The Role of Food Gardens in Addressing Malnutrition in Children

The role of food gardens in addressing malnutrition in children (0-5 years)

THE ROLE OF FOOD GARDENS IN ADDRESSING

MALNUTRITION IN CHILDREN (0-5 years)

This research was commissioned by the D G Murray Trust to enhance and support the work and strategy of the Early Childhood Development Portfolio.

OVERVIEW 2

Malnutrition in South Africa 2

Why is malnutrition an issue? 3

Interventions to improve nutrition 3

FOOD GARDENS AS A NUTRITION INTERVENTION 5

Do food gardens improve the nutritional status of children? 6Can food gardens provide sufficient nutrition? 6The importance of micronutrients and Vitamin A 7Income replacement 8The importance of Nutrition education 9

Implementing successful food gardens 11What to grow and how to grow it 11Important elements for success 11Setting: Rural versus Urban 12

Supplementary benefits of food gardens 14

BEYOND FOOD GARDENS 15

CONCLUSIONS 16

WAY FORWARD WITH THIS RESEARCH 17

Justine JowellNovember 2011

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Overview

Food insecurity, related to poverty, and low intakes of fruits, vegetables, energy and micronutrients, is widespread in South Africa. Despite the success of South Africa’s food security at a national level, there is little household food security, resulting in a range of social problems, including malnutrition.

Supporting the nutrition needs of children (0-5 years) is one of the aims of the DGMT’s ECD portfolio.The development of food gardens at an individual household level, in homes, ECD centres and schools, is a possible intervention to address this.

The nutritional impact of food garden projects is seldom measured, partly because this is difficult to do. This paper gathers relevant research from academic sources and informal interviews with NGOs working in food security and early childhood development, to attempt to reach some initial conclusions on the possible nutritional impact of food garden projects.

Malnutrition in South Africa

In 1999, children aged 1-9 years showed a national prevalence for underweight of 10.3%, stunting 21.6%, and wasting 3.7% which points to high rates of malnutrition in South Africa (National Food Consumption Survey(NFCS)). The prevalence of under-nutrition was highest in rural areas, particularly on commercial farms and in informal settlements, compared tourban areas.

According to the NFCS, dietary intake in most children was of low micronutrient status andwas particularly inadequate in rural areas. One in two children had an intake less than half the recommended requirement for vitamins A, C, riboflavin, niacin, B6, folate, calcium, iron and zinc. This informed the basis of mandatory fortification of maize and wheat flour introduced in 2003.

Furthermore HIV contributes to an increased prevalence and severity of under-nutrition and micronutrient deficiency in children- more than 50% of HIV positive children become stunted or underweight and at least 1 in 5 develop wasting.Vitamin A deficiency has also been associated with increased morbidity and mortality in HIV-infected children, as well as increased mother-to-child transmission of HIV in pregnant women.Deficiencies in micronutrients required for normal functioning may also compound the risk of acquiring opportunistic infections and facilitate the progression to AIDS.

Even though South Africa is considered to be relatively food secure, more than 14 million people (35%) are vulnerable tofood insecurity. Rural areas are particularly threatened as they include 70% of the country’s poorest households.

Hunger and under-nutrition are both outcomes of inadequate food intake but their meanings differ. Hunger is associated with not eating enough food, while under-

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nutrition refers to the lack of sufficient micronutrients. Addressing malnutrition is not just about ensuring access to food, but about ensuring that there is access to adequate types and diversity of food.

Hunger might have improved in South Africa, but malnutrition has not significantly improved because of the types of food consumed. The 2005 NFCS revealed that 1 out of every 5 children aged 1-9 years are stunted. This is only slightly better than the 1999 findings.

Why is malnutrition an issue?

Malnutrition remains the world’s most serious health problem and the single biggest contributor to child mortality. The Lancet estimates that malnutrition kills 3.5 million children and permanently damages 178 million globally.(The Lancet, Maternal and Child Under-nutrition Series, 2008).

Poverty and poor nutritional intake are significant causes of the high levels of poor infant and child physical growth and development. Poor nutrition can result in delayed cognitive development, long-term damaging effects on infants’ and children’s intellectual and psychological development, impaired immune functions and severe infection. As under-nutrition is a major contributor to the chances that an infant and child will succumb to a life threatening disease, it is estimated that poor nutrition accounts for about 40 per cent of under-five mortality in the developing world (www.gain.org).

