In high HIV prevalence settings, pregnancy and early childhood can be stressful periods for mothers with HIV, due to fear of HIV transmission, breastfeeding concerns, poor health and socio-economic challenges. Not much is known about how mothers of young children who are HIV exposed and uninfected (HEU) experience caregiving before and beyond the confirmation of their HIV-negative status. Using the Nurturing Care Framework for early childhood development, this qualitative study explores the caregiving experiences, challenges, and support needs of mothers raising young children who are HEU. Conducted in the Western Cape, South Africa, the study involved in-depth interviews with 20 mothers whose children were exposed to HIV, >1 year old, and tested HIV negative at 12 months. Reflexive thematic analysis guided the data analysis. Mothers' concerns persisted beyond ruling out HIV to encompass the overall health and development of their child during early years of life. Nurturing care practices were hindered by structural challenges - financial constraints, heavy caregiving demands, their own poor health, and limited partner/family support, which were further intensified by mothers' HIV and their child's HIV exposure. Existing efforts to operationalise the Nurturing Care Framework in high-HIV settings need to be strengthened to consider the specific needs and vulnerabilities of mothers of children who are HEU.
Himani Bhardwaj Pandya, Xanthe Hunt, Peter Suwirakwenda Nyasulu et al.
Childhood stunting is the most prevalent form of chronic malnutrition, affecting 149 million children under the age of five worldwide. As the determinants of stunting are complex and multicausal, it is important to look at area specific determinants and determine whether these are similar to the general determinants. This study investigated the prevalence and determinants of stunting in children under the age of five, visiting Bisho Hospital clinic in the Eastern Cape, South Africa. A cross-sectional, qualitative design was used. All children under the age of five, visiting Bisho Hospital’s clinic during the data collection period, and whose mothers provided consent, were included in the sample of 219 participants. An interview-administered questionnaire was used to determine possible factors that may play a role in stunting. Anthropometrical measurements (height, weight and mid-upper arm circumference) were used to calculate z-scores for the children. IBM SPSS Statistics 26 (version 24.0) was used for statistical analysis. Dietary diversity was calculated with a seven food group classification. The prevalence of stunting was 47.5 %, of which 57.7 % were classified as moderately stunted, and 42.3 % severely stunted. There was a significant correlation between the participants’ main form of sanitation and stunting in all age groups (p = 0.007; Cramer’s V = 0.413 and p = 0.04; Cramer’s V = 0.326, respectively). A statistical significance was found between the child support grant and stunting (p = 0.032) in children younger than six months, but not in the older group. No statistical significance was found between other determinants of stunting that were analysed. As stunting is multi-causal, it requires a combination of nutrition-specific and nutrition-sensitive interventions, together with strong political and financial commitment from stakeholders to eradicate stunting in children. Keywords: Stunting, Children, Sanitation, Infections, Breastfeeding
BACKGROUND: Globally, 15 million children were born HIV-exposed uninfected (CHEU) from mothers living with HIV. CHEU have increased mortality, morbidity and stunting compared to children HIV-unexposed (CHU). Our objective was to compare body composition between CHEU and CHU, which may underlie this vulnerability. METHODS: In a substudy among 223 children (36 CHEU and 187 CHU) enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe, we measured height, knee-heel length, weight, calf circumference, skinfold thicknesses (triceps, subscapular and calf), and bio-electrical impedance at 2 years of age. Generalised estimating equations were used to compare body composition between CHEU and CHU, and interactions with linear growth and birthweight. RESULTS: CHEU had significantly lower length-for-age, knee-heel length, weight-for-age, mid-upper arm circumference and calf circumference compared to CHU. CHEU had a lower impedance index (adjusted mean difference -0.49, 95% CI -0.87, -0.11), reflecting less lean mass, and lower skinfold thicknesses (subscapular Z-score adjusted mean difference -0.49 (95% CI -0.97, -0.02); triceps Z-score -0.48 (95% CI -0.83, -0.13)), indicating reduced subcutaneous fat. In early-life, CHEU had lower birthweight. However, no significant interaction between stunting or birthweight and HIV exposure was observed for body composition outcomes. CONCLUSION: CHEU have a distinct pattern of body composition by 2 years of age, characterised by reduced lean and fat mass compared to CHU which was not explained by reduced linear growth or lower birthweight. This pattern of early-life growth may contribute to the increased vulnerability of CHEU to mortality, morbidity and reduced neurodevelopment.
Joseph D. Piper, Robert Ntozini, Idah Mapurisa et al.
