Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa MEDUNSA, P.O. Box 215, Pretoria 0204, South Africa.
Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town 7505, South Africa.
Nutrients. 2022 Nov 25;14(23):5015. doi: 10.3390/nu14235015.
To address childhood malnutrition, the use of multifaceted methodologies, such as mixed methods research, is required to inform effective and contextual interventions. However, this remains limited in studying malnutrition among school children in a South African context, notwithstanding its persistence. We adopted a convergent parallel mixed methods design to best understand the magnitude of malnutrition through multilevel influences in a rural area. A quantitative survey determined the magnitude of malnutrition and associated factors among school children and their mothers (n = 508), parallel to a qualitative study, which explored mothers' insights into the influences of child growth and nutrition in interviews using seven focus group discussions. Mixed methods integration was achieved through convergence of the quantitative constructs developed from measured variables for malnutrition and related factors with ten emergent qualitative themes using a joint display analysis to compare the findings and generate meta-inferences. Qualitative themes on food unavailability and affordability, poor feeding beliefs and practices, and decision to purchase foods were consistent with the quantified poor socio-demographic status of mothers. Furthermore, the qualitative data explained the high prevalence of undernutrition among children but did not corroborate the high estimated households' food security in the quantitative survey. The misperceptions of mothers on child growth agreed with limited food knowledge as well as lack of knowledge on child growth gathered during the survey. Moreover, mothers believed that their children were growing well despite the high presence of childhood undernutrition. Mothers further overrated the effectiveness of school feeding programmes in providing healthy food to children as compared to their household food. They reported high incidence of food allergies, diarrhea, and vomiting caused by food consumed at school which resulted in children not eating certain foods. This might have impacted on the nutritional status of children since mothers depended on the school feeding program to provide food for their children. The ambiguity of cultural influences in relation to child growth was evident and substantiated during qualitative interview. Mixed methods integration offered a better understanding of malnutrition from empirical findings on interrelated factors at child, maternal, household, and school levels. This study points to a need for multilevel, informed, and contextual multidimensional interventions to contribute towards addressing childhood malnutrition in South Africa.
为了解决儿童营养不良问题，需要采用多方面的方法，如混合方法研究，以提供有效的、针对具体情况的干预措施。然而，在南非的背景下，研究儿童营养不良问题时，这种方法仍然有限，尽管儿童营养不良问题仍然存在。我们采用了收敛并行混合方法设计，以便通过多层次的影响，在农村地区更好地了解营养不良的程度。一项定量调查确定了学校儿童及其母亲（n=508）的营养不良程度和相关因素，同时进行了一项定性研究，通过 7 个焦点小组讨论的访谈，探讨了母亲对儿童生长和营养的看法。通过将从测量变量中得出的营养不良和相关因素的定量结构与十个新兴的定性主题进行收敛，使用联合展示分析来比较研究结果并生成元推断，实现了混合方法的整合。关于食物可得性和可负担性、不良喂养信念和做法以及购买食物的决定的定性主题与母亲贫困的社会人口统计学状况一致。此外，定性数据解释了儿童中营养不良的高患病率，但与定量调查中估计的家庭粮食安全状况不符。母亲对儿童生长的误解与有限的食物知识以及调查中缺乏儿童生长知识相符。此外，尽管儿童中存在较高的营养不良，但母亲们仍然认为自己的孩子生长良好。母亲们还高估了学校供餐计划为儿童提供健康食物的效果，而不是家庭食物。她们报告说，孩子们在学校吃的食物引起了高频率的食物过敏、腹泻和呕吐，导致孩子们不吃某些食物。由于母亲们依赖学校供餐计划为孩子提供食物，这可能会影响孩子的营养状况。在定性访谈中，文化对儿童生长的影响的模糊性得到了证实。混合方法的整合提供了更好的理解，即从儿童、母亲、家庭和学校层面的相关因素的实证研究结果中理解营养不良。这项研究表明，需要采取多层次、知情的、针对具体情况的多维干预措施，以促进南非儿童营养不良问题的解决。
