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NEWS AND VIEWS: The possible impact of inflation on nutritionally

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Article  in  Nutrition Bulletin · August 2010

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NE W S A N D VI E W S

The possible impact of inflation on

nutritionally vulnerable households in a
developing country using South Africa as a
case study
H. C. Schönfeldt*, N. Gibson* and H. Vermeulen†
*School of Agricultural and Food Sciences, University of Pretoria, Pretoria, South Africa;
†
Department of Agricultural Economics, Extension and Rural Development, University of Pretoria & BFAP, Pretoria, South Africa

Summary Food is a basic human physiological need that is important for survival, growth,
health and general well-being. Without an adequate supply of food, a human being
can neither grow or develop optimally, nor utilize energy for sustained livelihood,
thereby implying food insecurity. South Africa (SA) is classified as a developing
country, with developing countries representing a third of the worlds population.
Unfortunately, as is often the case in developing countries, limited up-to-date
surveys and consumption data are available. In fact, SA has only ever had one
National Food Consumption Survey (NFCS) in 1999, in preparation for the intro-
duction of a food fortification programme. Having said that, however, the available
information still sketches the severity of the situation within emergent economies. It
is recognised that modern rates of food inflation are a worldwide phenomenon and
it is argued that SA as a case study presents a much wider insight than just an
individual country. About 35% of the South African population is food insecure
and categorized as being poor. With the current continual increase in food prices,
especially staple food prices, most households need to employ food coping strategies
(FCS) to survive. Some of these FCS have a significant negative impact on their often
already deprived nutritional status. The possible added impact of current inflation
on the nutritional status of vulnerable South African households is discussed. A
consequent potential reduction in portion sizes of staple foods consumed because of
increased food prices, as well as a snapshot of the cost of a balanced varied diet
compared with average household income, are argued in the context of SA’s
prevailing inadequate nutritional situation.

Keywords: inflation, nutrition, household, vulnerable, developing country

Correspondence: Dr Hettie C. Schönfeldt, Nutrition Scientist,
School of Agricultural and Food Sciences, University of Pretoria,
Lynnwood Road, Pretoria 0002, South Africa.
E-mail: hettie.schonfeldt@up.ac.za
Introduction
Despite strong growth in global food production, Sub-
Saharan Africa is the only region in the world where
the number of hungry people has risen over 19%
during the last decade (USDA Food Security Assess-
ment 2005). The per capita food supply for direct

© 2010 The Authors 253

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
254 H. C. Schönfeldt et al.
human consumption in Sub-Saharan Africa decreased
by 252 kJ/day from 1960 to 1990–1992 (Seipel 1999),
while Northern Africa, East Asia, South Asia and Latin
America all reported an increase in food supply (FAO
1996, 2006). Africa is also the only continent where
per capita agricultural production has fallen over the
past 40 years, alongside an increase in malnourished
people. Sub-Saharan Africa was the only region that
recorded an increase in undernourished people, com-
pared with other developing countries whom all
reported a decrease (FAO 1996). In 2005, 1 in 2 house-
holds in SA experienced hunger as determined by the
hunger scale. Approximately one-third were at risk of
hunger and only 1 in 5 people were recorded as being
food secure (NFCS-FB-1 2008).
It is well recognized that food is a basic human physi-
ological need that is important for survival, growth in
children, health and general well-being. Without an
adequate supply of food, humans can neither grow and
develop optimally, nor utilize energy for sustained live-
lihood, thereby implying food insecurity. More than 14
million or about 35% of the South African population is
food insecure and categorised as being poor (De Klerk
et al. 2004; Lemke 2005). Estimates suggest that
approximately 43% of households in SA suffer from
food poverty (Rose & Charlton 2002). Poverty is a state
where physiological human needs are not adequately
met as the amount of available money is not enough to
purchase a basic nutritionally balanced diet (De Rose
et al. 1998).
The majority of South African households consume a
limited variety of foods (mainly consisting of staples)
within the home [NFCS 1999]. In 2003, 1 in 2 children
had an energy intake less than two-thirds of their energy
needs, and a great number of children consumed a diet
with poor nutrient density, not meeting their daily nutri-
ent (macro and micro) requirements [SADHS 2003].
The fortification baseline summary of the 2008 NFCS
reported that at a national level 1 in 2 households
(51.6%) experienced hunger, thus indicating no
improvement from the 1999 NFCS (NFCS-FB-1 2008).
As a consequence, inadequate food intake continues and
so malnutrition is now widespread in SA. According to
the 1999 NFCS, 1 in 10 children between the ages of 1
and 9 years were underweight, and more than 1 in 5
were stunted (NFCS 1999). Four years later, mean
intakes of calcium, iron, zinc and the vitamins A, D, E,
C, B6, B2 and niacin were all recorded as low compared
with recommended dietary allowances (RDAs) (SADHS
2003). Even after the implementation of the mandatory
South African food fortification programme in 2003,
the 2005 NFCS still found that 2 out of 3 children and
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
1 out of 4 women had poor vitamin A status, 1 out of 5
women and 1 out of 7 children had poor iron status and
45% of children had an inadequate zinc status [NFCS-
FB-1 2008]. These current findings indicate increases in
deficiencies compared with previous nutritional data,
regardless of the mandatory fortification of staple foods.
Food price inflation is a global phenomenon. This has
been reflected in the South African economy, where
severe inflation rates have been experienced during the
periods 2006–2008, as will be illustrated in more detail
later in this paper. Almost half of the South African
population have no more than 800 South African Rand
(ZAR) (US$106.48) per household per month, of which
up to an estimated 70% is used for food purchases
(Statistics South Africa 20081). Thus, it is expected that
the increase in food prices has unavoidably impacted
upon the purchasing and consumption patterns of con-
sumers, severely affecting the poor. The objective of this
paper is to explore the potential nutritional implications
of high food inflation in SA (as experienced from 2006
to 2008), particularly on very poor households that
experience the highest levels of nutritional vulnerability.
Limitations of food consumption studies
in SA
As is the case in most developing countries, food con-
sumption studies in SA are limited. The paucity of
national and regional studies conducted and published
on nutrient/food intake in SA can primarily be explained
by budget restraints and a lack of researchers at a
number of previously active organisations. The hetero-
geneity of the South African population has always
posed a problem in regard to food intake and nutrient
surveys, and it continues to be a stumbling block (Van
Heerden 2009). Furthermore, there are significant con-
straints in data interpretation of the existing studies.
These constraints include the skewed age emphasis of
large studies. The most representative study of food
intake is the NFCS of 1999, which studied children
from 1 to 9 years of age (n = 2894) (NFCS 1999). The
follow-up study, the National Food Consumption
Survey Fortification Baseline (NFCS-FB-II 2008), subse- 11
quently also only concentrated on the food intake and
nutritional status of 1- to 9-year old children, but
expanded the survey to include women of child-bearing
age. Taken together, current knowledge of the food
intake of adults in SA is thus limited. Another constraint
1
The 2005/2006 survey of Statistics South Africa (2008) on the
income and expenditure of households is the most recent official
income and expenditure survey available in SA at present.
© 2010 The Authors