Income poverty (low levels of household income, expenditure on food, employment status) is firmly linked with inadequate food consumption Stunting in early years is associated with inadequate growth and sub-optimal educational achievements (0.7 grade loss of schooling and seven months’ delay in starting school). In turn, sub-optimal educational achievement contributes to a reduction in lifetime earnings, and hence to poverty. A vicious cycle is thus created that needs to be broken. Improving nutrition for children therefore also has the potential to make inroads into changing the cycle of poverty.

Interventions to improve nutrition

Recent findings have highlighted evidence-based interventions that make a positive change to malnutrition (www.gain.org). These have been grouped into Essential Nutritional Actions, which promote, protect and support these behaviours:

Exclusive breastfeeding for six months Adequate complementary feeding starting at six months Appropriate nutritional care of the sick and severely malnourished children Adequate intake of Vitamin A for women and children Adequate intake of iron for women and children Adequate intake of iodine by all members of the family.

The target of these interventions needs to be women and children during the period from pregnancy to 24 months as this is a crucial window for reducing

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undernutrition and its adverse effects (Lancet series on Maternal and Children under nutrition).

Although food gardensare not specifically mentioned,they have the potential to impact on Vitamin A intake (and in a lesser way iron intake), provide support for malnourished and sick children and potentially provide nutritional diversity to support complementary feeding. This potential is discussed later.

In South Africa, nutritional problems in children are currently being addressed through the National Department of Health’s Integrated Nutrition Programme (INP). The main focus areas of this programme are:

Disease specific nutrition support, treatment and counselling Growth monitoring and promotion (road to health charts) Control of micronutrient deficiencies (vitamin A supplementation, salt

iodization, mandatory fortification of maize) Promotion, protection and support for breastfeeding Contribution to household food security (school feeding programmes and

the Integrated Food Security Strategy (IFSS) Social assistance (grants and extension of the child support grant).

The IFSS, as a sub-component of the INP, aims to provide access to sufficient, safe and nutritious food for all South Africans, at all times, to meet their dietary and food preferences for an active and healthy lifestyle. Some of the objectives of the IFSS are to:

Increase household food production; Improve income generation, food fety, safety nets and emergency food

management systems and information management systems; and Ensure capacity development, and stakeholder dialogue.

Household food security activities linked to the INP include: Education and promotion of school gardens and micronutrient-rich

foods; Advocacy for the use of appropriate methods of food production and

exemption of certain foods from value added tax (VAT); Nutrition guidelines for sectors caring for children e.g. creches, HIV

orphans; Provision of food to Early Childhood Development Centres; Establishment of day care centres linked to income generating activities

for women’s groups; Subsistence and commercial food production; and School feeding programmes.

Food gardens form an important part of the IFSS strategy, but finding evidence-based success stories is challenging.

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Food gardens as a nutrition intervention

The World Health Organisation advocates that to maintain a healthy diet with enough essential micronutrients, five portions of fruit and vegetables (400g collectively) need to be consumed daily. In 1996 the UNDP proposed that urban agriculture could contribute significantly to combatting urban hunger and malnutrition by providing increased and consistent access to fresh, nutritional food at lower than market cost. Households engaged in food production appeared to achieve greater food security and their nutritional status tended to be better than non-farming families of the same socio-economic status.

This initially positive view of food gardens was then tempered by increasing scepticism about the impact of food garden production. There was, and still is, some uncertainty about the ability of food gardens to deliver on nutrition outcomes, especially at the subsistence level largely because (according to Webb):

It has been shown that cultivation does not necessarily lead to more consumption

Often growers opt to grow maize thereby limiting diversity and not ensuring vitamin intake

Consumption of vegetables takes place sporadically and at low levels There is not enough education around what constitutes a nutritionally

deficient diet Emphasis on cash income at the expense of home consumption

More recently, some cautiously positive research has emerged, largely from the Asia-pacific region, but there areencouraging South African cases too. A more careful and critical approach is needed to understand the limits and possibilities of what food gardens can deliver to poor people, particularly in urban areas.

