Infant and young child feeding practices and behaviours of positive deviants among caregivers of children (6 - 18 months) at risk of stunting in informal settlements in Harrismith, Free State Province, South Africa
Article Sidebar
Main Article Content
Abstract
Background. The positive deviance approach has been used to identify infant and young child feeding (IYCF) practices associated with a reduction in stunting, but this research is limited in South Africa (SA).
Objective. To identify strategies among positive deviant (PD) caregivers of non-stunted children aged 6 - 18 months that influence infant and young child feeding (IYCF) practices and raise well-nourished children in two informal settlements in Harrismith.
Methods. This study employed a mixed-method design using a PD approach. Demographic questionnaires were administered to 28 purposefully sampled caregiver-child pairs to determine caregiver, child and household characteristics. Socioeconomic scores were obtained from these interviews and used to select six PD and six non-positive deviant (NPD) caregivers for semi-structured qualitative interviews between March and June 2019.
Results. Nutritional PD behaviours included consuming ‘flesh foods’ (meat) more often and practising responsive feeding and family eating. Non-nutritional PD behaviours included coping strategies involving health-seeking behaviour, financial strategy and social capital of caregivers. All caregivers displayed poor breastfeeding practices and an early introduction of solid foods. Primary healthcare nurses were reported to frequently provide breastfeeding advice from outdated prevention of mother-to-child transmission policy.
Conclusions. Poor IYCF practices highlight the need for continued advocacy and promotion of IYCF in SA. Nutritional PD behaviours are key to health promotional messages relayed within the local community where the research was conducted. The presence of nutritional and non-nutritional PD behaviours highlights the need for a multi-sectoral response to addressing stunting and improving IYCF practices.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
of stunting in South African children changed in 40 years? A systematic review. BMC Public Health 2015;15(1):1-10.
Shisana O, Labadarios D, Rehle T, et al. South African National Health and Nutrition Examination Survey (SANHANES-1). HSRC Press. Cape Town: HSRC Press; 2013.
Keats EC, Das JK, Salam RA, et al. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolesc Health 2021;5(5):367-384.
UNICEF. Infant and young child feeding - UNICEF data. UNICEF. 2018.
https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/(accessed 20 December 2019)
Statistics South Africa. South Africa Demographic and Health Survey 2016:
Key Indicators. Preotria 2017:1-57. https://www.statssa.gov.za/publications/ Report 03-00-09/Report 03-00-092016.pdf%0 (accessed 10 December 2019).
West NS, Schwartz SR, Yende N, et al. Infant feeding by South African mothers living with HIV: Implications for future training of health care workers and the need for consistent counseling. Int Breastfeed J 2019;14(1). https://doi. org/10.1186/s13006-019-0205-1
May J, Witten C, Lake L, Skelton A. The slow violence of malnutrition. South African child gauge 2020. Cape Town: Children’s Institute, University of Cape Town; 2020. 24-43.
Kanani S, Popat K. Growing normally in an urban environment: Positive deviance among slum children of Vadodara, India. Indian J Pediatr 2012;79(5):606-611.
Lapping K, Schroeder DR, Marsh D, Albalak R, Jabarkhil ZM Jabarkhil MZ.
Comparison of a positive deviance inquiry with a case-control study to identify factors associated with nutritional status among Agfhan refugee children in Pakistan. Food Nutr Bull 2002;23(4 Supp):28-35. http://ovidsp.ovid.com/ ovidweb.cgi?T=JS&PAGE=reference&D=emed5&NEWS=N&AN=12503229
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr 2013;9(S2):27-45. https://doi.org/10.1111/mcn.12088
World Health Organization. WHO Growth Standards. Geneva: WHO, 2022. https:// www.who.int/tools/child-growth-standards/standards (accessed 2 March 2020).
Tarumba C. Naude C DPL. Morbidity and mortality from malnutrition in HIV-
exposed infants enrolled in the prevention of mother-to-child transmission of HIV programme (PMTCT) at a district hospital in Namibia: the role of infant feeding practices. Stellenbosch University; 2016.
Dutton DS, Levine S. Overview, methodological critique, and reformulation. In Bunker JP, Gomby DS, Kehrer BH (Eds.) Pathway to health. Menlo Park, CA: The Henry J. Kaiser Family Foundation; 1989:29-69.
D’Alimonte MR, Deshmukh D, Jayaraman A, Chanani S, Humphries DL. Using positive deviance to understand the uptake of optimal infant and young child feeding practices by mothers in an urban slum of Mumbai. Matern Child Health J 2016;20(6):1133-1142. https://doi.org/10.1007/s10995-015-1899-3
du Plessis LM, Daniels LC, Koornhof HE, Samuels S, Möller I, Röhrs S. Overview of field-testing of the revised, draft South African Paediatric Food- Based Dietary Guidelines amongst mothers/caregivers of children aged 0–5 years in the Western Cape and Mpumalanga, South Africa. South African J Clin Nutr 2020:1-9. https://doi.org/10.1080/16070658.2020.1769334
Road To Health Book - Side By Side. https://sidebyside.co.za/resources/road- to-health-book/ (accessed 4 April 2022).
Finnane JM, Jansen E, Mallan KM, Daniels LA. Mealtime structure and responsive feeding practices are associated with less food fussiness and more food enjoyment in children. J Nutr Educ Behav 2017;49(1):11-18.e1. https:// doi.org/10.1016/j.jneb.2016.08.007
Mugode RH, Puoane T, Michelo C, Steyn NP. “Feeding a child slowly:” a responsive feeding behavior component likely to reduce stunting: Population- based observations from rural Zambia. J Hunger Environ Nutr 2018;13(4):455- 469. https://www.tandfonline.com/action/journalInformation?journalCode= when20
Harbron J, Booley S. Responsive feeding: establishing healthy eating behaviour early on in life. South African J Clin Nutr 2013;26(S):141-149. https://www.ajol. info/index.php/sajcn/article/view/97829
Faber M, Spinnler Benadé AJ. Perceptions of infant cereals and dietary intakes of children aged 4-24 months in a rural South African community. Int J Food Sci Nutr 2001;52(4):359-365. https://doi.org/10.1080/09637480120057594
Adekanmbi VT, Kayode GA, Uthman OA. Individual and contextual factors associated with childhood stunting in Nigeria: A multilevel analysis. Matern Child Nutr 2013;9(2):244-259. https://doi.org/10.1111/j.1740-8709.2011.00361.x
Von Fintel D, Von Fintel M, Butheleze T. The complementarity between cash transfers and financial literacy for child growth. SALDRU Working Paper Number 241 Version 1/ NIDS Discussion Paper 2019/8. Cape Town: SALDRU, UCT 2019:1-22.
Carter MR, Maluccio JA. Social capital and coping with economic shocks: an analysis of stunting of South African children. World Development 2003;31(7):1147-1163. https://doi.org/10.1016/S0305-750X(03)00062-7
Mphasha MH, Skaal L. Infant and Young Child Feeding Policy: do primary health care nurses adhere to the HIV breastfeeding recommendations in Limpopo Province? South African J Clin Nutr 2018;32(3):70-75. https://doi.org/10.1080/ 16070658.2018.1457863
Statistics SA. Income and Expenditure of Households. Statistical release P0100. Pretoria: Statistics SA. 2005/2006: 1-211. http://www.statssa.gov.za/publications/ P0100/P01002005.pd (accessed 11 March 2019).