is that, with few exceptions, the majority of research
papers published in the past decade on the intake of
South African populations, only report nutrient intake
(e.g. macronutrients, vitamins, minerals etc.) and omit
the actual food intake from which these data were
obtained (Van Heerden 2009). Although these limita-
tions constrain the current research, the available data
still provide a valuable reference for interpretation, and
permit forecasting the possible impact of inflation upon
a developing country.
South African demographics
SA is a diverse country with 49 million inhabitants
speaking 11 official languages, as well as a variety of
different income groups or living standards (Statistics
South Africa 2008). While more than 75% of SA’s
population comprises black Africans, this category is
neither culturally, linguistically nor financially homog-
enous. Of the black population, 60% live below the
poverty line (Euromonitor International 2008).The
unequal income distribution in SA is illustrated by the
fact that the wealthiest 10% of income earners accrue
almost 50% of total income. Furthermore, the fortifica-
tion baseline of the 2005 NFCS reported that 55%
of South African households earn between 1ZAR
(US$0.13) and 1000ZAR (US$133.11) per month [
NFCS-FB-1 2008]. Similarly, Prahalat and Hart (2006)
reported that almost half of the 10–11 million house-
holds in SA can be classified as very low income house-
holds with less than 800ZAR (US$106.48) per month to
spend. On average, these households typically consist of
five family members (Amuli 2006; Oldewage-Theron
et al. 2006), translating into an average total household
availability of 5.33ZAR (US$0.71) per person per day
to meet all of their individual needs. This amount of
available money is substantially lower than the interna-
tional poverty line indicator of US$1/day (7.51ZAR)
[IDA 14 2004, 2006]. A major contributing factor to
poverty in SA relates to the continuous migration of
people from neighbouring countries, often ending up
living in extreme poverty and relying on the South
African government intervention for survival.
South African consumer food
purchasing behaviour
The South African Advertising Research Foundation
(SAARF) have developed a wealth measure segmenta-
tion tool to profile the South African consumer market,
namely the Living Standards Measurement (LSM).
Accordingly, ten wealth groups were identified based on
© 2010 The Authors
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
Impact of inflation within a developing country 255
consumers’ socio-economic status from the lowest
status (LSM 1) to the highest status (LSM 10) (SAARF,
2008). For the majority of marginalised consumers
(LSM 1 to 3), their food cash expenditure, as a share of
total cash expenditure, amounts to up to 70% of their
average monthly household income, decreasing to as
little as 5% for the wealthiest consumers [as calculated
from food expenditure data from the Bureau of Market
Research, (Martins 2006)]. Market expenditure by the
poor and very poor households in SA amounts to 129
billion ZAR/year (US$17.17 billion/year), representing
15% of the total household expenditure in SA (Prahalat
& Hart 2006). The limited amount of income available
to spend on food results in a restricted food basket
(Golden 2000; Oldewage-Theron et al. 2006). An over-
view of the food expenditure patterns of the various
LSM groups is presented in Figure 1, (Martins 2006). It
can be seen from this figure that the very low socio-
economic group spends about a third of their total food
cash expenditure on starchy foods, which are dominated
by maize meal, followed by bread. Unfortunately, these
staples provide a limited variety of micronutrients and
even though carbohydrates are abundant in maize meal,
the meal itself has an incomplete amino acid profile and
a protein content ranging between 1 and 5 g per 100 g
cooked porridge (depending on the consistency and
moisture content) (Wolmarans, Danster & Chetty
2005). Most of the micronutrients present in maize meal
and bread are mainly derived from mandatory fortifica-
tion (consisting of vitamin A, thiamine, riboflavin,
niacin, vitamin B6, folic acid, iron and zinc). The poor
quality of food and the lack of diversity in these habitual
diets impose great costs in terms of ill health, loss of life,
reduced economic profitability and poor quality of life
(Shetty 2009).
Urbanisation is a growing trend in SA, with people
continually moving from rural areas into urban settle-
ments in search of better work opportunities and
income-generation potential. A study carried out in an
urbanised informal settlement found that the majority
of South African households (60%) had a monthly
income of less than 500 ZAR/month (US$66.55). Of the
amount available to these households, up to 71% was
allocated to the purchasing of food, which consisted
mainly of maize meal (Amuli 2006). Maize porridge
consumption by this population in 2006 amounted to
approximately 532 g/day (made up according to meal
times as 345 g stiff maize porridge plus 124 g soft maize
porridge plus 63 g crumbly maize porridge), eaten over
two or three meals, and representing 66% of their total
energy intake per day (Oldewage-Theron et al. 2006;
Duvenhage & Schönfeldt 2007). These portion sizes are
256 H. C. Schönfeldt et al.

%
100
Contribution to food expenditure within group

90

80
70

60

50
40

30

20
10

0
LSM 1 - 3 LSM 4 - 6 LSM 7 - 10
(Marginalised consumers - poorest) (Emerging consumers) (Established consumers - wealthiest)

Bread and cereals Meat Vegetables

Milk, cheese and eggs Sugar products and confectionery Oils and fats
Mineral waters, soft drinks, juices Fish Fruits
Coffee, tea and cocoa Various food products

Figure 1 The food expenditure patterns of the Living Standards Measurement (LSM) socio-economic market segments [Calculations based on food
expenditure data published by the Bureau of Market Research, Martins (2006)].