Evidence shows that food gardens have some success in acting as a buffer against crisis. Beyond the arguments around food security, they are supported for their proposed ability to provide nutritious food (improved nutrition status) to those who grow them, to provide access to nutritional diversity where this is difficult to achieve (in rural or very poor contexts) and - because they can help to build communities and empower their members.

Thispapercollates information from these various academic sources to form some conclusions about the potential of food gardens to impact on the nutritional status of children (and pregnant mothers) and provide access to nutritional diversity.

Do food gardens improve the nutritional status of children?

There is conflicting evidence as to the nutritional value of food gardens and scepticism about their ability to deliver onnutrition outcomes. For example, research into urban agriculture in Atteridgeville, Pretoria, showedthat it is used as a strategy to improve food security1, but on average home gardening did not provide enough to

1The World Food Summit of 1996 defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”. Commonly, the concept of food security is defined as including both physical and economic access to food that meets people's

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meet the daily nutritional requirements of children (only 6.7% of RDA), indicating that from a nutritional perspective it does not make an important contribution to food security (van Averbeke).

However,more recentSouth African studies, and many from Kampala and Bangladesh, have found that small-scale agriculture has had a positive and significant association with higher nutritional status in children. It is cautiously proposed that the existence of a food garden has the potential to providenutritional benefit in terms of an increase in micronutrient intake, andpotentially beneficial income replacement options, but with certain limitations.

Understanding these conflicting conclusions and making a case for the nutritional impact of food gardens requires understanding of:

What is improved nutrition, The impact that income replacement has on nutrition, And the need for nutrition education in food garden interventions.

Can food gardens provide sufficient nutrition?

When one considers the impact on nutritional status of food gardens, one first needs to be clear on the definition of nutritional status. Good nutrition requires sufficient energy, protein and important micronutrients.

Insufficient intake of energy and protein (macronutrients), rather than vitamins and minerals (micronutrients),are at the root of most nutritional disorders in the developing world. Stunting and underweight are largely caused by the lack of sufficient energy-rich food and protein. Lack of micronutrients, such as Vitamin A, iron and iodine have impacts on disease immunity, illness and health in general. Depending on which outcomes you are trying to address, food gardens will have a greater or lesser nutritional impact.

In order toaddress stunting and underweight, increasing energy rich foods and protein is essential.Food gardens, unless they grow particularly calorie dense items like sweet potatoes and potatoes at a large scale, are generally not able to provide enough calories to support an energy-rich dietthat is required to overcome the high incidence of stunting in South African children (Hendricks). This is ultimately provided by an increase in meat, calorie dense food and fats.

In order for food gardens to grow energy dense foods they need to be large enough and often semi-commercial. The ability for food gardens to make an impact on micronutrient status is, however, more encouraging.

The importance of micronutrients and Vitamin A

dietary needs as well as their food preferences.

Food security is built on three pillars:Food availability (sufficient quantities of food available on a consistent basis).Food access (having sufficient resources to obtain appropriate foods for a nutritious diet) and Food use (appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation)..

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Many children and adults suffer from an inadequate intake of vitamins and minerals. In South Africa, 33% of pre-school children have vitamin A deficiency – this is severe enough to be considered a public health problem.

Currently Vitamin A is supplemented nationally through clinic health programmes for children aged 6 – 60 months.Compulsory iodization of table salt was introduced in 1995 and mandatory fortification of all of all maize meal and wheat flour with vitamin A, thiamine, niacin, riboflavin, pyridoxine, foliate, iron and zinc, came into effect in 2003. However these measures have had varying success.

Vitamin A supplementation does not reach all children, or for long enough. For children aged 6 to 11 months and 12 to 59 months, vitamin A supplementation coverage rates nationally were 72.8% and 13.9%, respectively (www.hst.co.za) - the low rates probably reflect the poor clinic attendance of children above 2 years after completing their infant immunisations.

Vitamin A deficiency results in a higher risk of maternal death, increased risk of death from measles and diarrhoea in children, reduced resistance to infections, delayed recovery from illness, and eye damage.Household food gardens have the potential toaddress this by providing an accessible sourceof micronutrientsfor family members.

