Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

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.

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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