Understanding severe acute malnutrition in South Africa: a silent crisis
In the past two years, over 1,000 children in South Africa have tragically lost their lives due to severe acute malnutrition. This heartbreaking reality is not just a statistic – it represents the lives of young children who never got the chance to grow up, play, or dream.
For many South Africans, this crisis hits close to home, whether in our communities or through stories shared by loved ones.
Malnutrition doesn't always look like a bloated belly or frail body — it can be hidden in a lack of access to nutritious food, healthcare and the support children need to thrive.
Severe Acute Malnutrition (SAM) is a silent crisis affecting millions of children worldwide. In South Africa alone, alarming data from the Department of Health reveals that more than 1,000 children have died from SAM over the past two years.
This health emergency underscores the urgent need for intervention to save vulnerable children, particularly in provinces like KwaZulu-Natal, Limpopo, the Eastern Cape, and Gauteng, where malnutrition-related deaths are most prevalent.
But what exactly is severe acute malnutrition, how does it occur and what can be done to address it?
What does severe acute malnutrition look like?
Severe acute malnutrition is a life-threatening condition that occurs when a child’s body does not get the nutrients it needs to grow and function properly.
This condition is most common in children under the age of five, the age group most vulnerable to the effects of malnutrition.
Children suffering from SAM often exhibit the following symptoms:
Visible thinness (wasting): Their arms and legs may appear stick-thin, with little to no muscle or fat.
Swollen belly (oedema): Some children may experience swelling in their feet, face, or abdomen due to fluid retention.
Severe lethargy: A malnourished child may appear extremely weak or uninterested in their surroundings.
Loose, sagging skin: This is due to the loss of subcutaneous fat and muscle.
Changes in hair and skin: Hair may become brittle, discoloured, or fall out, and the skin may flake or develop sores.
These physical signs are coupled with a weakened immune system, leaving children highly susceptible to infections like pneumonia and diarrhoea, which are the leading causes of death in malnourished children.
How does severe acute malnutrition happen?
Severe acute malnutrition is caused by a combination of factors, many of which are preventable.
Poverty and food insecurity: Families with limited financial resources may struggle to provide their children with a balanced diet, leading to prolonged nutrient deficiencies.
Diseases: Illnesses like diarrhoea, measles and HIV/AIDS can deplete a child’s body of essential nutrients, exacerbating malnutrition.
Poor infant feeding practices: A lack of breastfeeding, delayed introduction of solid foods, or reliance on nutrient-poor diets can all lead to malnutrition in infants and toddlers.
Limited access to healthcare: Inadequate healthcare infrastructure makes it difficult to identify and treat malnutrition early, especially in rural or underserved communities.
According to TimesLIVE, Minister of Health Dr Aaron Motsoaledi emphasised that SAM often underlies other causes of death in children, such as diarrhoea and pneumonia.
This interconnectedness means tackling SAM is critical to reducing overall child mortality rates.
Addressing SAM: solutions and interventions
While the statistics are sobering, severe acute malnutrition is both preventable and treatable. Here are some actionable strategies to improve outcomes for affected children:
Early detection and treatment
Community-based programs that screen for malnutrition can identify at-risk children before their condition worsens. Once diagnosed, SAM can be treated with therapeutic foods, such as Ready-to-Use Therapeutic Foods (RUTF), which are nutrient-dense and easy to administer.
Promote exclusive breastfeeding
The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life. Breast milk provides all the nutrients a baby needs and strengthens their immune system, reducing the risk of malnutrition and disease.
Strengthen community outreach
As DA spokesperson Michele Clarke suggested, strengthening links between the Department of Health and community outreach programs is crucial.
These programs can educate caregivers on proper nutrition, hygiene, feeding practices and support for struggling families.
Nutrition education
Educating parents and caregivers about the importance of a balanced diet can help prevent malnutrition. Simple strategies, like incorporating locally available nutrient-rich foods into meals, can make a big difference.
The way forward
Reducing child deaths from severe acute malnutrition requires a collective, multi-sectoral approach.
Government departments, non-profit organisations, healthcare workers and communities must work together to address the systemic issues that contribute to malnutrition.
Minister Motsoaledi’s call for routine data collection through the District Health Information System (DHIS) highlights the importance of monitoring and accountability in addressing this crisis.
Globally, organisations like UNICEF and WHO have demonstrated that targeted interventions can save lives.
For example, UNICEF’s community-based management of acute malnutrition (CMAM) program has shown remarkable success in reducing child mortality rates in countries with high burdens of malnutrition.
Addressing malnutrition is not just a moral imperative — it is a necessary step toward building a healthier, more equitable society.
As Clarke aptly stated: “Urgent intervention is needed.”
The time to act is now.