Table 1 Portion sizes recorded with various prominent food consumption surveys in low-income populations in South Africa from 1983
to 2005

Average portion consumed (g)

Surveys done on food intake in low income populations Ethnic groups Maize Bread Milk Sugar

Adult Food Consumption studies 1983–2002* All 848 165 204 27

Lebowa Study 1991* Black, rural, 10 years+ 858 153 40.6 19.7
Dikgale study 1998* Black, rural, 19 years+ 891 121 121 26.8
THUSA Bana Study 1996–1998* Black, urban + rural, 10 years+ 532 115 72.4 20.5
Duvenage Study 2005† Black, informal urban, 20 years+ 532 150 56 22

*Nel & Steyn 2002.

†
Duvenhage & Schönfeldt 2007.

significantly lower than those reported in the South limited intake of fruit and vegetables. To emphasise the
African food consumption studies carried out among lack of dietary diversity, the 1999 NFCS recorded only
different population groups between 1983 and 2002 18 different food items which were consumed by more
(Nel & Steyn 2002) (as illustrated in Table 1). than 50% of the population. Within these 18 items, only
All of the food consumption studies listed maize as five (potatoes, cabbage, bananas, apples and butternut
the most commonly eaten food consumed by 78% of the squash) represented fruit or vegetables, while low
population with an average portion size of 848 g/ average intakes of these fruits and vegetables were con-
person/day (Nel & Steyn 2002). This is supported by the sumed per person per day, with average consumption
SADHS (2003), which reported maize meal porridge, rates reported as 40 g for potatoes, 17 g for cabbage,
government brown bread, full cream milk, white sugar 17 g for bananas, 26 g for apples and 14 g for pumpkin
and tea as the most commonly consumed foods, with a (Nel & Steyn 2002). Steyn et al. (2006) reported the

© 2010 The Authors

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266

average per capita fruit and vegetable intake for South
Africans to be 220 g/day in 2001, which is considered
extremely low. Table 1 illustrates average portions of
the most commonly consumed foods (maize meal,
brown bread, full cream milk and white sugar) as
recorded in a variety of South African consumption
surveys. The data in this table also emphasises the sig-
nificant dominance of staple foods (maize and bread)
within very poor consumers’ daily food intake.
According to the quarterly Food Price Monitor
media release by the National Agricultural Marketing
Council (NAMC, 2007, 2008, 2009, 2010), the Con-
sumer Price Index (CPI) for food and non-alcoholic
beverages was significantly above SA’s inflation target
of 6% during the period July 2006 to July 2007, with
inflation rates recorded as 9.5% for the year-on-year
period July 2006 to July 2007, and 17.8% for the year-
on-year period July 2007 to July 2008. Individual
products exhibiting inflation rates higher than the 6%
national inflation target included dominant staple
foods such as bread, maize meal and rice, as well as
other important foods such as milk and fresh produce,
potatoes, onions, tomatoes, cabbage, apples and
bananas. From July 2008 to July 2009, the CPI infla-
tion for food and non-alcoholic beverages was lower at
8.3%, reflecting the global slowing down of inflation
but still contributing significantly to overall inflation in
SA and being higher than the inflation rate in most
developing countries (NAMC 2009). Interestingly,
according to a recent Food Price Monitor media release
by the NAMC, CPI inflation for food and non-
alcoholic beverages was only 2.4% from January 2009
to January 2010, falling significantly below the lower
limit of the South African Reserve Bank’s target infla-
tion bracket. Moreover, according to this media
release, the period of high inflation is over for most
countries (including SA); even though SA’s food infla-
tion rate is higher than that of most developed coun-
tries (NAMC 2010). Bearing this in mind, the focus of
this paper in particular is on the high inflation period
observed from mid-2006 onwards.
Significant increases in food prices, or other forms of
strain exerted on very low income consumers, could
have a severe impact on their consumption behaviour in
terms of both their food basket composition and food
consumption intake. In a bid to survive, vulnerable
households therefore employ various food coping strat-
egies. Depending on the severity of food shortages trans-
lating into household food insecurity those affected
employ single, or combinations of food coping strate-
gies. Unfortunately, many of these have increasingly
negative consequences on the nutritional status of these
© 2010 The Authors
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
Impact of inflation within a developing country 257
individuals. In the poorer South African households,
these FCS include: (1) eating less preferred, cheaper
food; (2) gathering wild food; (3) consuming their seed
stock; (4) limiting portion sizes; (5) buying food on
credit; (6) restricting consumption in favour of their
children; (7) borrowing money or food; (8) sending
household members to eat elsewhere; (9) sending family
members to beg; (10) feeding working family members
at the expense of non-working members in the house-
hold; (11) rationing money to buy ready-to-eat food;
and (12) skipping the entire day without meals
(Maxwell et al. 2003; Kruger et al. 2008).
The burden of malnutrition
Many South Africans suffer from the health implica-
tions of inappropriate diets. Interestingly, a double
burden of nutritional imbalance exists within many
households, where the mother is often obese while the
infant is underfed. This phenomenon is unique to the
South African nutrition context. Even though it could
potentially be attributed to factors such as cultural tra-
ditions, including household rank affecting food allo-
cation within the household, many factors may
contribute towards this dilemma. Unfortunately, this is
still a largely unexplored research question. In the 2003
Demographic and Health Survey, 56.2% of SA’s adult
population was recorded as being either overweight or
obese, while in contrast 30.9% of preschool children
were too small for their age because of chronic nutri-
tional shortages (SADHS 2003). In 1999, 70% of
South African children aged between 1 and 9 years
consumed less than two-thirds of the RDAs for vitamin
A and iron (NFCS 1999). RDAs are amounts of essen-
tial nutrients which are required to meet the needs of
nearly all (97–98%) healthy individuals in order to
prevent nutritional deficiencies. The applicable values
used in SA are published in the Department of Health’s
Regulations Governing the Labelling and Advertising
of Foodstuffs (R. 2034 of 1993), and are presented in
Table 2.
A significant difference in nutrient intake can be seen
between rural and urban areas and between different
living standards within the same area. The SADHS
(1998) reported a significant difference in the health
situation of the population, with mortality rates in rural
areas as high as 7.12%, compared with a 4.32% rate in
urban areas (SADHS 2003). Stunting rates were also
higher in younger children (aged 1–3 years) and for
those living in rural areas and on commercial farms.
Chastre et al. (2007) point out that nutritional deficien-
cies in children before the age of 24–36 months are
258 H. C. Schönfeldt et al.

