has numerous rich natural resources like diamonds and gold. when diamonds and gold were discovered in 1867 and 1886, instead of causing widespread richness for the african people, it caused widespread subjugation to the boers (dutch settlers). upon their arrival, the dutch forced black farmers to either abandon their land, become sharecroppers, or become farm laborers. subjugation from non-native groups continued until south africa became a republic. this long period of subjugation eventually lead to the establishment of apartheid in south africa in 1948 by the national party (the ruling political party of the time). in the 1960s, the apartheid-centered government created african reserves where blacks could live and have a chance at "separate development." although the majority of south africans were (and continue to be) black, the reserves compromised a disproportionally small amount of land (13% of south africa). the reserves were geographically isolated and had poor healthcare, infrastructure and irrigation. although the first multiracial election in 1994 brought an immediate end to apartheid, the detrimental effects of apartheid in south africa continue to be felt today. the poorest south african provinces today are those that encompass former african reserves (eastern cape, limpopo province, and kwazulu-natal). these places are especially known for their higher rates of malnutrition as compared to the already high rates of south africa. these black areas also have the highest rates of aids in south africa – 13.6% of black africans in south africa are hiv-positive, whereas only 0.3% of whites living in south africa have the disease. while 72% of the south african population considered poor live in rural areas, 86.9% of the chronically poor in kwazulu-natal live in rural areas. whereas people in wealthy urban areas tend to have a better nutritional status, rural and agriculturally based people in south africa tend to have the most inadequate diet. this is because while wealthy urban residents have access to better education and food, their rural, chronically poor counterparts are less educated, have lower literacy levels, and have limited food access. in 1997, 900,000 households that were located in formal reserves had no arable land access, 1.4 million had no access to any livestock besides chickens, and 770,000 households had access to neither arable land or other livestock. unfortunately, many of the rural households that did have access to livestock had to sell the livestock in order to alleviate poverty. all this results in a severe shortage of food among the rural poor, thereby leading to a shortage of nutrients. treatment since the 1990s, the first millennium development goal of the united nations has been to eradicate world hunger and malnutrition. according to the united nations, there are certain steps that could be especially beneficial in combating malnutrition. it is estimated that by simply increasing vitamin a and c intake along with improving breastfeeding methods, the lives of 2.4 million children throughout the world could be saved annually. various programs in south africa have been established since then to help achieve this, all with different success rates. integrated nutrition program in accordance with the goal of the united nations, the south africa department of health established the integrated nutrition program in 1995. the inp aims to mainly help the people most prevalently at risk for malnutrition: children six years old and under, pregnant women, and lactating women. the main foci of the inp are breastfeeding promotion, growth monitoring and promotion, food fortification, micronutrient supplementation, hospital-based management of severe malnutrition, nutrition rehabilitation in communities, and nutrition management during illness. the inp addresses these foci through nutritional education, nutrition counseling services and support for specific ailments, and indirect provision of healthcare services. since the establishment of the inp in 1995, south africa has adopted the international code of marketing of breast-milk substitutes to promote breastfeeding. the code was cofounded by the world health organization and unicef during the thirty-third world health assembly. it aims to provide nutrition to malnourished infants through the facilitation of breast-feeding and proper use of breast-feeding substitutes only when absolutely necessary. unfortunately, there has been a delay in the legislation of the code. if passed, it will need to promote intensive training that follows along the national breastfeeding guidelines for health workers, so that they can reach out to individuals that are doubtful of the benefits of breastfeeding their children. it will also need to promote the extension of maternity leave benefits to give working south african mothers sufficient time and resources to breastfeed. the inp has implemented growth monitoring in south africa through the following measures: the provision of growth cards to all caretakers of children under two years old, the constant monitoring of growth and detection of malnutrition, the provision of counsel to caretakers, and the promotion of growth. however, there are various shortcomings in africa's approach to growth monitoring and promotion. these include inaccurate weight assessment, lack of weight plotting, nurses not trained sufficiently to detect malnutrition, inability to supply growth cards to all infants, and lack of sufficient communication with caretakers. in order to directly address nutrient deficiencies, the inp established a mandatory food fortification program in 2003, which is interrelated to the micronutrient supplementation program. however, the programs have not reached their anticipated success rates. the food fortification program has created a food fortification mix imbedded in maize meal and other complementary foods. the mix's high folate content seems to have eradicated folate deficiencies. the food fortification program also made the iodization of salt mandatory since 1995. this seems to have halted incidences of iodine deficiencies. however, any micronutrients lacking in the food