Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa

Abstract

Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers’ nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80–100), good (60–79), average (40–59), and fair (0–39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers’ nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers’ nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12–3.29), child’s age (6–11 months: AOR = 2.63, 95%CI: 1.53–4.53 and 12–23 months: AOR = 3.19, 95%CI: 1.41–7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15–0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.

Maternal factors associated with stunting among children under two years in South Nias, Indonesia: a cross-sectional study

“…Previous studies suggest a strong relationship between mothers' or family' knowledge and stunting [39], [40]. However, this study did not find any significance in the relationship between mothers' This may be influenced by other factors, such as economic, socio-culture, and environmental factors [41], [42]. Several respondents in the study reported that and hindered the researcher from asking the respondents to fill the questionnaire in person.…”

Comparison of Malnutrition Indicators and Associated Socio-Demographic Factors among Children in Rural and Urban Public Primary Schools in South Africa

“…Malnutrition indicators per setting showed that boys and school children in the intermediate learning phase were more likely to be stunted in the rural setting. In the urban setting, school children living in households with an income of USD 52.51 to USD 262.60/month and receiving the CSG were more likely to be thin, yet those from households with the same income of USD 52.51 to USD 262.60/month were also more likely to be overweight/obesity in the urban setting, as observed in several studies [35][36][37] and explained by the differences in the standard of living in the two settings [36]. To ensure achieving the UN's SDG goals 1, 2, and 3, the South African government introduced the National Development Plan (NDP) vision 2023, adopted in 2012 with the objective to reduce child malnutrition through eradicating poverty in all its forms, by provision of social grants [81].…”

“…in LMICs, including South Africa [71][72][73][74][75][76]. In fact, the poorer perceived health status and low quality of life among rural dwellers are attributed to a lower socio-economic status, which might affect the affordability of good nutrition to maintain proper feeding practices as well as access to health care [34,35,75].…”

“…Also, the impact of the social status of fathers on their children's nutrition and health has been acknowledge, but fathers are still underrepresented in child nutritional status research and interventions [86]. Nonetheless, the effects of parental education and employment status on child nutritional outcomes show the ability to acquire health knowledge on recommended feeding practices, as well as increased resources for food access, affordability, and availability [34,35,55]. There-fore, the social and economic situation observed-a disproportionate burden of poverty and unemployment-continues to predispose children to malnutrition.…”

“…Nonetheless, differences in the prevalence of undernutrition between urban, rural and commercial farms are evident in South African children [29], and other African countries such as Ethiopia [13,14], Nigeria [15] and Cameroon [30]. In both rural and urban settings, nutritional outcomes have been more associated with socio-economic characteristics in LMICs [31][32][33] but more in the rural in South Africa [34,35]. Evidently, a lower income restricts access to healthy diets and makes available more access to unhealthy high-energy-dense foods [36], while favorable socio-economic conditions positively influence infant feeding and caring practices in favor of the urban setting [28].…”