Table 2 Recommended dietary allowances for individual South trition is considered the single biggest contributor to
Africans >4 years of age (DH 1993) childhood mortality (Chastre et al. 2007).
Adults and children older than
Nutrient 10 years South African approach to combat
malnutrition
Protein 56 g
Vitamin A 800 mg (retinol equivalents) The high incidence of micronutrient deficiencies in SA
Vitamin D 6 mg prompted the Department of Health to implement
Vitamin E 15 mg a-(tocopherol equivalents) various mandatory programs to combat the situation,
Vitamin C 75 mg including a mandatory food fortification program which
Vitamin B1 or thiamin 14 mg
came into effect on the 7th of October 2003. The aim of
Vitamin B2 or riboflavin 16 mg
Nicotinic acid, nicotinamide or niacin 18 mg
this programme was to target micronutrient supplemen-
Vitamin B6 or pyridoxine 2 mg tation, dietary diversification and other public health
Folic acid or folacin 400 mg measures including parasite control (Witten et al. 2003).
Vitamin B12 or cyanocobalamin 3 mg The mandatory food fortification programmes initially
Biotin 30 mg started with the iodization of salt in 1995 and was
Pantothenic acid 5 mg followed by the extensive fortification of staple foods
Calcium 1100 mg
including maize meal and bread flour in 2003.
Phosphorus 880 mg
Iron 14 mg
In 1995, the South African Department of Health
Magnesium 350 mg tasked the Nutrition Directorate to implement an Inte-
Zinc 15 mg grated Nutrition Strategy (INS) to resolve the problems
Iodine 150 mg hindering previous nutrition and health approaches in
Choline 435 mg SA. The INS, which operated within the Integrated
Selenium 55 mg Nutrition Programme (INP), aims to facilitate a coordi-
nated inter-sectorial approach to solving nutritional
problems in SA. The key long term strategic priorities
(2004–2009) of the INP include: (1) the promotion of
virtually irreversible. There are also some globally healthy lifestyles; (2) the reduction of childhood mortal-
accepted long-term consequences associated with ity; (3) improvement of youth and adolescent health; (4)
chronic malnutrition, as a multi-country study reported maternal mortality reduction; (5) decreasing malnutri-
a 10% increase in stunting rates equalling to an 8% tion; (6) reducing the spread of human HIV through
drop in children reaching the final grade at school nutrition interventions; (7) nutrition interventions for
(Chastre et al. 2007). Undernourished children are people living with TB and chronic debilitating condi-
affected for the rest of their lives. This is because those tions; (8) improved management of communicable dis-
who do not achieve their optimum height (stunted), or eases; and (9) an emphasis on Millennium Development
consistently experience bouts of weight loss during their Goals and targets (Integrated Nutrition Programme,
childhood, seldom reach optimum size as adults, have 2004). The key long-term challenges (Millennium
lower mental capacity and have a greater risk of infec- Development Goal targets) (2004–2015) included: (1)
tions. All these factors translate into significant potential the reduction of hunger; (2) the reduction of under-5
economic losses for a country. Moreover, approximately mortality rates; (3) the reduction of maternal mortality
11% of the South African population suffer from HIV/ ratio; (4) halting and reversing the spread of HIV and
AIDS (Statistics South Africa 2008), and as stated by AIDS; (5) halting and reversing the incidence of major
Chastre et al. (2007) malnutrition can be particularly diseases; (6) the provision of sustainable access to safe
profound in those affected. This is as a result of oppor- drinking water; (7) improving the lives of people living
tunistic infections interacting with poor nutritional in informal settlements; and (8) the provision of access
status in a vicious cycle. Low intake levels of essential to affordable, essential medicinal drugs. The overall aim
micronutrients also have significant effects on health of the INP is to educate communities to be self-sufficient
and wellbeing in all age groups. Iron deficiency affects in terms of their food and nutritional needs, while simul-
performance in school and work; iodine deficiency can taneously protecting and improving the health of the
result in goitre and in severe cases cretinism, while most vulnerable groups, namely women, children and
vitamin A deficiency can result in blindness. Apart from the elderly. The INP provided the framework for the
being a large contributing factor to morbidity, malnu- transformation of the previous programmes, namely the

