Background: Infant and child nutrition in Zambia remains a pressing public health problem. The Zambia Demographic and Health Survey (ZDHS) indicates that 35% of children under-five and 36 % among those aged 6-23 months are stunted. This study set out to assess the influence of Infant and Child Feeding (IYCF) practices on child stunting (6-23 months) in Zambia. Methods: The 2008 ZDHS children’s data were analysed to measure stunting among infants aged 6-23 months. We fitted a bivariate logistic regression to measure association between feeding practices and stunting in children. Pearson’s Chisquare test of proportions and adjusted odd ratios (AOR) with confidence intervals at 95% are reported. Results: Findings indicate that 36% of children 6-23 months old were stunted. IYCF practices indicators remain relatively poor in Zambia with only 13% of children age 6-23 months having received minimum acceptable diet, 23% received minimum dietary diversity and 42% received minimum meal frequency. Breastfeeding and receipt of a minimum dietary diversity reduced the odds of stunting among children age 6-23 months by 38% and 33% respectively. A child’s perceived low birth size, being male, maternal anaemia status and mother’s use of the internet were significant predictors of stunting. Conclusion: The study shows that IYCF practices have an influence on stunting in Zambia and that socio-economic and demographic factors are likewise associated with stunting although the main determinants are amendable to intervention. Promoting the recommended WHO IYCF practices; breastfeeding, minimum meal frequency, receiving foods with diverse dietary content and accelerated investment in nutrition programs is recommended.
BACKGROUND AND OBJECTIVES This research emerges from Lesotho's diverse landscapes, where children’s stories remain largely unheard in the realm of health policy. The study aims to harness these narratives to drive equity, inclusivity, and human rights in health interventions, positioning youth not just as beneficiaries but as active participants in all health interventions. METHODS This research represents a meta-analysis of a larger, cross-sectional, qualitative research project, focused on understanding childrens’ narratives and experiences on their health and wellbeing. The study employed Participatory Learning Approach (PLA) tools, notably Social and Resource Mapping, Body Mapping, and Cause and Effect Analysis, to delve into these narratives. It involved a purposeful sample of 180 children, ranging from 6 to 19 years old, including school-goers, herd boys, children with disabilities, and teenagers. It occurred in diverse regions of Lesotho (Lowlands, Mountains, Foothills, and Senqu River Valley). This comprehensive approach also encompassed 18 Focus Group Discussions, enriched by Key Informant Interviews with local stakeholders. RESULTS Key findings from this study highlight significant issues in health, Water, Sanitation and Hygiene (WASH), education, nutrition, and child protection. The study underscores the challenges in accessing general healthcare services, particularly stressing the importance of sexual and reproductive health in high HIV/AIDS prevalence areas. The need for improved water and sanitation infrastructure is critically emphasised. In education, children and youth advocate for greater equity and inclusivity. The impact of climate change on nutrition is evident, leading to food insecurity and malnutrition, with high prevalence of stunting. Participants highlighted key facets of child protection, emphasising the increased vulnerability and exploitation of children and youth, alongside a considerable risk of gender-based and sexual violence. CONCLUSIONS Participants powerful testimonies advocate for a paradigm shift towards more inclusive and youth-involved policymaking, challenging the dominance of adult-centric approaches and calling for a holistic integration of their perspectives in programmes and policies.
Early childhood education plays a critical role in promoting children’s cognitive, social, and emotional development, laying the foundation for lifelong learning and well-being. Among the pedagogical approaches widely advocated in contemporary early childhood education, hands-on learning has gained increasing recognition for its potential to foster active engagement, problem-solving, communication, and collaborative learning. Despite growing international evidence supporting activity-based and experiential learning approaches, limited research has examined how hands-on learning activities support child development within preschool settings in Malawi. Furthermore, the study sort to fill the gap on the role of promoting children’s cognitive, social and emotional development by exploring how hands-on learning activities influence preschoolers’ cognitive and social development and identify factors that affect their effective implementation as specific gaps identified. Drawing from Vygotsky’s sociocultural theory, this study explored the role of hands-on learning activities in supporting preschoolers’ cognitive and social development in two early childhood centers in Lilongwe, Malawi. A qualitative-dominant comparative case study design was employed involving classroom observations, semi-structured teacher interviews, and document analysis. Data were collected from two preschool centers serving children aged three to six years and analyzed by using themes. Interview transcripts, observation notes, and documentary evidence were reviewed repeatedly to ensure familiarity with the data. The findings indicate that hands-on learning activities supported children’s cognitive development through enhanced problem-solving, creativity, language development, concentration, and numeracy skills. The activities also promoted social development by encouraging cooperation, communication, sharing, empathy, and collaborative participat ion. However, the developmental benefits of hands-on learning appeared to depend heavily on teacher scaffolding, peer interaction, and institutional support. Centers characterized by stronger teacher guidance, planning practices, and resource availability demonstrated more consistent developmental outcomes. This study contributes to sociocultural and early childhood education literature by demonstrating that the value of hands-on learning extends beyond children’s interaction with materials. Rather, developmental gains emerge through scaffolded social participation, collaborative learning, and supportive educational environments.
