Neural tube defects (NTD) are serious, life-threatening birth defects. Staple food fortification with folic acid (vitamin B9) is a proven, effective intervention to reduce NTD birth prevalence. Mandatory food fortification with folic acid was implemented in South Africa (SA) in 2003. This article provides an overview of NTD birth prevalence in SA, pre- and post-fortification, and evaluates current folic acid fortification regulations.

Fortification effectiveness data in SA were reviewed using published studies and national reports on NTD birth prevalence pre- and post-folic acid fortification. Current folic acid fortification regulations in SA were evaluated by experts.

Regulations were assessed using national health guidelines, legislation and regulations. NTD birth prevalence data were sourced from the published literature.

None.

Significant reductions in the birth prevalence of spina bifida and anencephaly and improved maternal folate levels have been achieved following the introduction of folic acid fortification in SA. However, there is poor overall regulatory compliance in some instances and a gap in current regulations that excludes the fortification of cake flour in SA.

While the SA NTD birth prevalence has decreased by 30% post-fortification, the regulatory exclusion of cake flour fortification is a significant and growing issue. Proposed 2016 regulatory amendments to address this gap urgently require finalisation and enactment by government to prevent negating benefits achieved to date and to ensure continued improvement. Fortification monitoring requires strengthening to ensure widespread compliance with policies, particularly in underserved areas.

To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance.

Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas.

Ghana and South Africa.

Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48).

Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination.

Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.

Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight into available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns.

This was an observational cross-sectional, mixed-method study.

Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n 3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers.

Majority (89 %) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores and were found in high-traffic areas, and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found.

The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socio-economic status (SES).

Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study.

North West Province, South Africa

Black and white adults (n 1153), aged 20–30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-h dietary recalls.

Among all participants, over 70 % failed to meet the estimated energy requirements and the estimated average requirements (EAR) for seventeen of the nineteen reported micronutrients. Across SES groups, more than 50 % of participants consistently did not meet the EAR for Ca, Mg, folate, pantothenic acid and biotin, as well as vitamins A, C, D and E. Participants’ distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in Mg, potassium, Ca, phosphorus and fibre. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, Zn and Fe nutrient pattern.

The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of CVD and hypertension.

This study aimed to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems.

This study used a cross-sectional design to assess household food acquisition and lived poverty index.

The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively.

An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study.

A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58·2 %) than Ghanaian households (41·8 %). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3·431 P < 0·001) and ultra-processed foods (OR 2·656 P < 0·001) compared with non-deprivation. In Ghana, no significant differences were observed between deprived households and non-deprived households in relation to the consumption of the NOVA food classes.

Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

To conduct a systematic review of the published peer-reviewed articles on the biochemical assessment of nutritional status of South African infants, children and adolescents in 1997–2022.

Online databases (Pubmed, CINAHL, EbscoHost and SAePublications) were used to identify thirty-nine papers.

South Africa, 1997–2022.

Infants, children and adolescents.

Vitamin A deficiency prevalence was 35–67 % before 2001 and mostly below 16 % after 2008. Anaemia ranged from 5·4 to 75·0 %, with 36–54 % of infants below 1 year being anaemic. Among 0- to 6-year-olds, iron deficiency (ID) was 7·2–39·4 % in rural and 16–41·9 % in urban areas. Zn deficiency remained high, especially among 0- to 6-year-olds, at 39–48 %. Iodine insufficiency (UIC < 100 µg/l) was between 0 and 28·8 %, with excessive levels in two areas. Vitamin D deficiency was 5 % for 11- to 17-year-olds in one urban study but 33–87 % in under 10-week-old infants. The 2005 national survey reported sufficient folate status among 0- to 6-year-olds, and vitamin B12 deficiency was 0–21 %. Low-grade inflammation was between 5 % and 42 % depending on the biomarker and cut-offs.

Vitamin A status may have improved meaningfully during the last 25 years in South Africa to below 16 %, and iodine and folate deficiency appears to be low particularly among 0- to 6-year-olds. However, confirmation is needed by a national survey. Anaemia, Fe and Zn deficiencies still pose severe problems, especially among 0- to 6-year-olds. Sufficient data on vitamin D and B12 status are lacking.