BACKGROUND: We evaluated growth outcomes in children and adolescents with HIV-1 initiating or switching to dolutegravir-based antiretroviral therapy (ART) in the single-arm trials IMPAACT P1093 (P1093) and IMPAACT 2019. METHODS: We performed descriptive post hoc analyses of body mass index-for-age (BAZ), weight-for-age (WAZ), and length/height-for-age z scores (L/HAZ) for each trial through Week 48. BAZ changes were assessed using a mixed model for repeated measures. RESULTS: We included data from 181 and 57 participants from P1093 and IMPAACT 2019, respectively (10% [23/238] were adolescents). Baseline mean BAZ was -0.1 in P1093 and - 0.7 in IMPAACT 2019. At Week 48, adjusted mean BAZ increased significantly in P1093 (0.3; 95% CI, 0.03, 0.49; p < 0.05) and non-significantly in IMPAACT 2019 (0.3; 95% CI, -0.03, 0.58; p = 0.074). Mean BAZ was in the normal range at Week 48 in both trials. Marked increases in BAZ were observed among subgroups with baseline BAZ < -2. By Week 48, 65% (117/181) of participants in P1093 and 74% (42/57) in IMPAACT 2019 remained in the same BAZ category. Improvements from severe or moderate malnutrition/thinness to normal weight occurred in 6% (10/181) and 7% (4/57) of participants in P1093 and IMPAACT 2019, respectively, while increases to overweight or obesity were observed in 9% (16/181) and 5% (3/57). Small changes were observed in overall mean WAZ and L/HAZ through Week 48 in both trials. CONCLUSIONS: Small overall increases in BAZ were observed over 1 year among pediatric participants on dolutegravir-based ART, with most participants remaining in their baseline BAZ category. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov, NCT01302847 and NCT03760458.
Michael McKenna, Zrinka Lulic, Ann M. Buchanan et al.
Background: Exposure to cigarette smoke indoors remains a concern among children in developing countries. Smoking poses serious health risks to children, as no safe level of secondhand smoke exposure exists. Family sociocultural determinants play a crucial role in shaping household smoking behaviors, thereby influencing children’s respiratory health and nutritional status. However, evidence remains fragmented and incomprehensively mapped. Objective: This study aimed to map evidence on family sociocultural determinants of household tobacco smoke exposure and their association with respiratory disorders and stunting among children aged 0–59 months in developing countries. Methods: This scoping review searched PubMed, ScienceDirect, Wiley Online Library, and Google Scholar for original studies published in English between 2015 and 2025 in developing countries. Eligible studies involved children aged 0–59 months or their caregivers/households exposed to cigarette smoke and examined family sociocultural determinants of smoking related to respiratory and nutritional outcomes. Irrelevant studies were excluded, and data were descriptively analyzed. Results: Eleven articles were included: 10 country-specific and 1 multi-country study, representing 9 unique countries. Country-specific studies were from India (4), Indonesia (2), South Africa (1), Albania (1), Malaysia (1), and Turkey (1), while the multi-country study included Cambodia, Indonesia, Lao PDR, and Timor-Leste. Studies showed that family sociocultural determinants influence children's exposure to secondhand smoke and increase the risk of respiratory disorders and stunting. Evidence on family-based interventions remains limited. Conclusion: Family sociocultural determinants shape tobacco smoke exposure and its adverse effects on children’s respiratory and nutritional health. These findings support culturally appropriate health promotion strategies and community midwifery policies.
Pascoela da Costa de Jesus Xavier, Dewi Rokhanawati, Ismarwati Ismarwati
We examine the effect of racial diversity on child stunting and underweight in post-apartheid South Africa, which has a strong history of systemic racial segregation. Using five waves of longitudinal data from the National Income Dynamics Survey (NIDS), and employing instrumental variable and propensity score matching methods, we find that racial diversity significantly reduces child stunting and underweight. This result is consistent across alternative measures of racial diversity, child stunting and underweight, and is also robust to different endogeneity-correction methods. The negative effect of racial diversity on child stunting and underweight is more pronounced among children under 5 years of age. Further analyses highlight increased employment opportunities, food expenditure per capita and financial inclusion as important channels through which racial diversity decreases stunting and underweight. We discuss the policy implications of these findings.
