Malnutrition is one of the world’s most pressing issues. Around the world, it is the leading contributor to disease. In Europe, it is estimated that around 33 million citizens are affected by the condition – and that’s without taking children into account. What’s more, the financial impact on the European healthcare system was believed to be at around 170 billion Euros – and that was back in 2014 according to the Report on the First Optimal Nutritional Care for All Conference (ONCA) https//european-nutrition.org
This points to the need for optimal nutritional care; an issue exacerbated by the insight that, although there is a great concern about obesity, patients on the other end of the scale are frequently overlooked (1).
Malnutrition has its genesis in a number of factors, from climate issues to conflict and violence, from socio-economic challenges to poor education and sanitation, and inferior access to food (2). Another key concern is disease related malnutrition, caused not only by hospital diets lacking in essential nutrients, but also from changes to the metabolism brought about by biological changes.
Hence the concern around Optimal Nutritional Care for All (ONCA); a movement which aims to ensure through screening of patients, followed by education and follow-up around the provision of guidelines to ensure optimal care, which aims to eradicate malnutrition.
The initiative was kick started by a multi-disciplinary group of stakeholders in Europe, who have come together to ensure that every citizen who is at risk of malnutrition, or who currently suffers from the condition, is both screened systematically, and then ensured access to equitable, high quality nutritional care (raps.org).
There are a number of steps to be fulfilled around this overarching objective, ranging from the establishment of a national alliance which will lead the development of a nutritional plan with a special emphasis on screening. At the same time, all stakeholders have pledged to raise public awareness around the issue. A sound definition of malnutrition, training for all medical care workers and the establishment of platforms to help draw on other organisations which may help promote the issue (such as PR firms) are other goals to work towards.
Ultimately, the concept of ONCA rests on ensuring that a measure of protection is provided to all against the ravaging effects of malnutrition.
Although the principles of ONCA are rooted in a European model, South Africa would do well to adapt a similar practice. Malnutrition is a pressing issue here: According to one study, which studied the extent of malnutrition amongst public sector hospital patients by measuring middle upper arm Circumference (MUAC), BMI and a Malnutrition Universal screening tool the overall risk of malnutrition stood at 72.3%, while 45.4% were judged to be malnourished (3). Further studies have shown that, in South Africa, malnutrition exists at both sides of the spectrum, with a large portion of the population classified as obese while others are malnourished.
Of course, our context presents a number of unique challenges. Particular areas of weakness, according to an article in the Daily Maverick by Peter Jacobs and Admire Nyamwanza, include a lack of coordination at policy development level (evidenced in, for example, the fact that food security is considered a priority, yet there are no interventions like regular food price monitoring).
Policy implementation is also problematic; for instance, the 2017 National Food and Nutrition Security (Implementation) Plan made provision for various bodies and councils intended to address the issue, but there has been little progress in this regard. The country does not have an official measure of food and nutrition security; another stumbling block when it comes to ensuring nutrition for all South African citizens.
Actions that may help include the introduction of an overarching food and nutritional security law; the promotion of nutritional knowledge; inviting input from a variety of stakeholders in various forms that include diverse knowledge; and the implementation of data collection which would make for more targeted interventions.
Full References available on request
1. Endevelt R, Kachal, J, Zinger P, Dogev R, Goldsmith R, Grotto I).
2. Cardenas D, Charles Bermudez, Echevarri S
3 Van Tonder, E, Gardner, L, Cressey, S, Tydeman-Edwards, R and Gerber, K