Background: When children experience food insecurity, in addition to poverty, their
resultant inadequate food intake and disease often leads to the development of proteinenergy
malnutrition and ultimately to death. In South Africa, where three out of every four
children live in poverty, food insecurity and its multiple negative effects are consequently
among the most urgent social issues affecting households and their children. Since
household food insecurity is thought to be associated with increased child mortality, it is
important to study any such associations amongst South African children to determine
additional risk factors for child mortality.
Objectives: The main objective of this study was to establish the relationship between
household food security and mortality in children under the age of five years in the
Agincourt field site, Limpopo Province, in 2004.
Methods: An analytical cross-sectional study of secondary data obtained from the 2004
census questionnaire and food security module of the Agincourt Health and Demographic
Surveillance System in rural Limpopo Province was conducted, involving a total of 7,790
black children under the age of five years. Certain exposure variables were selected for use
as indicators of food security and these were analysed with respect to child mortality using univariate and multivariate logistic regression.
Results: Based on the outcome indicators of food consumption, 37% of the study
population were found to have experienced household food insecurity in 2004, reporting
insufficient food for the entire household in the previous month and year. The limited
dietary diversity and insufficient quantities of food experienced by the majority of the
population were supplemented by the local growth of food crops and the gathering of food
from the bush. Of the 79 children (1%) under the age of five years who died in 2004, the majority (24%) died of HIV-related diseases, in addition to deaths caused by diarrhoea,
respiratory infections, and malnutrition. Child mortality was found to be associated with
the reporting of “unknown” for several indicators of food security. Additionally, expecting
the food availability of the household in the coming year to be less than that of the current
year (that is, the prediction of future household food insecurity) was significantly
associated with an increased risk of under-five child mortality compared to the expectation
of the same amount of food the following year (adjusted odds ratio (OR) 2.0), and with a
greatly increased risk of mortality compared to the prediction of more food (future
household food security) (adjusted OR 4.4). The latter association was age-specific to
infants under the age of one year (adjusted OR 5.6) and cause-specific to HIV deaths
(adjusted OR 5.9).
Conclusions: Following a significant trend in this study in the rural north-east of South
Africa, future household food security was inversely related to, and hence protective over,
childhood mortality in 2004, even after controlling for confounding factors. Further
research on the associations between household food security and under-five child
mortality, conducted following the development of a standard nation-wide food security
measurement tool specific to South African household conditions, would confirm
household food insecurity as a significant risk factor for under-five child mortality and,
consequently, as a target for future policies in the reduction of child mortality in this country.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/5816 |
| Date | 24 October 2008 |
| Creators | Crowther, Penny |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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