In Bangladesh, food gardens are proven to provide dietary diversity and support the micronutrient intake for children. In South Africa, the research has been more divided, with a number of unenthusiastic conclusions made about its value in impacting on micronutrient intake. . However, recent research supports positive findings particularly in relation to Vitamin A intake.

Positive case stories in South Africa are reported byFaber et al (2002), withincreased Vitamin A intake in children as a result of a home-based food production programme in rural KZN. One of the main reasons for this was the focus on growing Vitamin A rich foods. The project also had impact beyond those families with gardens.Increase in vitamin A intake was documented both for children from households with project gardens as well as for those without project gardens (although it was significantly higher for children with gardens.)

The Agricultural Research Council also conducted a food garden project in Lusikisiki, Eastern Cape, to investigate a food-based approach to dealing with Vitamin A deficiency. Evaluation of the project showed a favourable effect on child morbidity, nutritional knowledge and dietary intake of Vitamin A rich vegetables. Critically important to their success was the commitment of the health volunteers, and the use of staggered planting to ensure year round Vitamin A vegetables.

Income replacement

Although there is controversy about the ability of food gardens to generate a substantial income for gardeners, food gardens have the potential to both mitigate household expenditure on vegetables and, in some cases, generate a small income.This income ‘saving’ means that families are able to purchase more energy-

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http://www.hst.co.za/


dense foods and improve their nutrition because of the cost saving or incomegenerated.

This is an important factor to consider when calculating the value of food gardens. In schools and ECD centres, the addition of vegetables to the school meals potentially frees some of the school-feeding budget to purchase additional foodstuffs. How regularly this happens in practise, and how large a saving is not clearly documented.

Studies show that an increase in income in rural areas results in increased expenditure on fresh and processed fruit and vegetables and meat, which has an impact on rural diets. The fact that social grants in South Africa appear to have been the most important contributor to reducing poverty and food insecurity in the poorest households, also illustrates the impact of income on nutrition (Aliber 2009).

Generally, the research is quite pessimistic about the ability of small-scale (household/ school) food gardens to providean appreciable income. Selling home-grown food is not a common income-generating strategy in poor communities of South Africa– less than 5% derive income from sales of produce. These low figures point to the inadequacy of markets as a mechanism of getting household-level produce to the commercial consumer.

However there are a few cases indicating that food gardens are successful not only in “improving micronutrient intake and thus providing immunity against disease, [but also] a vegetable garden project will on average provide households with food with a monetary value of R300 per month “(Oldewage-Theron et al). Case studies such Abalimi Bezekhaya in the Western Cape, claim substantial income benefit for farmers (although importantly this is maintained by subsidy and on-going support - see the section on Abalimi later).

The importance of nutrition education

There is much evidence from the Asia-Pacific region, particularly Bangladesh, supporting the role of homestead food production in improving dietary intake, decreasing micronutrient deficiencies, increasing household earnings and improving women’s involvement in household decision- making. However this impact is only achieved through the inclusion of comprehensive nutrition education and behaviour change in the programmes (Drimie).

It has been shown that most people do not have sufficient knowledge or understanding of what constitutes a healthy diet. Increased access to fruit and vegetables doesn’t always equal more consumption - gardeners still do not eat the recommended fruits and vegetables a day despite having increased access to these foods.Without nutrition education, gardeners get only some benefits (increased income, empowerment of women), which might explain why food garden programmes don’t have an impact on nutritional status. This is why families who can afford to eat better, often still have nutritional problems.

Trends such as urbanisation and a preference for convenience foods (such as rice over maize) threaten the beneficial characteristics of a traditional rural diet. The

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nutritional benefits of agriculture will only be positive if dietary changes follow recommended guidelines. A food garden programme without an effective nutrition education programme cannot hope to have success, as people’s eating behaviour needs to change in order to make a difference (coupled with improved food storage and cooked methods).

Nutritional education alsohas a role to play when one considers the growing burden of over-nutrition in South Africa. As the issue of underweight children is so critical, the growing concern ofoverweight children is often overlooked. The 1999 NFCS found an incidence of overweight and obesity of 17.1% among children aged 1-9 years. This is directly related to poor nutrition choices and a lack of understanding of healthy diets. This prevalence of obesity continues into adolescence and adulthood and can result in numerous health risks (heart disease, diabetes, osteoporosis).

