“Nearly 7,500 children under the age of five die annually in South Africa as a direct result of hunger,” says an article published by the South African news site Daily Maverick in September 2020. 

Dr Tracy Ledger is quoted as saying that “this is not because of the long-term effects of malnutrition on the immune system, [these children] literally starve to death”. Ledger is a researcher at the Public Affairs Research Institute in Johannesburg, which studies the effectiveness of state institutions and service delivery.

Child malnutrition continues to be a serious problem in South Africa. The United Nations Children’s Fund (Unicef) estimates that more than a third of the country’s children under five suffer from under-nutrition or are overweight.

But do 7,500 children starve to death every year? We investigated this statistic. 

Claim traced to late Prof David Sanders

Ledger wrote a book about South Africa’s hunger crisis titled An Empty Plate, published 2017. She told Africa Check that she arrived at the number quoted by the Daily Maverick after consulting with paediatrician and nutrition expert Prof David Sanders from the University of the Western Cape’s School of Public Health.

“He said [official estimates] are complete nonsense because many more children die in South Africa outside of hospital than inside of hospital,” she explained.

Ledger said Sanders estimated that the actual number of children under the age of five who die annually as a direct result of hunger was between 5,000 and 7,500. 

Sadly, Prof Sanders died in 2019. We have been unable to find any research in which he cites this estimate or how it was calculated. We contacted the University of the Western Cape’s School of Public Health to enquire about research of this kind but received no response. 

Terms hunger and malnutrition not interchangeable

“Hunger is not a bad proxy for the term ‘lack of food’, which in most cases leads to malnutrition,” David Harrison, one of the founders of the Health Systems Trust and now chief executive of the DG Murray Trust, previously told Africa Check.

The Health Systems Trust publishes an annual District Health Barometer which contains information on health services in the country. The data is sourced from the Department of Health’s District Health Information System.

But there is a difference between hunger and malnutrition, Dr Nokukhanya Khanyile, paediatric registrar from Wits University in Johannesburg, told Africa Check.

“Hunger is the feeling that you get when you haven’t had enough energy for a short amount of time. Malnutrition occurs when even if you are eating every day you are not getting the right balance of nutrients to support growth.” 

Khanyile said children need particular nutrients for brain and body development. 

She said that parents may not be aware that their child is malnourished, either because they do not know what children need to eat or because they are unable to afford the necessary food. 

806 deaths recorded in 2018/19

According to the World Health Organization, malnutrition includes “undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight and obesity”.

Unicef describes severe acute malnutrition as “the most extreme and visible form of undernutrition”. A child is considered to have this condition if their mid-upper arm circumference is less than 11.5 centimetres or their weight is statistically too low for their height. Swelling of the body, or oedema, is also an indicator. 

The Health Systems Trust’s latest report showed that 11,280 children under the age of five were admitted to public hospitals and clinics with severe acute malnutrition in South Africa in 2018/19. Of the children that were admitted, 806 died. 

This is a decrease from previous years. In 2016/17, 1,188 deaths from severe acute malnutrition were recorded, compared to 817 deaths in 2017/18.

The latest data from Statistics South Africa, based on the official cause of deaths recorded on death certificates, shows that 828 children under five died from malnutrition in 2017.

Deaths from malnutrition likely higher

Experts agreed that the number of deaths due to malnutrition is likely higher than official records. 

Prof Rina Swart, a registered dietician from the University of the Western Cape, told Africa Check that an immediate cause of death, such as tuberculosis, is usually documented on a death certificate. 

“Underlying causes would not be added to the death certificate, even if they were present. [This leads to] an underreporting of nutrition related deaths.”

Khanyile told Africa Check that the 7,500 figure sounds “plausible”. But she added that because of the way deaths are recorded, it’s not possible to say what the actual number is.

Conclusion: No evidence shows 7,500 children die from hunger

An article in the Daily Maverick reported that “nearly 7,500 children under the age of five die annually in South Africa as a direct result of hunger”. Dr Tracy Ledger was quoted as saying these children “literally starve to death”. 

The latest official statistics are significantly lower. In 2018/19, some 806 children were reported to have died in public hospitals and clinics in South Africa from severe acute malnutrition. 

Experts say this is undoubtedly an undercount, as some children die outside health facilities or their deaths are misclassified. However we could find no evidence or research that put the true number of deaths at almost ten times higher than the official statistics. We therefore rate the claim as unproven. 

Researched by Naledi Mashishi, Africa Check, a non-partisan fact-checking organisation. View the original piece on their website