An assessment of the nutrient content of meals provided and facilities present at state-funded crèches in Cape Town

Abstract

Background: A large proportion of resources allocated to the Community-Based Nutrition Programme (CBNP) of the Department of Health in the Western Cape is spent on crèche-feeding schemes. To date, little evaluation of the CBNP has been undertaken. Aim: A cross-sectional study was conducted to assess the nutritional adequacy of meals provided, and facilities available, at state-funded crèches in the Cape Metropole. Methods: A questionnaire was administered to managers of 43 conveniently sampled crèches in two districts of Cape Town. Twenty-two of the crèches were randomly selected for nutrient assessment of a duplicate meal, and a typical meal sample was weighed and analysed for this purpose. Anthropometric measurements for a random sample of 10% of the children (N = 275) attending these 22 crèches were obtained. Results: Only one crèche did not have food preparation and storage facilities (due to theft). Toilet facilities were inadequate at some crèches. The ratio of children to toilets was 23.7 (± 16.6):1, ranging from 6.5:1 to 91:1. None of the meals provided met one-third of the age-related Recommended Dietary Allowance (RDA) for energy, calcium, iron or phosphorus. With regard to protein, 86.4% of the meals sampled did meet one-third of the RDA for 1 - 3-year-olds and 68.2% for 4 - 6-year-olds. At crèches where the meals provided ≥ 15% of the RDA for energy for 4 - 6- year-olds, it was reported that a mean of R1.18 (± R0.48)/child/day was spent on food, compared with a mean of R0.89 (± R0.20) /child/day in crèches at which the meals provided < 15% of the RDA for energy (P = 0.14). According to the World Health Organisation classification of moderate undernutrition, in the age group ≤ 60 months (N = 170) there was found to be a low prevalence of stunting (7%), a moderate prevalence of underweight (16%) and a very high prevalence of wasting (11.8%). In children older than 60 months (N = 105) there was found to be a low prevalence of stunting (12.4%), underweight (8.7%) and wasting (2.9%). Conclusion: The nutritional content of meals provided at state-funded crèches in two areas of the Western Cape is largely inadequate, and is positively associated with the amount of daily spending per meal. These findings suggest that more attention should be directed towards improved training of crèche staff with regard to menu planning and food budgeting.