Isaac Koomson, Clifford Afoakwah, Martinson Ankrah Twumasi
AbstractCovid-19 posed little danger to children. Nevertheless, the South African government imposed lockdown measures that impeded children’s education, play and food. Schools were closed, feeding schemes were halted and organised sports were banned. In this study of South African children’s experience during the 2020–22 pandemic, we use the capabilities approach, particularly Nussbaum’s ten capabilities, to assess how the lockdown measures affected their development. The one-dimensional nature of the government response was evident in its focus on physical health and safeguarding adults and the health system, at the expense of children’s well-being. Children were masked and their voices were not heard. Despite being far less at risk of illness or death than adults, children and young people were disproportionately affected by government regulations. Children from low-income environments were particularly severely affected.
Lochner Marais, Abraham Matamanda, Frances Gbadegesin et al.
The South African family well-being is compromised by issues of child neglect, paternal absence, and gender-based violence (GBV), among other issues. The institution of family and its well-being are undergoing significant transformations globally, and South Africa is not exempt from these changes and challenges. Furthermore, the impacts of globalisation and urbanisation have forced many families to relocate from their native communities, driven by economic, political, and social motivations. From a Christian theological perspective God ordains families for flourishing; love, unity, and provision reflect His will through care (Psalm 127:1; Joshua 24:15; Ephesians 5:25). As familial structures and dynamics develop, their well being may adapt to remain relevant to societal needs, deliver effective care, and function as a social buffer against these detrimental and destructive issues. This research explored these realities through an interdisciplinary lens, recognising that improving family well-being requires collaboration between different disciplines. Drawing on contemporary theories and frameworks, it highlighted culturally responsive, contextually grounded, and strength-based approaches to understanding and supporting families in crisis. The discussion emphasised the importance of integrating professional practice, community-based support, and policy reform to promote protective and nurturing environments for children. Situating the South African experience within a global perspective, the research offered insights into how evidence-informed and collaborative interventions can enhance resilience, restore family functioning, and build more equitable systems of care. Ultimately, it called for collective responsibility and innovative, multidisciplinary responses to address the persistent social and structural factors threatening South African children and families’ well-being.
Purpose This study aims to investigate the livelihood approaches, socio-economic effects and challenges related to informal waste collection, focusing on informal women waste collectors in rural QwaQwa, South Africa. It addresses gaps in gender and rural–urban divides by positioning these women as active place-makers who, through their daily practices, transform marginalised rural spaces into cleaner, more functional and resilient environments. This spatial agency supports household survival, inclusive rural development, and reduced vulnerability while advancing circular economy principles. Design/methodology/approach Grounded in the sustainable livelihood framework (SLF) and place-making theory, the study adopted a qualitative case study design. Data were collected through focus group discussions, interviews, field observations and secondary sources and analysed thematically. Findings Informal waste collection serves as a vital livelihood strategy for women in rural QwaQwa, driven by poverty and unemployment. Leveraging social networks, local knowledge and child collaboration, these women generate income and contribute to sustainable waste management. Critically, their everyday practices of waste recovery actively reshape rural landscapes, reducing illegal dumping, improving public spaces and fostering environmental stewardship, positioning them as unrecognised place-makers. However, earnings remain insufficient for resilient livelihoods, and they face significant challenges including resource scarcity, institutional neglect, social stigma, child labour concerns and exposure to violence. Research limitations/implications This research examines rural QwaQwa as a case study, limiting the generalisability of its findings to other rural areas in South Africa and beyond. Nonetheless, it provides insights into women’s roles in informal waste collection, its impact on livelihoods and the relevance of the SLF in analysing gendered livelihood systems. The integration of SLF and place-making theory provides a novel lens for understanding how marginalised women exercise spatial agency to build more sustainable rural places. Practical implications The study highlights the need for policy changes to integrate women who collect waste informally into formal waste management systems. Providing equipment, infrastructure and capacity-building programmes enhances their income, productivity and safety while reducing exploitation. Empowering these women supports rural livelihoods and promotes poverty alleviation, gender equity and environmental stewardship through initiatives like formal registration and participatory policy forums. Social implications The results highlight significant societal issues like stigma, gender inequality and child labour. Addressing these through awareness campaigns, social protection programmes and inclusive governance can enhance the dignity and well-being of women in the informal sector. Originality/value This study makes a novel contribution by foregrounding rural contexts and demonstrating the interconnectedness of informal waste collection, gender, livelihoods and place-making in QwaQwa. Guided by the SLF and place-making theory, it reveals how women transform passive survival strategies into active processes of spatial transformation, generating income alongside broader social and environmental value. This nexus offers a framework for reducing vulnerability and promoting inclusive rural development.
