The challenges of underweight and overweight in South African children: Are we winning or losing the battle? A systematic review

Full text: Background: Underweight and overweight are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with undernutrition and overnutrition in children. In line with the health promotion strategies, periodical tracking of underweight and overweight in children as well as promotion of government feeding scheme policies are recommended to improve children nutritional status. The purpose of this study was to review available literature regarding the prevalence's of underweight and overweight and evaluate government policies in addressing undernutrition and overnutrition in South African children. Methods: The electronic search included PubMed, Science Direct, Google Scholar and library catalogue journal for prospective longitudinal or cross-sectional studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African children within the age ranges of 0 to 14 between 1990 and 2013. Results: Fourteen cross-sectional and two longitudinal studies met the criteria for inclusion in this review. Data synthesis revealed the small number of prospective studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. Overall, a higher percentage of the studies (ten) were reported in the rural areas compared to two studies in urban areas. The remaining four studies were a mixed of rural and urban. In this review, a high percentage of underweight (0.7-66%) was reported among children in rural areas compared to a similarly higher proportion of overweight (3.1-32.4%) in urban areas. Similarly, all studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight affected the adolescent's performances in many forms including physical activity and fitness, academic performance and self-esteem. Numerous recommendations were made in the reviewed studies as well as the reports, but unfortunately effective strategic programs in eradicating both underweight and overweight are minimal. Conclusion: It is evident from the reviewed studies that underweight and overweight challenges are still huge in South African children. The most highly affected by underweight are rural children while children in urban areas in transition were faced with overweight. There are little efficient and effective strategic programs in addressing underweight and overweight in children. Based on these findings, the study recommends the introduction of efficient and effective four hour per week intensive physical activity in the school syllabi and government need to revisit its school-feeding scheme for optimal benefits. It was apparent from the reviewed studies that more robust longitudinal studies covering all provinces of South Africa are needed to elucidate the available literature. (author)