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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019
AFRICA
149
has demonstrated a significant association of gender (male) and
educational level (pre-school) with childhood underweight.
Strength and limitations
This study has both strengths and limitations. Among the
strengths, standardised techniques were used, which included
anthropometric and blood pressure measurements and the
WHO STEPS questionnaire. Another includes the availability of
data concerning various potential confounders.
The authors could not adjust maturation status in the
analysis as a possible confounder for hormonal changes with
undernutrition in boys, as reported previously.
33
The study
population comprised participants from the Ellisras rural
population. This limits the external validity of the study in that
results cannot be generalised to the total Limpopo Province
population. The results, therefore may not be generalisable to the
greater community outside this group. Due to the fact that this
was a secondary data analysis, there was no control over what
data were collected, or how they were collected or managed.
The study was cross-sectional, preventing the assertion of a
causal association of demographic, socio-economic and cardio-
metabolic risk factors with underweight.
Conclusion
Our results have shown a high prevalence of childhood
underweight in a rural sample of young black South Africans,
indicating a village-level burden. A CHAID decision tree
identified different interactions between predictor variables
of childhood underweight. Mild undernutrition in a male
child aged 11 to 16 years, normal nutrition in a pre-school
child aged between eight and 10 years, and moderate or
severe undernutrition in a child aged five to 10 years were
highly associated with childhood underweight. However being
hypertensive was not associated with childhood underweight,
suggesting that hypertension may not be clinically relevant in
young black South Africans for the prediction of childhood
underweight. Further research is needed to explore the risk of
blood pressure on underweight adults.
The authors thank Vrije University, Amsterdam, the Netherlands, the
University of Limpopo, South Africa, and the National Research Foundation
for the financial support received. We are indebted to the Ellisras Longitudinal
Study administrators Thomas Makata, Simon Seleka, William Makata and
Jan Mabote for coding the data.
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