Stop nutritional stunting of young children

Grow Great

Grow Great partners with multiple stakeholders, including government departments, civil society and parents, to deliver a package of social and behaviour change interventions aimed at improving maternal and child health, nutrition and early childhood development practices in the first 1000 days of life.

Child and Youth Care Workers work closely with school learners to address issues like bullying, peer pressure, and other issues which contribute to drop out as part of the NACCW Isibindi Ezikoleni programme.

The disconnect

This explains why the project exists

Stunting is a (largely preventable) condition where young children are excessively short for their age and do not reach their full growth potential due to chronic nutritional deprivation, repeated infections and poor psychosocial stimulation. Stunting is associated with lifelong cognitive defects, educational and employment challenges, increased risk of chronic diseases in adulthood and cycles of intergenerational poverty.

Economic models suggest there is a sizeable economic penalty to not reducing stunting. It is estimated that stunting places a Gross Domestic Product (GDP) per capita penalty on African and South-Asian countries of approximately 9%. In other words, if the current South African workforce had not been stunted as children, South Africa’s GDP per capita would be approximately 9% higher.

The determinants of stunting are not limited to an absolute lack of food alone but perpetuated by both nutrition-sensitive and nutrition-specific factors, such as poor maternal health (pre & post pregnancy), poor breastfeeding and complementary feeding practices, poor hygiene and sanitation, gastrointestinal infections and/or worms, a lack of dietary diversity and the purchasing power of low-income households.

Although the burden of stunting attributable to the various risk factors is not clearly defined in our country, South Africa performs poorly on many of the known key drivers, suggesting that through a concerted multi-pronged approach there are some substantial wins to be made in this area with potentially high gains for South Africa’s children.

South Africa’s high levels of stunting have persisted for at least the last two decades. The prevalence of stunting among our children is worryingly high – as many as 27% of children (and 36% among the poorest wealth quintiles) under the age of five suffer from stunting. South Africa’s stunting burden is far higher than would be expected for an upper middle-income country and far higher than many of South Africa’s developing country counterparts.

The majority of South Africans are stuck in an inequality trap with wealth concentrated in the hands of a few. Most are stuck in intergenerational loops of exclusion with few chances to escape. Breaking this cycle requires a fundamental change in life trajectories, starting in the womb.

Think of a Möbius strip – just one twist in the circle allows you to trace a completely different pattern. Instead of being stuck on the inside of a loop, you emerge on the outside. In the same way, escaping the inequality trap requires a fundamental twist to set South Africa on a new path.

The twist in thinking

This explains how the project approaches problems

The time of greatest vulnerability to stunting is what is called the first 1 000 days of a child’s life. It’s a time when brain development is happening, so an opportunity to establish a foundation for children’s academic success, health and general well-being but also a time when the brain is most sensitive to poor nutrition and toxic stress.

How well or how poorly mothers and children are nourished and cared for during the first
1 000 days has a profound impact on a child’s ability to grow, learn and thrive. But sadly, in our context, the first 1 000 days are a time of great vulnerability for many of South Africa’s women and children.

Countries, like Ghana, Chile, Senegal, Peru and Brazil – with similar resource constraints to South Africa – have demonstrated that through evidence-based interventions targeting women of reproductive age and children under five, with an emphasis on the critical first
1 000 days of life, garnered high-level government prioritisation of stunting and drove community-level interventions grounded in high-quality data. The Grow Great Campaign seeks to achieve similar results in the South African context by:

Mobilising stakeholders through an advocacy strategy informed by quality evidence that encourages national action to achieve zero stunting.
Inspiring the public to shift behaviour and practice (of multiple stakeholders at multiple levels) around maternal and child health, nutrition and early childhood development.
Empowering practitioners and catalysing community health workers to be ‘Grow Great Champions’ that support parents and children by focusing on maternal and child health, nutrition and early childhood development.
Supporting parents and empowering women through a social franchise model that delivers universal access to structured quality antenatal and postnatal support outside of the clinical setting.

The trajectory change

This explains what the project is doing to make a difference

Over the last five years, Grow Great has successfully run various mass media advocacy campaigns to increase public awareness of the injustice of stunting, changing behaviour around the drivers of stunting at a household level and encouraging the public to hold their leaders accountable.

Through the Grow Great flagship programmes – Flourish and Grow Great Champions – we have been successful in driving public discourse around stunting and moving closer to the overall goal of driving national action to end stunting and support early childhood development in the first 1 000 days.

Flourish was launched in June 2018, informed by the work done in the six-month period prior, which included consultation with experts in early childhood development, a landscape analysis of antenatal and postnatal programs in South Africa and other developing countries. To date, Flourish has reached over 20 000 moms through in-person and virtual classes across the country, and trained and licensed over 250 franchisees.

The Grow Great Champions was launched in mid-2018 and currently over 2 000 community health workers across four provinces (Limpopo, Mpumalanga, Gauteng, and the Western Cape) have collectively growth monitored over 116 000 children under the age of two years and provided support to over 54 000 pregnant women to date. A retrospective chart review found that community health worker visits positively impacted low birth weight and early access to child support grants when compared to District Health Survey (DHS) prevalence.

What is very exciting to see is the trend over time and positive changes in the nutritional status of children visited by Grow Great Champions-trained health workers. When compared to provincial averages, children visited by these workers appear to be growing better than their provincial counterparts.

Recognising the need for quality baseline data on stunting and its drivers in the South African context, Grow Great has led a number of research-based activities. This has resulted in the accumulation of diverse data to inform and mobilise local communities, district health departments and national policymakers towards a stunting-free future. These activities have leveraged partnerships with the government, academia, civil society and private research institutions.

Visit the Grow Great website to learn more: https://www.growgreat.co.za

Trying to change life trajectories is ambitious and profound. It requires us to radically influence the lives of individuals and to be part of changing the circumstances in which they live.