HEALTH AND EDUCATION
Poor nutrition is stunting intellectual development
Free education means little if poor health and hunger continue to hobble children, writes Samantha Richmond
There are certain factors to consider regarding President Jacob Zuma’s plan for tertiary education to be subsidised for about 90% of households from 2018.
While it will have given hope for many who had previously been unable to study further, some factors, beginning at birth, have long-term significance.
A 2016 analysis by Daniela Casale, using data from the National Income Dynamics Study (NIDS), underlined the links between child health and educational outcomes and highlighted how much work remains to pave the next generation’s path to success.
The research suggests that poor child health, particularly poor nutrition resulting in stunting (impaired growth and development), is a cause of poor educational outcomes.
Evidence from the South African Birth to Twenty Cohort Study suggests that it is not just the quantity and quality of nutrition that make a difference, but also its timing. Children who have been stunted, even if they later recover, never quite catch up. If nutrition interventions are to make a real difference, they must be timely, targeting nutritional problems before damage is permanent.
Unfortunately, SA is not getting this right. According to the 2016 Global Nutrition report, the country is ranked 70th of 132 countries for the prevalence of stunting (low height-for-age). South African children were worse off than their peers in Haiti, Senegal, Thailand and Libya.
Because of NIDS, we are beginning to understand the effect of stunting on a child’s future. NIDS data paint a worrying picture of avoidable damage to children’s future prospects. There is significant inequality in child health along socioeconomic lines, and lagging behind in education means that, for many, the cycle of poverty is set to continue.
NIDS is the first and only large-scale, national longitudinal study of South Africans. An initiative of the Department of Monitoring and Evaluation, it is implemented by the Southern Africa Labour and Development Research Unit at UCT.
What makes this study special is that it follows the same participants over time, which allows researchers to see how earlier circumstances affect later life. The study has been following the same 28,000 South Africans over the past 10 years, which means it is now a powerful tool to assist in evidence-based policy making.
Casale’s paper analysed data from children in the first four "waves" or rounds of NIDS data collection. Anthropometric data such as height-for-age and body mass index, as measures of stunting and obesity, were used as a proxy for child health.
As is often the case in SA, the results were starkly divided along racial lines. When looking at children aged six months to 14 years in wave 1 of NIDS (2008), African and coloured children were far more likely to be stunted or severely stunted than Indian and white children.
Specifically, 18% of African children were stunted, 20% of coloured children, 11% of Indian children and 7% of white children (though the Indian and white sample sizes were very small). Interestingly, rates of obesity were also highest among African and coloured children at 7.2% and 13.9%, respectively, compared with 1.5% of Indian children and 5.9% of white children.
Focusing on children who were aged up to eight years in 2008 and seven to 14 years in 2014-15, the research compared educational outcomes of children in wave 4 (2014-15) with their nutritional status during wave 1 (2008) (over an eight-year period).
It used three main factors to measure educational outcomes: the age the child started grade 1; the number of grades they had completed by 2014-15; and the answers to a series of questions on whether the child passed, failed or withdrew before completing grades in which they had enrolled.
It found that later educational outcomes of children stunted in wave 1, when they were aged eight or younger, were significantly poorer than those of their non-stunted peers for analysis restricted to Black African and coloured children (the white and Indian sub-samples were very small). These stunted children — aged seven to 14 — were found to have enrolled later for grade 1, completed fewer years of schooling and were more likely to have failed other grades. This could have a knock-on effect on their future.
Children who were stunted and had completed fewer years of schooling by age 14 gave their peers a head start both in terms of further education and, later, in the job market. Late enrolment does not fully account for this difference.
Even after controlling for age at first enrolment, Casale’s analysis found that stunted children tended to progress through the schooling system slower, meaning a potential reduction in lifetime earnings (if they graduate later).
The research found that obesity did not have a significant effect on educational performance. However, Casale noted that the effect of obesity in childhood could be further researched.
There are further concerns. The paper also mentions findings from analysis by Casale and Desmond (2016), which examined changes in stunting status versus cognitive outcomes in preschool children using Birth to Twenty cohort data.
This research found that children who recover from stunting in early childhood still do worse, on average, than children who were never stunted. According to Casale’s paper, this suggests that "the timing of good nutrition is key in the child’s development", but unfortunately this remains an underresearched area in SA.
According to Casale, the reasons for poor nutrition’s effects on child development, which have been suggested by previous research, are varied. She highlights how previous research suggested that a lack of nutrients may cause structural damage to the brain, particularly during the earliest stages of development. Other research suggested that poor nutrition may also affect social development in various ways.
There are environmental factors that may go hand in hand with poor nutrition, which means that while not all aspects of a child’s development can be put down to nutrition alone, stunting is a powerful indicator of many aspects of a child’s future. Poor nutrition may function as a litmus test of sorts within a larger social, economic and family environment.
This means as SA works towards giving its youth better prospects for employment and higher education access, the government must not lose sight of the process to get them there.
It will be helpful to dig deeper in future: where can caregivers, schools and communities be better supported? How can the allocation of child support grants be improved so that children benefit in a timely fashion? How can we offer support to stunted children to give them the best chance alongside their peers? How can we address stunting earlier so that we avoid bottlenecks in the schooling system?
With the school year beginning, a new generation of learners have embarked on their journey to matriculation and — hopefully — beyond. It is a time of hope and optimism, and data from NIDS can contribute to that.
Armed with reliable information, we can begin to look for solutions and ultimately build environments that nourish both our children’s bodies and their future prospects.
• Richmond is senior operations manager for the National Income Dynamics Study at the University of Cape Town.