Just as there is growing evidence that food production alone makes little impact on dietary practices unless it is backed by nutrition education, the combination of nutrition education and vegetable gardening is starting to have a proven impact on diet. It has been demonstrated that nutrition education, which focuses only on knowledge, seldom transfers to practice. On the other hand, direct gardening experience can increase children’s preference for vegetables and demonstrably result in behavioural change.

In support of school food gardens, there is clear and growing evidence that: Growing and preparing garden food at school increases children’s preferences

for healthy fruit and vegetables; Food gardening, combined with nutrition education, results in voluntary

changes in diet; Gardening activities, especially with organic approaches, improve children’s

understanding of and attitudes to the natural environment; Hands-on learning and learning -by -doing induce a much higher retention

rate than ‘chalk and talk’ (from the FAO).

This research is mainly American and South African evidence needs to be sourced.

Implementing successful food gardens

What to grow and how to grow it

For gardens to have an impact, they need to grow the right mix of vegetables in such a way that they are produced as regularly as possible throughout the year.

A Lesotho study of pre-schoolers and associated home gardens, found that thesegardens do not produce enough beneficial vegetables to make a significant contribution to the prevention of malnutrition.In order to have an impact on micronutrient nutritional status,sufficient Vitamin A rich foods need to be grown(butternut, orange flesh sweet potato, carrots, dark green leafy vegetables, and pumpkin). Although many households grow green leafy vegetables, the incidence of the other vegetables is minimal.

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To grow these, and other vegetables successfully, training needs to be provided on homegrowing practices and technological solutions, particularly staggered planting and cost effective garden management, which are accessible to communities.Most poor peoplecannot afford fertilizers and pesticides, pest control practices and techniquesthat are affordable and safe (such as integrated household management techniques)need to be supported and trained.

Important elements for success

Establishing and maintaining a productive food garden requires hard work and constant inputs. Key elements for success include:

Dedicated gardeners. In household gardens, the livelihood need drives food garden success. In community gardens,potential income revenue isa motivator. In school gardens, neither of these is present. Anecdotal evidence suggests that food gardens with a dedicated school maintenance person succeed, while those run by volunteer teachers do not.

Access to sufficient land, with secure tenure. It is commonly agreed that a garden of 10m x 10m can support a family of 6- 8 members. This is sufficient to add significantly to the daily food of an ECD Centre.

Fencing (to preventtheft in urban areas, and to keep out goats and other livestock in rural areas)

Start up costs – starting a food garden is expensive for a poor person, and training and support is required to ensure success.

On-going access to quality seeds, seedlings and virus-free plants Water – The Medical Research Council has shown that access to a secure

water supply for irrigation is the biggest challengeto implementing household/ community-based gardening activities. A public service commission survey in Limpopo and Eastern Cape showed that although several schools had vegetable gardens, most were dysfunctional because of a lack of water.

On-going technical mentorship in terms of planting, pest control, and general advice. With sufficient planning (for example staggered planting) year round availability of crops is possible, but this needs a good understanding.

A focus on both agriculture and nutrition is needed. For example, some food gardens grow mainly lettuce (this is produce that takes up space, is difficult to grow and has comparatively little nutritional value). A balance of micronutrients and dense energy foods are needed.

For income generation, access to markets and infrastructure that supports the sale of produce needs to be present.

Whether the food garden is in an urban or rural location also plays an important role in its success.

Setting: Rural versus Urban

It appears that rural food gardens are generally more successful at meeting nutritional outcomes and that theypotentially meet a greater needed.However it is important to understand both contexts.

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Urban AgricultureAlthough urban agriculture has been sold as a critical initiative for improving food security, three-quarters of SADC households growing food are still food insecure.This suggests that urban food production might ameliorate the worst aspects of food insecurity, but not necessarily solve the problem. Participation rates are low in SADC countries in urban agriculture, even in poor areas (22% on average). When households are engaged in agriculture only 8% get food from this source once a week, and only yield produce for three months of the year (Webb).

Urban agriculture is not as widely practised or as important to the food security of the urban poor as is sometimes claimed. Small plot size (especially in informal settlements) has meant that there is not much space to grow food.It is generally accepted that a 10m x 10m food garden can support of family of 6-8 members. This space is seldom available in poor urban households. Thelack of certainty in terms of land use also plays a role. Over two-thirds of households who are dependant on food production own their own houses.