© 2010 The Authors

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266

National Nutrition and Social Development Program
(1991), the Primary School Nutrition Program (1994)
and the Protein-Energy Malnutrition Scheme (2004), in
order to be more comprehensive and effective [INP
2004].
South African food based dietary guidelines
With food and nutrition regarded today as being fun-
damentally important to public health, there is a general
consensus that obtaining and maintaining a desirable
nutritional state demands a concerted, holistic and
multi-sectorial approach. The key areas to address the
double burden of disease in SA lie within the develop-
ment of sound education programmes; teaching people
how to eat healthily. Thus, 11 food-based dietary guide-
lines (FBDGs) were developed from 1998 via a scientifi-
cally based process recommended by a joint FAO/World
Health Organization (WHO) expert consultation
(Vorster et al. 2001). The implementation of the FBDGs
started in 2004, with the training of health-care workers
regarding the use of the FBDGs in mid-2004 [INP
2004]. The FBDGs were developed based on prevailing
eating patterns and diet-related health issues, isolated
from the 1999 NFCS, which unveiled various areas of
nutritional need that needed to be addressed.
South African food fortification programme
On World Food Day, the 7th of October 2003, SA
implemented a mandatory food fortification programme
which entailed the compulsory addition of eight micro-
nutrients, namely vitamin A, thiamine, riboflavin,
niacin, vitamin B6, folic acid, iron and zinc to all maize
meal and wheat flours (Tswane University of Technol-
ogy 2004). The fortification cocktail and the addition
rates were based on food consumption patterns
observed from the NFCS of 1999 and the South African
Vitamin A Consultancy Group (SAVACG, 1995) study
of 1994. The percentages of the micronutrients in
selected fortified foodstuffs compared with current
RDAs for people >5 years are presented in Table 3. It
can be seen from this table that most added nutrients
contribute to 25% or more of the recommended dietary
requirements for each specific nutrient in 200 g of raw
product. This means that maize meal or wheat flour
products with a 200 g raw weight should be consumed
daily in order to obtain 25% of the recommended
dietary intake requirements. This 200 g raw weight
translates into approximately 370 g baked brown bread
and depending upon the consistency of cooked maize
porridge, between 530 g (stiff porridge) and 1450 g
© 2010 The Authors
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
Impact of inflation within a developing country 259
Table 3 Average percentage recommended dietary allowance in
200 g of South African fortified maize meal or wheat flour
(Tswane University of Technology 2004)
Maize meal Wheat flour
Micronutrient (% per 200 g raw) (per 200 g raw)
Vitamin A 25 25
Thiamin 25 25
Riboflavin 17 20
Niacin 25 25
Vitamin B6 25 25
Folic acid 50 50
Iron 25 25
12 (unsifted)
Zinc 20 20
(soft porridge) that should be consumed to meet the
RDAs. As stated previously, the 2005 study by Duven-
hage and Schönfeldt (2007) reported the average daily
intake of maize porridge to be 532 g. This is in line with
the amounts required for stiff maize porridge, while
daily bread intakes were reported to be much lower than
the required amounts at approximately 150 g/day.
Bearing in mind that the effect of inflation may result in
consumers employing coping strategies such as consum-
ing even smaller food portions, it is possible that current
daily intakes may be even less than those recorded in
2005.
The SA Food Fortification Programme is overseen by
the National Fortification Alliance (NFA) including the
Milling and Baking Industry of SA, the National
Department of Health, The United Nations Children’s
Fund, the Micronutrient Initiative and the Global Alli-
ance of Improved Nutrition in-country advisor. The
NFA is responsible for compliance monitoring of forti-
fication mixes, training, communication and dissemina-
tion of grants, as well as national assessment of
micronutrient status. Two years after the commence-
ment of fortification, in 2005, the National Department
of Health executed an NFCS Fortification Baseline
reporting the findings of micronutrient status of children
(aged 1–9 years) and women (aged 16–35 years) (De
Hoop 2009). Although the final report has not yet been
made public, summaries of the findings have been pre-
sented at National and International congresses and are
presented later in this document. Previous assumptions
suggest that food intake was lower than reported in the
national consumption studies, as confirmed by the
results from this fortification baseline survey, which
showed further decreases in vitamin A and iron status in
children, despite mandatory fortification (NFCS-FB-1
260 H. C. Schönfeldt et al.
2008). Recommendations from this study suggest that
future attention be paid to actual food intake, along
with bioavailability and stability of the fortification mix
to increase the effectiveness of the fortification pro-
gramme in alleviating malnutrition.
The potential impact of inflation on the
nutritional status of poor households in SA
According to institutions such as the World Bank, the
World Food Program and the United Nations (UN), a
wave of food price inflation moved through world
markets before and around 2008, leading to what some
refer to as a ‘silent Tsunami’ of hunger. For example,
from 2000 to 2008, global wheat prices increased by
about 200%, while overall food prices increased by
about 75% (World Bank 2008). Severe food inflation is
particularly problematic in Africa, because according to
the UN FAO (2009), 21 of the 36 countries around the
globe experiencing a food price crisis during that period
were in Africa. Countries relying on imports of basic
staple grains such as maize, rice and wheat are particu-
larly vulnerable in this regard (World Bank 2008). As
discussed earlier in the paper, food price trends in SA
were characterised by significant inflation from about
2006 to 2008, particularly among the aforementioned
staple food types. These trends reflected the phenom-
enon of increasing food prices at a global level during
that period (NAMC 2007, 2008, 2009, 2010), Even
though SA produces surplus maize, the impact of global
agricultural commodity price increases and rising input
costs (in particular crude oil) translates into increases in
food processing, transportation and distribution costs
(OECD-FAO 2008). Furthermore, the domestic com-
modity market is in the process of adjusting to a new
equilibrium and this adjustment process is attended by
increased food price volatility, particularly among
staple products. For example, the average retail price
for a 5 kg bag of maize meal fell 3% from December
2004 to December 2005, but rose nearly 23% from
December 2006 to December 2007 (Vermeulen et al.
2008) as can be seen in Figure 2. More recently, the
average retail price of a 5 kg bag of maize meal
increased further by about 17% from January 2008 to
December 2009, after which the price remained rela-
tively more stable and even exhibited a decreasing trend
in the case of special maize meal as is illustrated in
Figure 3 (NAMC, 2010)
Globally, food availability is adequate and food short-
ages are not a problem, however, access to these foods is
often lacking. According to the INP (2004), the Project
for Statistics on Living Standards and Development, it
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
was estimated that 39%of the South African population
were vulnerable to food insecurity in 1994 (INP 2004).
Ten years later, the NFCS showed that only 25% of
households in SA were food secure at a national level
(Labadarios et al. 2001). This translates into a 52%
increase in food insecurity within a 10-year period. Fol-
lowing on, household food insecurity is reported as one
of the underlying causes of malnutrition and death
(American Dietetic Association 2006). Households
become insecure when their livelihood systems, e.g.
capabilities, assets and activities required for a means of
living, change or fail to adapt to the challenges and
shocks from the external environment (Lindenberg
2002). Household food security thus depends on access
to and availability of food, in terms of financial, physical
and social aspects (Bellamy 1998).
The impact of urbanisation on the nutritional status
of South Africans is no different than what is experi-
enced globally. The 2005 NFCS-FB-1 reported the
highest percentage of no income households (6%) as
well as an income of 1ZAR (US$0.13-500ZAR
(US$66.55) to be within the informal urban sector (an
urban settlement with no structures, e.g. roads, running
water, squats, etc.). The informal urban sector is mostly
represented by informal housing (squatters) on the out-
skirts of major cities. Many households move from rural
communities to these cities in search of employment.
Subsequently, not only does urbanization result in a
total reduction in food intake, as a consequence of
decreased disposable income because of unemployment,
but it also distances people from primary food produc-
tion, which has a negative effect on the availability of a
variety of fruits and vegetables for the diet (WHO
2003).
Increases in food prices result in the implementation
of certain food-coping strategies by people in order to
remain food secure. However, as mentioned earlier,
some strategies may cause impairment to their health
status. The low-income South African population
already consumes a monotonous diet with a limited
variety and access to nutrients. Thus, inflation could
further decrease variety in the type and amounts of
foods consumed. This may have a severe negative
impact on health status. When smaller portions of foods
are consumed, less macro and micronutrients are
obtained from the diet. The fortification of staple foods
assumes a minimum consumption of 530 g/person/per
day for maize and 370 g/person/day for bread. Given
that actual consumption is below that which is consid-
ered as ‘basic portions’, fortification contributes signifi-
cantly less to improving the nutritional status of South
Africans than what the programme had originally
© 2010 The Authors
 Impact of inflation within a developing country 261

