The CEO Notes

Massive and complicated: The SA National Health and Nutrition Survey (SANHANES)

In 2008, former KwaZulu-Natal premier, Dr Zweli Mkhize, and the then-chair of the Board of Development Bank of Southern Africa, Jay Naidoo, organised a health stakeholder’s group to initiate a process to turn around the South African healthcare system in preparation for the new administration that would take office in 2009. There were robust debates from public and private sector participants about how to reverse the downward trend of the healthcare system. This process was finalised in December 2008, and it was agreed to recommend 10 priority actions to President Jacob Zuma’s administration to consider for implementation. Two successive ministers, Barbara Hogan and Dr Aaron Motsoaledi, embraced the ten-point plan and initiated improvements in the healthcare system. One of the key objectives was to strengthen research and development by introducing a health and nutrition examination survey to track the health of the population.

Mammoth undertaking
The HSRC, represented by four principal investigators – myself, Dr Olive Shisana and Professors Demetré Labadarios, Thomas Rehle and Leickness Simbayi – planned the study. We invited scientists from the Medical Research Council to join us in the undertaking.

This was going to be an expensive exercise and required multidisciplinary teams of researchers to conduct a bio-psycho-social survey. We expected challenges, since the infrastructure was limited for undertaking such a survey that included physical examinations, laboratory tests and administering questionnaires. It was in this light that the HSRC, with the support of Minister Motsoaledi, reached out to the US Centers for Disease Control which sent Dr Clifford Johnson, the director of the US National Health and Nutrition Examination Survey (NHANES), to advise us. This move proved to be critical in strengthening our resolve to undertake this massive survey.

Tried-and-tested approach
Taking a well-proven scientific approach and applying it in a new setting to answer emerging social and public health problems often results in benefits for the country that were not previously imagined. This was the case when we decided to review the experience of the USA in implementing the NHANES, which has been running for the last 50 years.

Using a well-proven concept to address the emerging non-communicable diseases and the concomitant risk factors arising from a changing population lifestyle and diet that mimic those of industrialised countries was crucial to the success of undertaking the South African version of NHANES, i.e. SANHANES.

With the financial support of the South African Department of Health and the UK’s Department for International Development (DFID), we successfully undertook this mammoth study. Most South Africans opened their houses to our researchers and with the help of many scientists, medical doctors, nurses, nursing assistants and nutritionists we successfully interviewed 25 532 individuals in their homes, physically examined 12 025 individuals and obtained blood samples from 8 078 individuals for analysis to estimate the prevalence of specific diseases, assess health and nutritional status of the population and understand the risk factors of the population.

The study was able to assist the country to evaluate the:

  • Health status of South Africans with respect to the prevalence of non-communicable diseases (specifically cardiovascular disease, diabetes and hypertension) and their risk factors (diet, physical activity and tobacco use).
  • Knowledge, attitudes and behaviour of South Africans with respect to non-communicable and communicable infectious diseases.
  • Nutritional status of South Africans as an outcome of food security, dietary intake/behaviour including the consumption of alcohol and body weight management.
  • South Africans’ general perceptions of health and healthcare services.
  • Health status of children under the age of five years with respect to early childhood development, care of illness, immunisation and the use of the Road to Health Booklet.
  • Health status of children between 2-9 years with respect to physical and/or mental disabilities.

The study results were presented to the minister of health, members of executive councils responsible for health, and to senior staff in the Department of Health nationally.

It was gratifying to see that the study recommendation immediately informed policy; the Department of Health invited research staff
to contribute specifically to food security and nutrition policy. We expect the data to be used to set standards in the areas of nutrition, weight, height, body mass index and a range of important biomarkers, such as glycosylated haemoglobin (HBA1C), cholesterol, vitamin A, iron and cotinine, and also to inform the development of interventions
to reduce risk factor for non-communicable diseases.

In this HSRC Review we represent three survey topics included in the survey (pages 4 to 13), with others scheduled to follow in forthcoming editions.

Dr Olive Shisana