However this does not mitigate the importance of developing urban agricultural projects but just means that these need to be carefully analysed and generally be on scale larger than household. Household gardens can be useful as in providing some food security but the need for space has meant that many urban projects look to commonage areas or school properties to house gardens. Success stories such as Abalimi Bezekhaya based in Cape Town are testimony to the possibility of urban agriculture (below), while examples of successful food gardens at primary schools and ECD centres, where space is available, are starting to emerge.

Abalimi Bezekhaya, in the Western Cape, runs a training and support programme for food gardens. Their Harvest of Hope programme is an income generation programme that assists community gardens to become semi-commercial. Abalimi buys the farmers’ quality produce and then through marketing, packing and delivery services, sells their produce on to consumers. Thisallowsfarmers to earn a minimum income of between R200 –R2000 a month (with leftover produce for home consumption/sale). The community gardens are all self-managed, often on school premises. This is a unique project in that it allows urban microplots (a minimum of 500m2) to produce significant income through a centralisation process that costs R100 per famer per month. This kind of project has the potential to impact on the nutritional outcomes of children through income replacement and leftover produce. There are also 2000 home gardeners who they support with training and subsidised inputs (manure, seeds, training) but the impact of these gardens is not explored in this paper.

Urban agriculture, on a household level, has limited possibility as an income generation activity, however there is potential for community foods gardens run by self managed groups to generate income, if they can overcome issues of land availability, access to markets, group dynamics and on-going costs. Critical to their success of those examined was the role ofsupport organisations,which provided subsidies and technical support.

Rural food gardens

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Rural agriculture and food gardens have had more positive results. Access to land and relatively larger plots mean that establishing gardens is often easier. Also, for many rural people, gardening is part of their experience and so is easier to start.

Homegrown or small-scale food production can be significant contributors to rural food security – the HSRC has estimated that there are approximately 3 million small-scale farmers, mostly womenthat produce food primarily for household consumption. Food from farming is often not the major source of food for the household, but it constitutes an important source and is utilised as a reserve incrisis.

In rural contexts, however,the increased cost of food and the limited availability of choices are barriers to a healthier diet.This further strengthens the argument for supporting rural agriculture. For many rural people, the closest shop stocks only a limited range of fresh produce – potatoes, tomatoes and onions, and these are more expensive and of a lesser quality than their urban equivalents. Diets are monotonous, resulting in low intakes of vitamins and minerals. School feeding programmes cite difficulties in rural areas in accessing a sufficient variety of fruit and vegetables to provide a balanced diet rich in micronutrients. This in itself is a good reason to support the cultivation of nutrient rich vegetables – especially the Vitamin A varieties – in rural areas.

In urban areas, people also have easier access to clinics for Vitamin A supplementation -for many rural people, clinics are far away, so supplementation rates arelower and fortified foods are less available or not bought in favour of home-production. Also in rural areas food is sourced from far away, stored for a long time, therefore losing nutritional value, and often produced with the use of many pesticides and chemical fertilizers, and therefore there is an argument to be made for supporting the production of fresh, organic food produce.

Nationally, only 1 in 5 households spend enough on food to afford a nutritionally adequate basket, however a rural urban breakdown shows that a substantially smaller number of rural households can afford such a food basket (1 in 10 rural compared to 1 in 4 urban) (Altman et al). This coupled with the larger burden of nutritional issues in rural areas, makesa clear case for a rural focus for nutrition interventions.

Supplementary benefits of food gardens

Although the scope of this paper is to examine the nutritional benefits and, to a lesser extent, the income benefits of food gardens, it is important to mention some of the other benefits of food gardens.

These include: Education – food gardens have been shown to have a positive impact on

nutrition understanding and behaviour. Empowerment – particularly of women, who subsequently have greater

control offood provision, and sometimes of income generation as well. For the establishment of social networks, to symbolise a senseof security and

encourage community development (Slater)

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Psycho-social benefits – these include purposeful work, a positive experience of working with nature, and a reduction insocial alienation and family disintegration (van Averbeke)

Beyond Food Gardens

Nutrition impacts depend on more than access to food.