21.00

19.00

17.00
ZAR/5kg

15.00

13.00

11.00

9.00
SE 6
04

05

06

JU 6

06

06

JU 7

SE 7
07

07
04

06

07
05
SE 4
04

SE 5

07
04

04

05
05

05

0
0
0
0
N

AY
AR

P
AR

AR

AY

LY
L

LY
AR
L

V
AY

N
P

P
AY

V
JU

JU

O
O

O
JA

JA

JA

JA
M

M
M

M
M

M
N

N
N

Super Sifted

Figure 2 An illustration of staple food price volatility: South African retail prices of selected maize meal products (January 2004–November 2007)
(Vermeulen et al. 2008).

intended. Reduction in portion sizes remain one of the
simplest and least severe coping strategies (Kruger et al.
2008), and many South African households probably
employ this strategy in the case of increased food prices
without a corresponding increase in income. Accord-
ingly, the estimated effect of inflation on the portion
sizes of the main staple foods consumed, namely maize
meal, bread, full cream fresh milk and sugar is presented
in Table 4.
With respect to the nutritional implications of
increased food prices and poverty upon South Africans,
the 1994 SAVACG (SAVACG, 1995) of children aged
6–71 months found that 33% of South African children
were vitamin A deficient (as indicated by serum retinol
<20 mg/dL), 21% had anaemia, 10% were iron deficient
and 5% experienced iron deficiency anaemia (INP
2004). Five years later, (1999) the NFCS reported that 1
in 2 children consumed less than half the recommended
intake levels for vitamin A, riboflavin, niacin, vitamin
B6, folic acid, calcium, iron and zinc. Referring back to
Table 2, the portions of food consumed during previous
years were substantially higher than the amounts
recorded in 2005, with even smaller portion sizes as a
result of inflation. Bearing this in mind, the nutritional
situation is bound to have worsened since then. Accord-
ing to Table 5, during the period of high food inflation
(the analysis period 2006–2008), energy intake could
have potentially decreased to about 30% of the total
daily requirements or approximately 3048 kJ/person/
day (728 kcal/person/day), with SA gradually moving
closer to the FAO’s ‘hunger threshold’ of 1260 kJ/
person/day (300 kcal/person/day). Therefore, the poten-
tial reduction in portion size because of food inflation
may be only 61% of the RDA for iron being consumed,
54% of the RDA for vitamin A and a very sparse intake
of protein amounting to only 35% of the RDA.
According to the WHO, a diet is considered accept-
able for an individual if it covers both micro and

© 2010 The Authors

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
262 H. C. Schönfeldt et al.

25

20

15
ZAR/5kg

10

0
De 8

De 9
Fe 8

08

Fe 9

09

10
M 8

Ap 8

M 9

Ap 9
Au 8

Se 8

O 8

Ja 8

Au 9

Se 9

O 9

Ja 9
M 8

M 9
Ju 8

Ju 9
No 8

No 9
0
-0

0
-0

0
l-0

l-0

0
0

r- 0

r- 0
-0

-0
0

0
-0

-0
v-

v-
n-

n-

n-

n-

n-
b-

b-
g-

p-

c-

g-

p-

c-
ar

ar
ay

ay
ct

ct
Ju

Ju
Ja

Maize special 5kg Maize super 5kg

Figure 3 An illustration of more stable staple food prices: South African retail prices of selected maize meal products (January 2008–January 2010)
[NAMC 2010].

Table 4 Estimated effect of inflation on portion size and nutrient intakes in South Africa

Typical portion Estimated reduced Estimated non-reduced Energy value

Scenario Inflation size (g) Price portion cost portion cost of portion (kJ)*,†,‡

Maize meal ZAR/5 kg

Typical§ 532 16.43 0.70 0.70 2420
June 2006 to June 2007 0.28 381 20.00 0.61 0.85 1737
June 2007 to June 2008 0.05 361 20.63 0.60 0.88 1643
June 2008 to June 2009 0.03 349 21.29 0.60 0.91 1590
Bread ZAR/700 g
Typical§ 150 4.51 0.97 0.97 1545
June 2006 to June 2007 0.10 108 5.06 0.78 1.08 1396
June 2007 to June 2008 0.24 102 6.74 0.98 1.44 1061
June 2008 to June 2009 0.00 99 6.76 0.95 1.45 1058
Full cream fresh milk ZAR/2L
Typical§ 56 10.13 0.29 0.29 164
June 2006 to June 2007 0.05 40 12.73 0.26 0.37 156
June 2007 to June 2008 0.29 38 14.78 0.29 0.43 111
June 2008 to June 2009 0.09 36 16.08 0.31 0.47 101
White sugar ZAR/kg
Typical§ 22 13.20 0.12 0.12 341
June 2006 to June 2007 0.06 15 13.92 0.09 0.12 321
June 2007 to June 2008 0.04 14 14.56 0.09 0.13 307
June 2008 to June 2009 0.03 15 14.97 0.09 0.13 299

*Wolmarans et al. 2005.

†
Danster et al. 2008.
‡
Medical Research Council of South Africa 1991.
§
Duvenhage & Schönfeldt 2007.