Steveria Limbani, Yamikani Chikhwaza, Alfred Shumba Hara et al.
COVID-19 emergency measures disrupted access to essential health services in many low- and middle-income countries. In Zimbabwe, maternal and child health (MCH) services are central to primary healthcare, yet evidence on the magnitude of disruption and recovery remains limited. This study assessed changes in selected MCH service indicators before, during, and after COVID-19 lockdown measures across Zimbabwe’s ten provinces. We conducted a secondary analysis of monthly provincial DHIS2 data from January 2016 to December 2024. Segmented interrupted time-series regression with generalized estimating equations with a Poisson distribution and log link to estimate immediate lockdown and post-lockdown recovery effects for first antenatal care (ANC) visits, completion of at least four ANC visits, institutional deliveries, newborn postnatal care within three days, primary immunisation course completion, and neonatal deaths. Models adjusted for province, calendar month, and within-province correlation. Completion of at least four ANC visits declined during lockdown (aRR 0.68, 95% CI 0.61–0.76), as did newborn postnatal care within three days (aRR 0.81, 95% CI 0.76–0.87). First ANC visits remained stable during lockdown (aRR 0.99, 95% CI 0.84–1.16) but increased post-lockdown (aRR 1.23, 95% CI 1.05–1.43). Institutional deliveries also increased during recovery (aRR 1.25, 95% CI 1.11–1.40), while neonatal deaths increased post-lockdown (aRR 1.38, 95% CI 1.17–1.62). Provincial patterns indicated heterogeneous disruption and recovery. COVID-19 lockdown measures disrupted selected routine MCH services, particularly continued antenatal and early postnatal care, whereas institutional deliveries and childhood immunisation were comparatively resilient. Strengthening emergency preparedness and recovery planning is essential to maintaining continuity of MCH services during future public health emergencies.
Tadiwanashe Mutemeri, Neuville Katandika, James January et al.
Background: Multinational food and beverage corporations, collectively termed 'Big Food,' contribute substantially to the global obesity crisis through deliberate product formulation, distribution, sales and marketing. Although food marketing in schools is recognized as a contributor to unhealthy dietary behaviors, evidence on its extent in South African secondary schools is limited. Objective: To identify food and non-alcoholic beverage marketing and sponsorship at secondary schools in the City of Cape Town. Methods: An observational, cross-sectional study was conducted in 37 purposively selected public secondary schools from the two largest educational districts in Cape Town. Fieldworkers captured observations of food and non-alcoholic beverage marketing material (names/logos/brands) visible from outside the school premises and within public view. A web-based search was also done to identify marketing and sponsorship activities on schools’ website pages and Twitter/X accounts. Prominently observed food and non-alcoholic beverage companies were invited to complete an online survey. Results: A total of 137 sightings of visible marketing and sponsorship materials from 35 food and non-alcoholic beverage companies were recorded in and around school premises, on school websites and Twitter/X accounts. One hundred sightings were recorded in and around school premises at 89.2% of the schools, with materials mostly displayed on signboards (40%), retail stores (33%), banners (7%), and flags (5%). The predominant company observed was The Coca-Cola Company, contributing 31.4% of the total sightings. Second was the Spar Group (12.4%). The most observed product was sugar-sweetened beverages (SSBs), contributing 29.2% of the total sightings. No online questionnaires were completed by the seven most prominent companies sighted and approached, regardless of repeated reminders. Conclusions: Food and non-alcoholic beverage marketing and sponsorship were widespread across secondary schools, with SSBs being the most prominent single category, followed by companies and supermarkets that manufacture or sell a combination of ultra-processed food and SSBs. These findings support the need for stronger regulatory measures to protect children and adolescents from unhealthy food marketing within school environments.
Lisanne du Plessis, Kirsty Louw, Henriëtte Joubert et al.
Introduction: Appropriate complementary feeding from 6–23 months is essential for child growth and development, yet dietary diversity remains inadequate in many resource-constrained settings. Understanding contextual influences on feeding practices is important for improving child nutrition. Objective: This study examined qualitative evidence to identify dietary patterns and factors shaping complementary feeding among children aged 6–23 months in Chinyunyu, Rufunsa District, Zambia. Methods: This Framework Analysis applied Gale et al. (2013) and the WHO Infant and Young Child Feeding framework to interpret qualitative data. The study was conducted in drought-prone Chinyunyu Ward, Rufunsa District, Zambia. Participants included 24 women aged 18–49 years with a child under two years and seven mothers-in-law who participated in Photovoice and focus group discussions, alongside three husbands and four community leaders who participated in in-depth interviews. Results: Caregivers generally described awareness of recommended feeding practices; however, poverty, limited maternal decision-making power, and heavy workloads were perceived to constrain adherence. Diets cited were dominated by cereal-based porridges prepared with groundnuts, sugar, or salt. Groundnuts were reported as the main protein source, and reliance on them may have limited dietary diversity. Furthermore, increasing dependence on commercial foods was also perceived to undermine optimal complementary feeding. Conclusions: Despite awareness of recommended feeding practices, poverty, gendered resource control, and heavy workloads were reported to constrain adherence to WHO recommendations. Empowering women, improving livelihoods, and promoting affordable dietary diversity, including legumes beyond groundnuts, may strengthen complementary feeding and child nutrition.
