SHADI NYOKONG | Malnutrition reversing years of progress in reduction of infant mortality

Over the past 20 years, SA has done something remarkable. Through a range of healthcare and social interventions, we have cut child mortality dramatically, saving thousands of young lives. But today,malnutritionthreatens to undo all of our hard-earned gains.

SA’s Child Death Review has shown that sustained investment in maternal and child health delivers results. We’ve seen a steady decline in under-five mortality to 28.6 per 1,000 live births in 2024. This progress is driven by improvements in healthcare quality and access, expanded vaccination coverage, stronger health data systems and social protection measures such as thechild support grant.

Community-based interventions by the likes of the Nelson Mandela Children’s Fund have also played a critical role in improving life outcomes for children under five. In hisstate of the nation address, President Cyril Ramaphosa recommitted the government to ending child stunting by 2030, tackling malnutrition among young children and prioritising the critical first 1,000 days of life. He emphasised targeted nutritional support for pregnant women and low birth-weight infants, recognising that early intervention determines lifelong outcomes.

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And yet, while progress is real, it is fragile. Child mortality rates remain unacceptably high. Poverty and inequality continue to shape life chances before a child is even born.

The lingering effects of Covid-19, alongside preventable illnesses such as diarrhoea, pneumonia, and HIV-related infections, threaten young lives. Above all, malnutrition remains the single greatest risk to reversing the gains of the past two decades. Policies alone do not save lives; systems do.

And systems are only as strong as the communities that drive them. Through its Child Survival, Development and Thriving (CSDT) programme, the Nelson Mandela Children’s Fund supports infants from birth to five years and pregnant women. The CSDT works at the family level, providing customised, need-responsive health services during the first 1,000 days of life.

This includes support for growth monitoring, exclusive breastfeeding, maternal mental health, nutrition, pre- and post-natal care, and early childhood development. In 2025 alone, more than 15,000 children, mothers and caregivers were reached in five provinces. From farms to villages, community health workers ensure that immunisations are completed, growth is monitored, and vulnerable children are identified early.

At the heart of this model are 55 trained community healthcare workers. They’re not just programme staff. They are trusted neighbours who visit residents in their homes.

They sit with young mothers and catch warning signs of a range of conditions early. They are the difference between survival and decline. Evidence underscores the value of this approach.

Recent research by the University of Zululand and Humana People to People shows how community-based health education strengthens both outcomes and accountability. Community dialogue remains key. In Mpumalanga, mothers engaged in discussions on exclusive breastfeeding. In KwaZulu-Natal, community members examined the importance of father involvement in the first five years of life.

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