MATERNAL NUTRITION KNOWLEDGE AMONG CAREGIVERS OF MALNOURISHED UNDER-FIVE CHILDREN: A QUALITATIVE HOSPITAL-BASED STUDY IN RURAL SOUTH AFRICA

Abstract

Background: Child malnutrition remains a preventable contributor to under-five morbidity and mortality in rural South Africa. Although updated global and South African guidance emphasises prevention, early identification, breastfeeding support, safe complementary feeding and timely referral, caregiver knowledge and care-seeking pathways remain uneven in resource-constrained settings [1]. Aim: To explore caregivers’ feeding practices, understanding of malnutrition, home responses to childhood illness and pathways to formal care among under-five children admitted for nutritional rehabilitation. Setting: A rural district hospital serving low-income communities in King Cetshwayo District, KwaZulu-Natal, South Africa. Methods: A qualitative descriptive study was conducted with purposively selected mothers and primary caregivers of under-five children admitted with malnutrition. Ten unstructured face-to-face interviews were conducted in isiZulu, audio-recorded, transcribed, translated into English and analysed using qualitative content analysis. Rigour was strengthened through an audit trail, reflexive notes, de-identification of transcripts and language verification. Results: Four interrelated themes were identified: feeding practices; caregiver knowledge of malnutrition; interventions undertaken after recognising illness; and access to health care services. Caregivers described early introduction of thin cereal-based feeds, formula dilution, low dietary diversity, limited recognition of danger signs, reliance on home or traditional remedies, and delayed care seeking shaped by poverty, cultural explanations of illness and fear of negative staff attitudes. Conclusion: In this rural setting, inadequate nutrition knowledge was not a stand-alone problem; it operated with poverty, sociocultural illness interpretations and perceived health-system barriers. Routine primary health care should therefore combine practical feeding counselling, safe formula-preparation support, ORS demonstration, culturally respectful harm-reduction messages and respectful provider-caregiver communication. Contribution: The study provides context-specific evidence on how caregiver knowledge, household constraints and care-seeking decisions interact before hospital admission, offering practical entry points for strengthening PHC-based prevention and early management of child malnutrition in rural South Africa.

Keywords: infant and young child feeding; malnutrition; caregivers; care seeking; cultural beliefs; rural primary health care; KwaZulu-Natal; South Africa.