Priscilla Funduluka, Mercy Mukuma, Regina Murphy Keith et al.
Background Quality antenatal care (ANC) is essential for reducing maternal and neonatal mortality; however, access remains inequitable in Southern Africa. Women's empowerment is increasingly recognized as a key determinant of health-seeking behavior; however, its role in shaping ANC quality has not been adequately examined in the region. Methods This study used cross-sectional Demographic and Health Survey (DHS) data from 2015 to 2023 across seven Southern African countries ( n = 36,671). Women's empowerment was measured using the SWPER Global Index, which covers the domains of attitude toward violence, social independence, and decision-making. Quality ANC was defined as the receipt of four essential services: blood pressure measurement, urine testing, blood testing, and iron supplementation. Hierarchical models were fitted, and the measures of variation and model fit were evaluated. The significance level was set at p < 0.05, with a 95% confidence interval. Results Overall, 45.1% of the women received quality ANC, with wide variation between countries (27.4% in Malawi vs. 92.1% in South Africa). A high level of empowerment against violence and decision-making was observed among the women in most of the countries. Women with high social independence (aOR = 1.12, 95% CI: 1.01–1.24) and strong rejection of gender-based violence (aOR = 1.15, 95% CI: 1.05–1.26) were significantly more likely to receive high-quality ANC. Early ANC initiation, ≥8 visits, and doctor-led care were the most powerful predictors of quality ANC care. Conclusion Women's empowerment, particularly social independence and autonomy from violence, plays a critical role in improving the quality of ANC in Southern Africa. However, persistent socioeconomic and geographic inequities highlight the need for context-specific strategies. Policies that integrate gender equality frameworks with strengthened ANC service delivery, especially in rural and low-performing countries, are essential for achieving maternal health targets.
Gender Based Violence (GBV) has been referred to as the Shadow Pandemic, since it has tripled internationally from the startof the outbreak of COVID-19. The increased rates of reported GBV around the globe have ranged from 30% to 200%. We have seen high numbers of GBV reports in SA as well, with the GBV toll-free emergency hotline reporting 120 000 calls in the first three weeks of lockdown.
Abstract Background In contexts where poverty and mental health stressors already interact to negatively impact the most vulnerable populations, COVID-19 is likely to have worsened these impacts. Before the COVID-19 pandemic, adolescent girls and young women (AGYW) in South Africa already faced intersecting mental health stressors and vulnerabilities. It is critical to understand how additional challenges brought on by COVID-19 have intersected with existing vulnerabilities and mental health risks AGYW faced, particularly given the intersections between psychological distress and increased risk behaviours that impact sexual and reproductive health. We aimed to examine socio-economic and mental health impacts of COVID-19 on South African AGYW in order to understand how additional challenges brought on by COVID-19 have intersected with existing challenges, compounding AGYW vulnerabilities. Methods Using qualitative and quantitative methods, framed by the syndemic theory, we examined the intersections between mental health and the COVID-19 epidemic amongst AGYW in six districts of South Africa characterised by high rates of HIV, teenage pregnancy and socio-economic hardship. Between November 2020 and March 2021 we conducted a cross-sectional telephone survey with 515 AGYW, and in-depth interviews with 50 AGYW, aged 15 to 24 years. Results Our findings reveal how COVID-19 restrictions led to increased experiences of stress and anxiety. Poor mental health was compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity. Respondents described feelings of boredom, frustration, isolation, loneliness, fear and hopelessness. However, despite the multitude of challenges, some AGYW articulated emotional resilience, describing ways in which they coped and retained hope. Conclusion Various psycho-social risk factors already disproportionally affect the mental health of AGYW in these communities; the COVID-19 pandemic intersects with these pre-existing social and environmental factors. Understanding strategies AGYW have used to positively cope with the uncertainty of COVID-19 amongst an array of pre-existing mental health stressors, is key in informing efforts to respond to their needs. Multisectoral interventions are needed to address the drivers of poor mental health among AGYW, and bolster healthy coping mechanisms; interventions seeking to mitigate the mental health impacts on this vulnerable population need to be responsive to the unpredictable pandemic environment.
Children and adolescents under the age of 18 years comprise 34% of the population, and child and adolescent Mental, Neurological and Substance Use (MNS) disorders are common and an important cause of disability and distress. Providers at all levels should be competent to screen for and identify common childhood mental disorders, which usually present with developmental delay, emotional and/or behavioural symptoms and/or learning difficulties. Given the burden of disease, the fact that many mental disorders begin in childhood, and that early intervention is most effective in childhood and adolescence, it is essential that effective promotion, prevention, treatment, care and rehabilitation interventions should be provided for children and adolescents. In this webinar, hosted by the Academy of Science of South Africa, leading experts in child and adolescent mental health presented their priorities for child and adolescent mental health services and research in South Africa.
