The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100 g/day in adolescents. This represents roughly 5-10% of dietary energy, but could be as much as 20% in many individuals. This paper briefly reviews current knowledge on the relationship between sugar intake and health. There is strong evidence that sugar makes a major contribution to the development of dental caries. The intake of sugar displaces foods that are rich in micronutrients. Therefore, diets that are rich in sugar may be poorer in micronutrients. Over the past decade, a considerable body of solid evidence has appeared, particularly from large prospective studies, that strongly indicates that dietary sugar increases the risk of the development of obesity and type 2 diabetes, and probably cardiovascular disease too. These findings point to an especially strong causal relationship for the consumption of sugar-sweetened beverages (SSBs). The authors propose that an intake of added sugar of 10% of dietary energy is an acceptable upper limit. However, an intake of < 6% energy is preferable, especially in those at risk of the harmful effects of sugar, e.g. people who are overweight, have prediabetes, or who do not habitually consume fluoride (from drinking fluoridated water or using fluoridated toothpaste). This translates to a maximum intake of one serving (approximately 355 ml) of SSBs per day, if no other foods with added sugar are eaten. Beverages with added sugar should not be given to infants or to young children, especially in a feeding bottle. The current food-based dietary guideline is: “Use foods and drinks containing sugar sparingly, and not between meals”. This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate dietary advice.
Poverty and health
This report is a call to action for the world to rediscover the importance of breastfeeding and for a commitment to support mothers to breastfeed their babies, especially in the poorest communities in the poorest countries. It calls for world leaders, international institutions and multinational companies to take action to ensure that every infant is given the life-saving protection that breastfeeding can offer. All countries should put breastfeeding at the centre of efforts to improve infant and child nutrition, and should develop specific breastfeeding strategies as well as including breastfeeding in their nutrition strategies. Developing countries should ensure that they address all of the obstacles identified in this report that deter optimal breastfeeding practices. The four major barriers are community and cultural pressures, the health worker shortage, a lack of maternity legislation and the promotion of formula by big business.
In the context of rapid urbanisation in Democratic Republic of Congo, increasing population density in Kinshasa is associated with inequalities, poverty, environmental degradation, socio-economic tension, spontaneous settlements and sprawl. Rapid urban growth without planning in some areas and with limited employment underlies negative health outcomes. The author points to sustainable urbanisation as a priority, with a need to reconsider urbanisation processes to stimulate economic growth and mobilise resources at local, national and global levels. In this paper, the author reviews approaches to urban planning that balance development and the transformation of the city. He presents urban renewal as remedial action holding opportunities to improve environmental and social quality.
Though global progress in sanitation has been poor, some low income countries have achieved a reduction of up to 60% in the proportion of people without improved sanitation. This article argues that it is likely that this progress was not simply due to installing infrastructure, but also due to political support, modest financing cleverly applied and a focus on changing behaviour and social norms. Building demand for toilets, especially among those people who have practiced open defecation all their lives, helps trigger household investments. Evidence that these approaches are effective suggests that accelerated progress is possible. Barriers in providing drinking-water can also be overcome using innovations like low-cost drilling techniques and cheaper hand pumps, the use of locally-managed, small-scale systems and civil society intermediation between poor communities and service providers. Providing water, sanitation and hygiene in schools is increasingly a priority for ministries of education in developing countries. Emerging designs for toilets that incorporate privacy and facilities for menstrual hygiene provide a multitude of benefits. Water, sanitation and hygiene also enable women to play roles in their community’s development, including decision-making and management of water and sanitation systems.
This chapter analyses the alternative approaches to targeting the poor that have been used in healthcare delivery and draws together evidence from a range of countries about their effectiveness. The authors emphasise the importance of programme design and implementation issues and argue that successful programmes will need to identify these issues and devote adequate resources to overcoming them. The authors propose a conceptual framework for understanding the key elements of targeting policies.
A number of studies have looked at who benefits from public sector funding of health services. Different conclusions are drawn about the best way to reach the very poor, depending on the health system in question, the broader social, economic and political context, and the conceptual and ideological approaches underpinning the studies. A key area of debate concerns the respective benefits of non-targeted strategies, such as provision of universal free health care services, versus specific, targeted strategies for reaching the very poor.