The MRC research found that when vegetable garden projects focus on children under five years of age, they also need to pay attention to the following issues:

Promotion of breastfeeding Up-to-date immunisation of children Teaching mothers the role of Vitamin A supplementation Teaching mothers the role of deworming Encouraging mothers to take their children to the clinic for regular growth

monitoringAddressing aspects of hygiene and sanitation (food quality, disposal of household refuse, sanitation and clean, safe water)

Additionally, an USAID Infant and child nutrition project showed that the short-term effect of increased household food availability translates poorly into nutritional status. In order for this to be significant for younger children, the increased food availability has to be accompanied by some combination of improved caring and feeding patterns and better access to health services. The essential nutrition actions mentioned above, such as exclusive breastfeeding for the first six months and adequate complementary feeding afterwards, are considered essential nutrition actions that will have a large impact on child nutrition.

GAIN estimates that present levels of stunting and Vitamin A deficiency in South Africa result in 10 000 extra child deaths annually. Poor breastfeeding habits are contributing a further 7312 child deaths. Breastfeeding makes a major contribution to child health by protecting against morbidity and mortality associated with common infectious diseases. Despite the proven benefits, South Africa has made little progress on promoting exclusive breastfeeding between 1998 and 2003.

The early introduction of complementary foods is also related to perceptions around the inadequacy of breast milk, and cereals, maize and wheat are often added to feeding bottles as early as 2-3 months old. Current evidence is conclusive that six months of age is appropriate for the introduction of complementary foods. The 1999 NFCS showed that dietary intake in most children was confined to a relatively narrow range of foods of low micronutrient density. It would therefore be important, as GAIN recommends, to include: improving infant and young child feeding practice; improving current health based programmes (importantly nutrition education); and addressing HIV/AIDS nutrition.Another important intervention to support is the effective rollout of income grants. The value of increased income in improving nutritioncan be enhanced by ensuring that all those eligible for grants are accessing them. An analysis of the 2007 General

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Household Survey shows that 51% of seriously hungry households appear to be eligible for social grants that they do not receive (Aliber 2009 quoted in Altman).

Conclusions

Vegetable gardens, at the scale and setup of most food garden projects, are not able to address the increased energy consumption requirements needed to overcome the high levels of stunting among South African children. On a household/ centre-based level, they also do not demonstrate a very successful income generation solution unless they are part of a structured programme such as Abalimi.

However they do have the potential to provide an important source of increased micronutrient intake, to fill the gaps not met by supplementation and fortification, and therefore to support improved nutritional status and immunity to disease. They also have a proven ability to act as a buffer against extreme poverty and therefore play an important food security role. To ensure this impact, however, there are a number of guidelines that need to be considered:

Vitamin A rich foods need to be the main component of any garden and strategies for growing these effectively, all year round, need to be developed and supported. Technical mentoring/ training on this, needs to be provided.

The cost of fencing needs to be provided There need to be solutions to providing safe, affordable water Projects appear to have more successin rural contextsand there is potentially

a greater nutritional need particularly on commercial farms. On-going access to quality seed and seedlings is often an issue in rural areas.

The establishment of seed banks/ community nurseries is an innovative intervention that could also provide income generation opportunities (especially to a school or ECD centre).

Centre based gardens need dedicated personal to ensure theupkeep of the garden.

Nutrition education needs to be included in any food garden programme, and needs to include over-nutrition outcomes as well.

Target women (as food for women and children is more likely to be available when women have budget/production control) particularly pregnant women.

It is critical to reach children under-2years as this is a crucial period Food gardens cannot be separated from other issues of hygiene and food

preparation School food-gardens should incorporate an educational aspect, but this

cannot be the sole purpose otherwise motivation, and therefore maintenance, wanes.

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Interviews were conducted with:

Mieke Faber, Medical Research Council Philani Health and Nutrition project Abalimi Bezekhaya, Food Gardens project (interview and site visit) Ntataise Loweveld Trust, Free State ARK Orphans and Vulnerable children’s programme Laura Poswell, Fuel SA Siyakhana Programme Wits Ekukhanyeni Relief Project

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http://heapro.oxfordjournals.org/content/25/1/33.full.pdf

http://www.wrc.org.za/