Abstract

PILDITCH, K; DU PLESSIS, L  and  DRIMIE, S. 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. S. Afr. j. child health [online]. 2024, vol.18, n.1, pp.33-40. ISSN 1999-7671.  http://dx.doi.org/10.7196/SAJCH.2024.v18i1.795.

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 Primary healthcare nurses were reported to frequently provide breastfeeding advice from outdated prevention of mother-to-child transmission policy.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.

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