This paper seeks to describe obesity trends among women of childbearing age over recent decades, along with trends in over and under nutrition among children under five years of age, in sub-Saharan African countries. An ecological study with temporal trend analysis in 13 sub-Saharan African countries was carried out covering trends in nutritional status such as adult obesity, childhood overweight, low height-for-age, low weight-for-height, low weight-for-age and low birth weight. Publicly available data from repeated cross-sectional national surveys were used. The authors chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. The authors investigated women aged 15-49 years and children under five years of age. In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings. The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider both nutritional deficiencies and nutritional excess.
This article analyses the effectiveness of the investment that the Rockefeller Foundation and the Bill & Melinda Gates Foundation recently announced - a joint ‘Alliance for a Green Revolution in Africa’ (AGRA). The authors argue that, based on the first Green Revolution experience, this initiative will not succeed because: 1. The Green Revolution actually deepens the divide between rich and poor farmers; 2. Over time, Green Revolution technologies degrade tropical agro-ecosystems and increase environmental risk; 3. The Green Revolution leads to the loss of agro-biodiversity; 4. Hunger is not primarily due to a lack of food, but rather because the hungry are too poor to buy the food that is available; 5. Without addressing structural inequities in the market and political systems, approaches relying on high input technologies fail; 6. The private sector alone will not solve the problems; 7. Genetic engineering (GE) will make Sub-Saharan smallholder systems more environmentally vulnerable; 8. GE crops into smallholder agriculture will likely lead to farmer indebtedness; 9. The assertion that “There Is No Alternative” (TINA) ignores the many successful agro-ecological and non-corporate approaches to agricultural development; 10. AGRA’s “alliance” does not allow peasant farmers to be the principal actors in agricultural improvement. The authors conclude that if the Gates and Rockefeller Foundations want to end hunger and poverty in rural Africa, then they should invest in the service of the struggle by peasant and farmer organisations and their allies to truly achieve food sovereignty.
In this study, a cohort of 100 HIV-unexposed, 203 HIV-exposed (HIV negative children born to HIV-infected mothers) and 48 HIV-infected children aged six weeks to one year were recruited from an area of high malaria transmission intensity in rural Uganda and followed until the age of 2.5 years. All children were provided with insecticide-treated bed nets at enrolment and daily trimethoprim-sulphamethoxazole prophylaxis (TS) was prescribed for HIV-exposed breastfeeding and HIV-infected children. Monthly routine assessments, including measurement of height and weight, were conducted at the study clinic. The researchers found overall incidence of malaria was 3.64 cases per person year. Mild stunting and moderate-severe stunting were associated with a similarly increased incidence of malaria compared to non-stunted children. Being mildly underweight and moderate-severe underweight were not associated with a significant difference in the incidence of malaria compared to children who were not underweight. There were no significant interactions between HIV-infected, HIV-exposed children taking TS and the associations between malnutrition and the incidence of malaria. The researchers point out, in conclusion, that they were unable to disentangle the relationship between malnutrition and the incidence of malaria, and their findings do not necessarily indicate any causal connections between malaria and malnutrition.
According to this article, the absence of a threshold in the association between maternal education and child survival suggests that the obvious causal pathway - increased understanding of disease causation, prevention, and cure - might only be part of the explanation. This has led to investigations of many possible behavioural links, including better domestic hygiene, more intense mother-child interactions, and greater maternal decision-making power among mothers who are more educated than among those who are less educated. However, the use of child health services offers the strongest empirical support. Exposure to primary schooling increases a mother's propensity to seek modern preventive or curative services for her children. Schooling seems to engender in adults an increased identification with health institutions, and the confidence and skills to access services and comply with advice. It is likely that the symbiotic effect of schooling and health-service use indicates that improvements in the education of women of reproductive age might account for half of the reduction in mortality in children aged under five years. This contribution is far greater than increased income, a finding that is consistent with previous studies. Income and educational increases are only slightly correlated. Analyses of states that achieved high life-expectancies despite low-income levels (eg: China, Costa Rica, Kerala, and Sri Lanka) revealed a common characteristic: sustained political commitment to equitable access to primary schooling and health care for both sexes.