© 2010 The Authors

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
 Impact of inflation within a developing country 263

Table 5 Estimated effect of inflation on energy intake, protein, iron and vitamin A levels in South Africa during the period June 2006 to
June 2009

Intake of certain essential nutrients Maize meal Bread Milk Sugar Total intake RDA (%)

Energy (RDA 10 000 kJ/day)*†‡

Typical§ 2420 1545 164 340 4470 44.7
June 2006 to June 2007 1736 1395 156 320 3609 36.1
June 2007 to June 2008 1643 1061 110 307 3122 31.2
June 2008 to June 2009 1590 1058 100 298 3048 30.5
Protein (RDA 56 g/day)*†‡
Typical§ 14.4 13.5 1.85 – 29.7 53.1
June 2006 to June 2007 10.3 9.69 1.33 – 21.3 38.1
June 2007 to June 2008 9.75 9.16 1.25 – 20.2 36.0
June 2008 to June 2009 9.44 8.87 1.21 – 19.5 34.9
Iron (RDA 14 mg/day)*†‡
Typical§ 6.92 6.15 – – 13.1 93.3
June 2006 to June 2007 4.96 4.41 – – 9.37 70.0
June 2007 to June 2008 4.69 4.17 – – 8.87 63.4
June 2008 to June 2009 4.54 4.04 – – 8.58 61.3
Vitamin A (RDA 400 mcgRE/day)*†‡
Typical§ 180.9 126 19.0 – 326 81.5
June 2006 to June 2007 129.8 90.4 13.7 – 234 58.5
June 2007 to June 2008 122.8 85.5 12.9 – 221 55.3
June 2008 to June 2009 118.8 82.8 12.5 – 214 53.5

*Wolmarans et al. 2005.

†
Danster et al. 2008.
‡
Medical Research Council of South Africa: Food Composition.
§
Duvenhage & Schönfeldt 2007.
RDA, recommended dietary allowance.

macronutrient requirements. Hence, dietary tools are
often developed as a guide to ensure that complete
intakes are being met. Unfortunately, however, the
South African Food-based dietary guidelines have yet
to be developed into a functional tool to be used as a
quantifiable reference for a healthy balanced diet.
Other countries, however, have such nutrition educa-
tion tools to enable consumers to plan their daily
eating patterns. The Canadian Food Guide, for
example, recommends proportional consumption of
five basic food groups, with specific amounts depen-
dent upon age and gender (Health Canada, 2008). This
tool recommends that an adult aged between 19 and
50 years should try to consume 7–10 portions of fruits
and vegetables, 6–8 portions of starch, 2–3 portions of
meat and 2 portions of dairy per person per day to
ensure optimal intake of all essential macro and micro-
nutrients. As yet, no consensus has been reached on
such a tool that would be applicable to meet the nutri-
tional requirements of South Africa. Implementation of
would help a dietary tool of this kind to facilitate nutri-
tion education in SA.
Food security implications of rising food
prices in SA
In order to explore further the food security implica-
tions of rising food prices in SA, the typical cost of a
daily balanced diet was estimated and compared to the
average daily available income of a poor consumer in SA
(as reported by the latest Income and Expenditure
Survey Statistics SA, 2008). This estimation of the actual
cost of a balanced diet was based on a snapshot of food
retail prices at a specific prominent South African
retailer in July 2008. As SA lacks an appropriate food
guide (healthy eating tool), the Canadian Food Guide
was used in this instance. This is because it most closely
reflects the South African Food Based Dietary Guide-
lines, which are simple sentences recommending healthy
eating habits. The most affordable and regularly con-
sumed foods were purchased so as to represent the
balanced diet recommended by the Canadian Food
Guide. Price observations were used to develop a pre-
liminary indication of the cost of a healthy diet for
urban consumers in SA. A retail price observation

© 2010 The Authors

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
264 H. C. Schönfeldt et al.
method was used for two reasons. In the first instance,
the official food price monitoring mechanisms employed
in SA do not include all the products present in this
hypothetical, affordable, nutritionally balanced food
basket, e.g. excluding products such as bananas,
oranges, spinach and soup bones (e.g. bones with some
meat still intact, sold as a budget option from the
butcher who cut off other meat for further processing,
e.g. minced meat). Furthermore, as very poor consumers
have a very limited amount of cash available on a daily
basis, the prices observed in-store were based on loose-
sell fresh produce because these consumers are often
unable to afford to purchase an entire packet of apples
for example, despite the fact that it is more economical
in the long run to purchase in bulk. In addition, food
products monitored for official inflation measurement
purposes are not usually loose-sell goods, rather pre-
packaged fresh produce. Accordingly, the hypothetical
food basket consisted of fruit vegetables, staple foods
(maize meal and bread) and meat, with eight different
fruits and vegetables purchased out-of-pack (loose-sell
produce). A government subsidized brown bread and a
5-kg bag of maize meal was also purchased. The price
for the bread and maize meal was adapted proportion-
ately in order to represent eight portions of starch. Soup
bones (the most affordable animal protein available in
the supermarket) were purchased and represented the
two required portions of meat, while a 500-mL carton
of maas (cultured milk), a cultural favourite of African
consumers, represented the two portions of dairy rec-
ommended. In this particular example, the recom-
mended balanced diet, although not representative of
the complete market, amounted to 22.31ZAR
(US$2.97) per person per day, which is far beyond the
5.33ZAR (US$0.71) available to vulnerable population
groups (Statistics South Africa 2008). Thus, having
devised this hypothetical food basket and calculated the
cost, it would appear that the consumption of an
adequate and balanced diet seems out of reach for the
majority of poor households in SA. This implies that
most South Africans would not consume a balanced
amount of all required macro- or micronutrients pro-
vided by a prudent, diverse, diet.
To further emphasize the cost of introducing diversity
into a poor South African consumer’s food basket, addi-
tional analysis revealed that staple foods (maize meal
and bread) only contributed 1.38 ZAR (US$0.18) of the
total cost of 22.31 ZAR (US$2.97) (i.e. 6.7% of the cost
of the daily food basket), while the remaining expenses
went towards establishing dietary diversity in the food
basket. These staple portions provided about 48.7% of
the energy within the food basket, with 43.9% from
Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 253–266
protein, 52.4% from iron and only 6.8% of vitamin A.
In addition, it is also worth noting that the current price
of one apple was similar to the total price of all the daily
recommended starch portions (bread and maize), inevi-
tably making it more difficult for South Africans to
incorporate fruit into their diet. Therefore, it comes as
no surprise that a low incidence of fruit and vegetable
intake within developing countries is an increasingly
global phenomenon. As stated by the WHO (2003),
only a minority of the global population consume the
recommended average intake of fruits and vegetables
within their diet.
Conclusions
As reported by the FAO (2006), the success in meeting
the Millenium Development Goals of halving the
number of undernourished people by 2015 will require
a sharp reduction in the rate of undernourished. In order
to meet the World Food Summit pledge of eradicating
hunger in developing countries, the number of under-
nourished people needs to be reduced by a staggering 31
million per year from 2001 to 2003 until 2015 (FAO
2006). Unfortunately, the rate of reduction of under-
nourished people in developing countries have previ-
ously fallen short of what is required to reach this target
– a target which seems to be even more out of reach as
a consequence of current global food inflation.
Affordability of food within the global population is
essential. We need food to maintain health and ulti-
mately to survive. However, very few people are
immune to the effects of increased food prices. As a
developing country, the majority of South Africans live
in poverty, with much less money available for food
than the cost of a balanced diet. Taking energy intake,
satiety and inadequate education together, it comes as
no surprise that most low-income South African house-
holds consume mainly staple food starches, very little
fruits and only the most affordable vegetables, which
are often low in bio-available nutrients.
As the current surge in inflation has increased food
commodity prices, it is inevitable that low-income
households in SA may progress to consume even smaller
amounts of staple foods (although fortified), and virtu-
ally omit any variety from their daily diets in order to
survive. Although fortification has been implemented in
most staple foods (bread and maize meal), the reduced
portion sizes (because of increased costs) would not be
able to contribute significantly to micronutrient intake.
Without intervention, this may result in SA aligning
with many predictions that malnutrition will increase,
instead of decreasing by 2015 (Chastre et al. 2007).
© 2010 The Authors

