, said many children were unable to concentrate in class because of hunger. (Thabo Mkhize, Sunday Times, 2002/09/15)

The Western Cape government is in talks with German pharmaceutical giant Bayer about the discounted or free provision of a drug used in the fight against sexually transmitted diseases. It also eases the transmission of HIV. The discussions were initiated during a recent visit to Munich by premier Peter Marais and his delegation to attend a meeting of representatives of regional governments with which the Western Cape has partnership agreements namely Bavaria, Upper Austria and Shandong. Quebec was also represented. The drug, Ciprofloxacin (Ciprobay in SA) is an expensive antibiotic that is essential in the province's HIV/AIDS treatment programme. The drug is also used for treating tuberculosis and urinary infections. The province spendsabout R1m acquiring the drug annually, which is not enough to meet the need. Marais said he wanted to provide the drug free to private doctors for dispensing to patients. He added that it might be necessary for the province to package and distribute the drug itself to bring down the cost. The partners agreed to intensify co-operation in the fields of education, health, professional training, environmental protection and economic and technological exchange. The partners agreed to meet every two years with the next summit in 2004 taking place in the Western Cape. It will also be pursuing a partnership agreement with Quebec. The premier stressed the expansion of the province's international relations with a view to attracting foreign investment and creating awareness of the problems we face with regard to poverty and globalisation. (Source: Business Day, 7 February 2002)

While malnutrition is considered one of the greatest risks to the well being of South Africa's children, growing numbers of obese or overweight youngsters could have a greater part in threatening the country's future health. Dr Tessa van der Merwe, senior consultant physician/endocrinologist at Johannesburg General Hospital and the Witwatersrand University said a quarter of South Africa's 12 to 18 year olds classified as overweight or obese would have a catastrophic impact on future national health. Van der Merwe said that the increasing prevalence of obesity among South African children would force the government to formalise a policy on the management of overweight and obesity. According to an October 1998 national demographic and health survey conducted by the Medical Research Council, the trend towards greater percentages of obesity and overweight in young females continues in adulthood. Black women have the highest incidence of obesity among males and females, at 30 percent, followed closely by white women at 26,3 percent; coloured women at 25,3 percent and Indian women at 21 percent. White South African men scored the highest on the male obesity scale at 19,8 percent followed by coloured men (10 percent), black men (nine percent) and Indian men (8,6 percent). (Source: The Star, 15 January 2002)

A landmark survey has revealed that almost half of South Africans over the age of 15 are overweight or obese. These statistics on obesity are becoming increasingly comparable with those of the United States, where 61 percent of the population is obese or overweight. South Africa's first national demographic and health survey indicated that 25 percent of its citizens fell into the overweight category, with a Body Mass Index in excess of 25, while 20 percent fell into the obese category, with a BMI of more than 30. At 30 percent, black women have the highest incidence of obesity, followed closely by white women at 26,3 percent, coloured women at 25,3 percent and Indian women at 21 percent. White South African men scored the highest on the obesity scale at 19,8 percent, while coloured men followed at 10 percent. Black men and Indian men scored nine percent and 8,6 percent respectively. Dr Tessa van der Merwe, senior consultant physician endocrinologist at the Johannesburg General Hospital and Wits University, said that because of the results of the survey, the government might be forced to formalise a policy and draw up guidelines on obesity management. (Source: The Mercury, 3 December 2001)

An evaluation report of the Primary School Nutrition Programme (PSNP) will he handed to the Ministry of Health in a press conference to be held at the Department of Health, Room 1127, 120 Plein Str, Cape Town, at 13h00, Tuesday 9 September 1997. The PSNP was introduced as one of the Presidential Lead Projects of the Reconstruction and Development Programme in 1994. The evaluation was based on a national collaborative effort by a number of research institutions using a multi-disciplinary framework.

The purpose of this guide is to provide health district nutrition workers with the steps and information necessary to complete a participatory NSA within the framework of the district health system. It will go through a framework and give examples of where and how information can be collected. This guide is meant for health district PHC workers who are motivated to implement an integrated nutrition programme.