fortification mix can still cause malnutrition. unfortunately, it has been difficult for the micronutrient supplementation program to provide all the lacking micronutrients to those in need. the program faces various limitations in the forms of supply, supplement quality, bio-availability, outreach, and compliance. for example, the vitamin a supplementation program has been criticized for its struggles with reaching its most vulnerable target: children and post-partum women. by the year 2050 the world's population is expecting to hit 9.7 billion, as a consequence the poorest countries will still be living 7 years less according to the united nations. in response to covid:19 and in order to address these risks, the food and agriculture organization urges countries to: meet the immediate food needs of their vulnerable populations, boost social protection programmes, keep global food trade going, keep the domestic supply chain gears moving, and support smallholder farmers' ability to increase food production. africa and asia are at the biggest risks right now more than ever when comes to food insecurity and malnutrition. the 2015/2016 drought that hit africa has pushed them back since then with the continent making slow recoveries however the drought is still very much present. the inp has not failed to recognize the challenges that arise in the hospital-based management of severe malnutrition. south african hospitals admit numerous children for severe malnutrition, yet many of these children end up suffering easily avoidable deaths. even after the 2006 south african amendment of the district health information system, which was supposed to provide the case fatality rates of severe malnourishment among children in hospitals, the lack of identification of malnutrition-related deaths remains high. however, there has been a notable drop of malnutrition-related deaths among hospitals due to training and capacity development geared at the hospital staff. in order to address the problem of nutrient supplementation on a community-wide level, the inp helped establish the short-term program "nutrition supplementation program" (previously known as the pem scheme). this program has been fairly effective because of the well-trained nutritionists that assist it. however, various shortcomings remain. the program has struggled with community based interventions and with properly reaching out to and enrolling all malnourished children without misusing resources on children that are not truly malnourished. if the child support grant was extended to apply to all families of malnourished children, all at risk children could be reached and enrolled at hospitals, clinics, and other places that participate in growth monitoring. nutrition management during disease is another method used by the inp to prevent malnutrition. south africa's department of health adapted the integrated management of childhood illness to encourage proper nutrition management. unicef, in conjunction with the world health organization, established the imci to increase child survival in areas with poor resources. imci aims to achieve this through a combination of improved management of common childhood diseases and proper nutrition and immunization. however, there are various vague generalities in imci's guidelines that make it difficult for south african health providers to know exactly how to train mothers to provide food for their children. this presents a problem because most ill south african children are never seen by a nutritionist so they have no other way of learning how to have a proper nutrition. epidemiology the article agreement on defining malnutrition defines malnutrition as affecting individuals whom "food and nutrient intake is consistently inadequate to meet individual requirements." by the standards of this definition, malnutrition is a prevalent problem in south africa. in the year 2000, 39% of the country's population suffered from malnutrition. children are the most affected by this problem, especially young children. south africa's problem of malnutrition is unique to other countries' malnutrition problems because south africa is a primarily young country, with one third of the population being under the age of 15. thus, the fact that 25% of pre-school children and 20% of primary school children in south africa suffered from malnutrition in the year 2000 means that the future population of south africa is being endangered by the problems of malnutrition the problem of malnutrition in south africa can be individually assessed through the deviation of weight of each child from the average weight for their age. according to the world health organization, the deviation from the average weight of children under age five in south africa has dropped from 31.5% to 8.7% from 1994 to 2008. malnutrition can also be individually assessed through the deviation of height of each child from the average height for their age. this is because malnutrition stunts growth. the world health organization showed that over the span of thirteen years (1995 to 2008), the deviation from the average height of children under age five in south africa has slightly decreased from 28.7% to 23.9%. these decreases in deviation show that the problem of malnutrition in south africa has decreased over recent years. however, it remains a prevalent problem, notably in the regions of eastern cape and the limpopo province. these two areas are especially poor and rural as compared to the rest of south africa. according to unicef, although 84.5% of south africans have access to piped water, only 62.4% of eastern cape residents have access to piped water. also, although only 13.6% of south african households have no toilet facilities, 30% of eastern cape residents lack toilet facilities. similar statistics are true for the rural areas of the limpopo province in northern south africa. the prevalence of malnutrition in limpopo is so vast that 48% percent of children in the limpopo province evaluated in a 2005 study were shown to have stunted growth. thus, the high levels of poverty and the rural state of these two areas reflect back through high levels of malnutrition.