Increased malnutrition, affecting mostly the already
malnourished poor (FAO 2009), will increase the pres-
ence of irreversible problems in childhood development,
including poor cognition, weaker educational perfor-
mance, increased risk of morbidity and impaired
immune function. Within adults, frequent tiredness,
decreased work performance and decreased immune
function may also be symptomatic of under-nutrition,
affecting overall quality of life (Altman et al. 2009).
Unfortunately, it appears that SA is moving further
away from the 1st MDG established by the world’s
leaders in 2000, to reduce the proportion of the popu-
lation living on less than a dollar a day (ZAR7.51) and
to reduce the proportion of the under-5 population that
are underweight.
Recommendations
The current efforts by the South African government to
fortify staple foods in order to increase micronutrient
intake should be reconsidered. This is because the afford-
ability of foods, particularly the consumption of larger
food servings among the more vulnerable consumers, is
much less than what was previously recorded. Subse-
quently, the fortification cocktail currently contributes
significantly less to the RDAs of those nutrients. Govern-
ment intervention to increase the consumption of a
variety of foods other than staples, and the lowering of
food pricing would help to eliminate hidden hunger. SA
requires further research into potential policy interven-
tions to increase food affordability for poor consumers,
e.g. food stamps and subsidized balanced food baskets to
help enhance their health/nutritional status. Attention
should also be paid to daily food consumption rates, as
well as the bioavailability and stability of the fortification
mix, in order to increase the effectiveness of the fortifi-
cation programme.
Conflict of interest
The authors have no conflict of interests to disclose.
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NE W S F RO M E U R ES E A R C H

Preparation of active packaging with

antioxidant and antimicrobial activity based
on astaxanthin and chitosan
A. Sanches-Silva*, H. S. Costa*, P. P. Losada†, R. Sendón†, D. I. Sánchez-Machado‡, H. S. Valdez§, I. A.
Varona¶ and J. López-Cervantes‡
*Department of Food and Nutrition, Instituto Nacional de Saúde Doctor Ricardo Jorge (INSA), Lisbon, Portugal;
†
Department of Analytical Chemistry, Nutrition and Food Science, University of Santiago de Compostela, Spain;
‡
Department of Biotechnology and Food Science, Technological Institute of Sonora, Obregón, Sonora, México;
§
Research Center for Food and Development, Hermosillo, Sonora, México;
¶
Gaiker, Technological Center, Zamudio, Spain

Summary The project ‘Preparation of active packaging with antioxidant and antimicrobial
activity based on astaxanthin and chitosan’ (PAPAAABAC, in Spanish PEACAA-
BAQ) brings together a multi-disciplinary team from Mexico, Spain and Portugal,
with expertise in different areas of food and polymer sciences. The working pro-
gramme includes optimisation of the extraction and characterisation of astaxanthin
and chitosan from shrimp waste, and incorporation of these compounds into plastic
(polymeric matrices), in order to obtain new packaging with antioxidant and
antimicrobial properties (active packaging) and finally control-release studies which
are carried out in order to determine the quantity of active compounds that should
be included in the packaging. This is a 2-year project which started in 2009 and is
funded by FONCYCIT (Fund for International Cooperation of Science and Tech-
nology EU-Mexico; Fondo de Cooperación Internacional de Ciencia y Tecnologia
Unión Europea-Mexico) under the coordination of Professor Jaime López Cer-
vantes from the Technological Institute of Sonora (ITSON).

Keywords: antimicrobial activity, antioxidant activity, astaxanthin, chitosan, packaging,

shrimp waste

Introduction packaging with antioxidant and antimicrobial activity,

Nowadays, a lot of attention is focused on the use of
industrial waste, namely food industry by-products. The
use of biotechnology in the utilisation of shrimp waste
in order to eliminate the effects of its accumulation in
the environment and the development of active new
Correspondence: Dr Ana Sanches-Silva, Researcher, Department of
Food and Nutrition, Instituto Nacional de Saúde Doctor Ricardo
Jorge, I.P., Avenue. Padre Cruz, 1649-016, Lisbon, Portugal.
E-mail: ana.silva@insa.min-saude.pt
incorporating astaxanthin and chitosan extracted from
this waste into plastics, are aims of this project. There is
an increased interest in the development of active new
packaging with these types of natural compounds
because of the potential to increase the shelf life of foods
and to increase their safety.
Astaxanthin has great scientific and commercial inter-
est, as it is an active molecule of natural origin and has
great prospects for its application. For example, in the
pharmaceutical industry, it is used as a marker of cells
and as an antioxidant; in the cosmetics industry, it is

© 2010 The Authors 267

Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 267–270

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