SA's malnutrition ‘tragedy' — death of 155 children this year alone sparks calls for urgent state action

Daily Maverick

20-05-2025

Experts, however, say this number is not the full picture and they too are calling for a shift in strategy to avoid the tragedy of stunting and moderate and severe acute malnutrition.
Health Minister Aaron Motsoaledi has revealed that since January 2025, 155 children under the age of five have died in South African public health facilities, with moderate or severe acute malnutrition as an underlying condition.
This emerged in an answer to a written parliamentary question by the DA.
DA MPs Michele Clarke and Bridget Masango issued a statement on Sunday calling for multidisciplinary action.
'The DA is devastated to learn that 155 children across our country under age five have died in public health facilities with moderate or severe acute malnutrition as an underlying condition since January 2025. The majority of children affected were in Limpopo (32), Gauteng (30) and KwaZulu-Natal (29),' they said.
'The DA believes that the solution is a cross-cutting intervention, because both the departments of Health and Social Development must work together to address this.'
The DG Murray Trust, which has done extensive work to advocate for and help create food security for children, told Daily Maverick that South Africa has to increase national accountability for child nutrition.
'Countries that have successfully reduced stunting have one thing in common: they track child growth rigorously. South Africa needs to shift from crisis response to prevention. That means measuring, reporting and acting on early signs of child growth falling behind the curve at community level,' the nonprofit's chief executive, David Harrison, said.
Severe acute malnutrition in children younger than five has risen by 26% over the past five years, despite a number of programmes in the Health and Social Development departments.
Explaining why so many South African children are still dying from moderate to severe acute malnutrition, Harrison said: 'In the main, children who get moderate or severe malnutrition have no access to social safety nets.'
Safety nets such as the Child Support Grant did not reach children owing to administrative failures or problems with documentation. 'There are about 2.2 million children who are eligible for the grant but don't get it.'
Regarding the children of foreign citizens who are not entitled to the grant, 'we know from hospital studies that they present sicker and die more from severe acute malnutrition than South African children'.
There were also cases of extreme neglect, often when the caregiver had a drug or alcohol dependency problem, but extreme poverty and exclusion from social support were the primary reasons children presented with moderate or severe malnutrition.
The DA emphasises that this is a serious and growing tragedy across South Africa, correlating with a legacy of increasing unemployment and rising cost of living.
The party demands that the Department of Social Development ensure that mothers, fathers and carers receiving the Child Care Grant are thoroughly informed about the best and most nutritious foods the grant should buy every month.
'This is not a passive obligation, but one that the Social Development Department and [the South African Social Security Agency] must do actively for all mothers, fathers and carers who struggle to nourish their children in trying economic circumstances,' it says.
'The Department of Health must address childhood malnutrition deaths with vastly enhanced public information campaigns on the signs of malnutrition and clear direction on seeking treatment, before it is too late. This must be stopped with greatly improved public information campaigns that reach millions of mothers and carers.'
Drop in numbers
Lori Lake, an education and communications specialist at the Children's Institute, said data dating to 2013 shows that child deaths from malnutrition have decreased in South Africa – 'from the high of 2000 in 2014 to 574 in 2024'.
'And you would think on the surface of things that that is a good-news story. Yet more than 50% of all child deaths occur outside healthcare facilities and the chances are that those children who died without being able to access healthcare are as likely, if not more likely, to have been experiencing severe acute malnutrition than those dying in facilities. So what we are seeing in the data is really just the tip of the iceberg,' she added.
The prevalence of wasting in South Africa is estimated at 5%, which means about one in every 20 children are wasted.
'Wasting is an acute form of malnutrition that indicates either recent or severe weight loss and is often caused by inadequate food intake or frequent and or prolonged illness,' Lake said.
Stunting not only compromised physical growth, but also brain development, in ways that had a lifelong impact on children's health and educational outcomes.
Lake stressed that severe acute nutrition is just one of many nutritional challenges affecting South African children.
'The third area of concern that I'm particularly worried about is the very rapid increase that we have seen in overweight and obesity in children under five, which increased from 13% in 2016 to 23% in 2022 – almost doubling in less than 10 years – and that's a very frightening trend for anybody who is concerned not just about child health but the growing burden of noncommunicable diseases in South Africa.'
Statistics showed that 40% of children were living in households below the food poverty line which cannot afford to meet the basic nutritional needs of the children in their care, while 38% of poor infants (under one year) were not receiving the Child Support Grant.
Solutions
To boost the fight against severe acute malnutrition, Harrison suggested that the first strategy must be to make a basket of basic, protein-rich staples a lot more affordable.
'Most children are getting pap or rice, but what's lacking from their diets are proteins and micronutrients, which are essential for growth. This strategy is most important because of the 2.5 million children who are at risk but have no social safety net.'
Then, close the gap between the buying power of the Child Support Grant (R560) and the food poverty line (R796 in 2024). The grant only covered 70% of the basic food requirement, and very poor families had no other way to plug the gap.
'Improve maternal nutrition. Babies born with low birthweight are three times more likely to be stunted later. Providing food or cash to pregnant women who are underweight, especially through antenatal services, could break the cycle of malnutrition before it begins. Global studies show that balanced protein-energy supplements during pregnancy significantly reduce low birthweight and improve breastfeeding outcomes,' Harrison said.
Echoing this, Lake said this is why civil society organisations and academic research units such as the Children's Institute have been calling on the government to restore the value of the Child Support Grant to the food poverty line, 'so that we provide young children and families with resources they need to not only survive but thrive and reach their full potential'.
In addition, Harrison said, for just R40-million, South Africa's 60,000 community health workers could be given a basic mechanical scale and training to identify children who are starting to fall behind their growth curves. 'This is one of the most cost-effective ways to catch and treat malnutrition early.'
Another solution would be to encourage local food production and supply and increase national accountability for child nutrition.
'There are now many examples of local schools, clinics and community organisations growing food and selling to or sharing it with children in home-visiting programmes and ECD centres. We need to keep growing these initiatives.'
The DA is also calling for a shift in strategy in the relevant departments.
'With more than a quarter (28.8%) of South Africa's children under five being stunted and the number of children still succumbing because of limited access to nutritious food, it is clear that the departments of Health and Social Development must review and strengthen the effectiveness of interventions,' the party said.