Food security and coping strategies of an urban community in Durban
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Introduction: Food and Agriculture Organisation (FAO 2015a) estimated that 220 million people (23.2%) in Sub-Saharan Africa were undernourished. Parallel to hunger, obesity rates have more than doubled globally since 1980; in 2014, 1.9 billion adults in the world were overweight and 600 million were obese (FAO 2015a). Obesity is a serious concern facing the world today and a major contributor to chronic disease such as diabetes and cardiovascular disease, which are often fatal (Bray, Frühbeck, Ryan and Wilding 2016: 1947). In South Africa, overweight and obesity have reached unacceptable numbers as over 60% of South Africans are overweight or obese. Furthermore, in 2015 South Africa was declared the fattest nation in Sub-Saharan Africa, adding another burden to the HIV epidemic (Ng, Fleming, Robinson, Thomson, Graetz, Margono, Mullany, Biryukov, Abbafati and Abera 2014: 777). Unemployment is one of the major factors that drive household food insecurity due to the fact that most people access food commercially. Therefore, income is a significant factor in ensuring that a healthy and nutritious diet is consumed regularly. The study community was at Umbilo, Durban, KwaZulu-Natal in a government owned estate called Kenneth Gardens. The estate has 286 units and accommodates approximately 1500–1800 residents. It formed part of an extensive network of cluster housing schemes developed by the apartheid government as a protectionist strategy to provide safe and affordable housing for poor and working class whites. Kenneth Gardens is currently managed by KwaZulu-Natal (KZN) Province and offers subsidized housing to residents from diverse background. Residents are low income bracket earners and many rely on state disability and pension grants for survival. Kenneth Gardens faces a wide range of social problems such as alcohol, drug abuse, domestic violence, unemployment and limited access to education (Marks 2013:26). Aim: The aim of the study was to determine the food security status, coping strategies, food intake and the nutritional status of the Kenneth Gardens community, which is situated in an urban area in KwaZulu-Natal. Methodology: One hundred and fifty (n=150) randomly selected caregivers participated in the study. The sample size was calculated using a power calculation indicating that 150 participants represent a reliable sample. The sampling procedure was simply random sampling. This study was quantitative and partly qualitative and descriptive in nature therefore, different measuring instruments were used to collect relevant data. The research tools for various variables measurements included; food security questionnaire, anthropometric measurements, a socio-demographic questionnaire, a food frequency questionnaire, and 24-hour recall questionnaires conducted in triplicate. Food security coping strategies were documented through a focus group interview with the Kenneth Gardens community members to determine strategies used to address food scarcity. All participants were weighed and measured to determine body mass index (BMI), classified according to the World Health Organisation (WHO) cut-off points. Data for socio demographic, FFQ, anthropometric measurements, and coping strategies was captured by the researcher on Excel® Spread sheets and analysed by a statistician for descriptive statistics using the Statistical Package for the Social Science (SPSS) version 17.0. Data for the 24-hour recall was captured and analysed by a nutrition professional using the MRC Food Finder® version 3.0 software, based on the South African composition tables. Results: The study population consisted of 150 households, including women (n=122) and men (n=28). The results revealed that the majority of households (52.7%, n=79) were headed by a mother, and only 40% (n=60) of households were headed by a father. Majority (47.3%, n=71) of the participants had completed matric and 7.3% (n=11) had tertiary education. English, (52%, n=78), was the most spoken home language, followed closely by Zulu, (43.3%, n=65). Thirty six percent (n=54) of the participants were unemployed and 26.7% (n=40) were employed; however over, 50% (n=40) of the employed participants were temporary. Twenty eight percent (n=42) of the participants earned less than R3000.00 per month and 31.3% (n=47) earned between R3000.00 and R6000.00 per month. Pensioners were 17.3% (n=26), who therefore received a government grant that ranges between R1500 and R1520 per month depending on the claimant’s age. The average household income was reported as R4429.20. The average number of people in the household was five, which equates to R6.00 per person per day. The results also revealed that 38% (n=57) of the household had a sole contributor to the household income; other households had two contributors (42.7, n=64) and 11.3% (n=17) had three contributors. Urban South Africans tend to purchase food as opposed to growing their own food. A lack of purchasing power results in food insecurity that eventually leads to malnutrition. The majority (56.6%, n=85) of the participants indicated a shortage of money to buy food and this inevitably leads and drive utilisation of coping strategies with high severity rate during periods of food scarcity. Bulk food was purchased once a month by the majority (68%, n=102) of the participants. The most commonly used coping strategy during periods of food scarcity was “Rely on less expensive and preferred food” with the mean score of 4.56 (±SD 2.772). The second used coping strategy was “Reduce the number of meals eaten in a day” with a mean score of 3.85 (±8.163), followed by “Contribute to a food stokvel in order to ensure food over a scarce period” (3.31, ±7.505) and “Restrict consumption by adults in order for small children to eat” (2.24, ±5.333). Utilisation of these food coping indicate a degree of food insecurity. The Body Mass Index (BMI) classification indicated that women had a higher (31.46 ±8.474) BMI than men (26.00±5.445). A total of 26.2% (n =32) women were overweight and 51.7% were obese category I, II and III. The mean BMI for the whole group was (30.44±8.261) which clearly demonstrated obesity. Nonetheless, men were not overweight; however 25% (n=7) were obese category I. Collectively, underweight was prevalent in women (3.3%, n=4) and men (3.6%, n= 1). The Food Variety Score was medium (31.91, ±10.573), which indicated a consumption of 30- 60 individual foods from four to five food groups during the seven day period; however the top 20 foods consumed from the 24-hour recall revealed that the diet was energy dense and the most consumed foods were primarily from the carbohydrate and fat group and a low consumption of fruits and vegetables was reported; hence the nutrient analysis showed a deficient intake of several nutrients, such as: calcium, vitamin A, zinc, vitamin D, vitamin E, vitamin K, zinc, magnesium, phosphorus, selenium and thiamine by both men and women. According to the WHO dietary factor goals, the acceptable macronutrient distribution ranges (AMDRs) and fruit and vegetable intake based on the 24-hour recalls, fat and protein intake exceeded the recommended 15-30 percent goal. Fruit and vegetable intake was very low in comparison to the minimum recommended intake of >400g. Carbohydrates intake for women were within the recommended 55-75 percent; however, men aged 19-50 years (50.70%) and >50 years (53.74%) did not meet the recommended intake. Conclusion: The results of this study reveal that the nutrition status of this community was compromised. The top 20 food intake indicated inadequate eating patterns and that diets comprised of energy dense foods, such as carbohydrates and fats, which could directly be responsible for the high obesity levels of >50% in women and >25% in men. Furthermore, there was low income and a high unemployment rate that proliferates the prevalence of food insecurity, hence the coping strategies reported. Malnutrition exists in communities as a result of food and nutrition insecurity which is affected by a significant number of factors that need to be considered and addressed. Nutrition interventions and nutrition education on a balanced diet, healthier methods of preparing food, and physical activity are required to ensure and improve health status, quality of life and better and sustainable coping strategies for our communities.