Food consumption patterns and nutritional risks of women in low and middle income communities in KwaNdengenzi, KwaZulu-Natal

Abstract

Food consumption patterns have changed dramatically in the recent times, with traditional diets being replaced by so-called “westernised diets” and leading to nutritional risks such as malnutrition. Contributing factors are urbanisation, climate change, agricultural produce supply (food demand is greater than produce supply) and rising prices, to name but a few. The food security status is also in question as more and more South African households are said to be living in poverty and consequently undernourished even though the country was found to be nutritionally stable compared to previous years. Unemployment and lack of nutrition education also have an impact on communities, in terms of the food being purchased and consumed.

The study was conducted to determine the socio-demographic status, food consumption patterns and nutritional risk of a low-income and middle-income community that resides in KwaNdengezi Township in KwaZulu-Natal.

A sample of two hundred and fifty eight participants was required for the study. The households in both the north and south of KwaNdengezi Township were randomly selected by using the number of roads listed in the eThekwini municipality map. A sample of 130 households per area was targeted. The required number of households was selected by dividing the number of identified roads resulting in three households targeted in each of the 39 roads in the north section and five households in 26 roads in the south section being targeted.

Upon the agreement by participants, the study was conducted where data was collected by means of an interview setting, where participants were interviewed by fieldworkers using pre- designed and tested questionnaires. The follow up was conducted on the days following. The participants answered a three set of questionnaires including, a Socio-demographic Questionnaire (Annexure D), a Food Frequency Questionnaire (Annexure F), 24-Hour Recall questionnaires (Annexure E). The anthropometric measurements were taken in order to determine the BMI status of the participants. The participants were weighed using a Physician Scale for weight, the Stadiometer for height and non- stretchable measuring tape for waist circumference.

The north and the south sections of the township were both affected by unemployment, showing worrying rates that also corresponded with other studies illustrating that unemployment is a challenge in South Africa. The unemployment rate in the north section was very high, sitting at 78.5%, compared to the south section at 63.1%; even so both these communities are economically challenged. Food insecurity was more prevalent in the north section as 36.9% of the participants reported always not having enough money to purchase food whilst 0.8% of the participants in the south section reported the same, concluding that the north section is more vulnerable to hunger leading to malnutrition and poverty.

The education status of the participants in the north section was a point of concern as only 3.1% of the participants had graduated while almost 29.2% in the south section had graduated; this illustrates a very clear difference, which might also be due to unemployed household caregivers who cannot afford further education.

The mean Food Variety Scores (FVS) (±SD) for the north section for all food consumed from the various food groups during seven days was 34.44 (±8.419) and for the south section it was 33.87 (±10.670), indicating a medium food variety score where both sections had a good dietary diversity score ranging from 7-9 food groups, summarising the food group diversity as being in the majority in the north section at 63.85% (n=83) while in south section it was 60.77% (n=79).

The results of the energy distribution of macronutrients from the average of the 24-hr recall results when compared to the WHO dietary factor goals showed that the participants’ diet was well balanced in terms of macronutrient intake for both sections while the diet for both sections was lacking in micronutrient intake.

The results of the women caregivers for both the north and the south sections illustrated a high consumption of the following foods out of the top twenty foods consumed by the community. The foods mostly consumed included sugar, maize, bread and rice for both the 19-30 and 31- 50 years age groups ranging from 195.15-248.82g for maize, 17.61-18.90g for sugar, 82.73- 108.16g for bread and 127.14-131.69g for rice, meaning that the respondents’ diet was high in calorie intake, hence the doubled DRIs for carbohydrate.

Overweight and obesity tests showed alarming results as the majority (56.15%) of women caregivers in the north section were found to be obese while 63.8% of the women in the south section fell into the obesity classification, showing that the women caregivers for both sections are at risk of obesity related illnesses (NCDs). The results for waist circumference showed that 71.53% and 78.46% of the women in the north and south sections respectively were above the waist circumference cut-off point (≥88cm). When the weight-for-height ratio was measured for the whole sample most of the women caregivers (69.23%) were found to be at risk of developing metabolic syndrome.

The food consumption patterns illustrated in the study corresponded significantly with the results found. Both the communities consumed a diet high in caloric and fat intake but was low in fruit and vegetable intake. This leads to obesity, resulting in non-communicable diseases as well as micro-deficiencies, leading to malnutrition because of the lack of variety in the food consumed by the population. The lack of food variety is the result of not having enough money for food purchases, explaining the question why the community cannot meet the DRIs as a result of unemployment and poverty as well as a lack of nutrition education.

With that said the two communities did not show much of a difference in lifestyle and food choices being made except for the education level that was low for the north section and a bit higher for the south section, as well as livelihoods that also showed that the north section was at a lower economic level than the south section but both the sections were at risk of malnutrition and poverty and needed the same intervention in terms of assistance.

In the study it was recommended that policies drafted by the government and stakeholders should be focused and tailored more on women caregiver headed households. More nutrition knowledge should be geared towards educating the most vulnerable and poverty stricken communities. The micronutrient intake must be promoted at lower and middle income communities. The agricultural sector needs to recognise and promote women farmers as well as offer assistance in order to grow their standing as farmers. The government should devise and implement projects that empower women so that they not dependent on their male counterparts.