Casale analysed data from the National Income Dynamics Study (NIDS) and found a link between child health and education outcomes.

The NIDS is a longitudinal survey that collects detailed information on the health status of children, including anthropometric data (body measurements), and on their progression through school.

“Using South Africa’s first national longitudinal study, which follows participants over time, this work highlighted how children who were stunted in early childhood had poorer educational outcomes later on,” said Casale. “The likely mechanism is through poorer cognitive function in malnourished children.”

She analysed the sample of children aged between six months and seven years in 2008 when Wave 1 of the data was collected. She then followed their outcomes in Wave 4, which was conducted in 2014/15, when the children were aged 7 to 14 years.

The children who were stunted in Wave 1 had completed fewer years of schooling by Wave 4 compared to non-stunted children, both because they started school later and were more likely to fail the grades they were enrolled for.


Casale’s analysis suggests that the timing of good nutrition is key in the child’s development, and global research shows that the first 1000 days, from conception to the child’s second birthday, are critical.

“Policy-makers need to find more creative ways of accessing children and their caregivers in the early childhood period,” said Casale.

“This is a largely under‐researched area of analysis for South Africa, and much more work needs to be done on the biological and socio‐economic factors that determine malnutrition in the first instance and subsequent recovery,” she said.

Even though school feeding scheme plays an important role in the child’s nutrition, the prevalence of stunting reaches a peak between two and three years of age, before a child gets to school.

“So clearly something more needs to be done to reach children and their caregivers earlier on. While the child support grant is an important policy intervention, and it has been shown to have many benefits, it appears not to be sufficient to prevent stunting,” said Casale.

Research suggests that, in addition to economic resources, mother’s education is an important protective factor in reducing the chances of stunting

“Policy-makers will need to find ways of reaching mothers early on to ensure that they are well nourished during pregnancy and that they know how to care for and feed their children appropriately,” she said.

According to Casale, clinic interactions during the antenatal and postnatal periods may be one area where policy could be strengthened “Mothers, and of course, fathers need to be educated and supported, and children’s weight and height need to measured repeatedly in the early period to monitor progress.”