How to cite: Fagan, D 2026, ‘Integrating artificial intelligence into early childhood development: Afrocentric and inclusive approaches’, in T Moodley, S Stofile & R Govender (eds.), Holistic and inclusive education practices for young learners in South Africa: From early childhood to Foundation Phase, The University of the Western Cape Faculty of Education Book Series, vol. 2, AOSIS Books, Cape Town, pp. 63–78. https://doi.org/10.4102/aosis.2026.BK568.04
Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age. Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children. Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants’ Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human). Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2= 45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001). Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.
Background Adequate infant nutrition is essential for optimal growth, cognitive development, and overall health. Although breastfeeding is the recommended source of nutrition during infancy, micronutrient deficiencies, particularly iron, vitamin A, iodine deficiencies, and anaemia, remain major public health concerns in developing countries. In South Africa, especially in rural communities, limited information exists on breastfeeding practices and the micronutrient status of breastfed infants and their mothers. This study aims to assess feeding practices, growth patterns, and the prevalence of iron, vitamin A, and iodine deficiencies among breastfed infants younger than 12 months in Thulamela Municipality, Limpopo Province. Methods A quantitative cross-sectional study will be conducted among breastfeeding mothers and their infants aged less than 12 months attending selected primary healthcare facilities in Thulamela Municipality. Based on a prevalence estimate of 13.1%, a 95% confidence level, and a 5% margin of error, a minimum sample size of 175 participants was calculated. After accounting for a 10% non-response rate, 193 mother-infant pairs will be recruited using a multistage sampling procedure. Data collection will include interviewer-administered questionnaires, anthropometric measurements, and biochemical analyses. Information on sociodemographic characteristics and breastfeeding practices will be obtained through structured questionnaires. Maternal and infant anthropometric measurements will be recorded, while haemoglobin concentration will be measured using the HemoCue® Hb 201+ Analyzer. Serum biomarkers of iron, vitamin A, iodine status, and inflammation will be analysed using the Q-Plex™ Human Micronutrient Array. Data will be analysed using SPSS. Results and Conclusion : The study is expected to determine the prevalence of iron deficiency, anaemia, vitamin A deficiency, and iodine deficiency, describe breastfeeding practices and growth patterns, and explore associations between maternal and infant nutritional status. Findings will provide evidence to guide nutrition interventions, breastfeeding promotion strategies, and public health policies aimed at improving maternal and child health in rural South African communities.
Introduction Household food security and food preparation practices are shaped by social roles, caregiving responsibilities, and economic conditions. We examined everyday household food practices in Timor-Leste within systems of caregiving, authority, and resource constraints, and their implications for household food security and child feeding. Methods We conducted an exploratory qualitative study from August to October 2025 using semi-structured, in-depth interviews with mothers who had caregiving responsibilities for children in their households across urban Dili and the rural municipalities of Ainaro and Ermera. Data were analysed using a hybrid deductive–inductive thematic approach. A total of 34 mothers participated in the study. Results Food practices were organised through women’s caregiving roles, household decision-making, and economic constraints. Women coordinated everyday food work and maintained food adequacy even under financial strain. Food allocation followed a hierarchy but remained flexible, with children prioritised during periods of scarcity. Neighbourhood sharing functioned as an informal redistribution system shaped by reciprocity and social obligation. Ceremonial obligations reinforced social cohesion but introduced financial pressure. Meal frequency and food choices were shaped by income stability, while caregiving authority determined the prioritisation of limited resources. Food knowledge was transmitted intergenerationally, and diets combined traditional staples with selected market foods. Discussion Household food practices in Timor-Leste are shaped by caregiving roles, social relationships, and economic constraints, with implications for household food security and child feeding. These findings identify caregiving, food allocation, and adaptive responses to resource constraints as household processes potentially relevant to child nutrition vulnerability. Interventions that recognise women’s central roles in everyday food management, stabilise income, and build on reciprocal systems may support household food security and child feeding.
Md Abu Sayeed, Lesy Careca Atok, Salvador Amaral et al.
Child mortality and morbidity remain significant public health concerns in sub-Saharan Africa, with universal health coverage (UHC) for children under five identified as a critical strategy for addressing these issues. This study explored professional nurses’ perspectives on the engagement of caregivers in community- and home-based care practices as a pathway to advancing UHC in Vhembe District, South Africa. A qualitative descriptive explorative design was employed. It involved 15 purposefully selected professional nurses from two primary healthcare centres. Data were collected through semi-structured individual interviews conducted between March and June 2022 and analysed using Braun and Clarke’s thematic analysis framework. Three overarching themes and seven sub-themes emerged. The first theme highlighted the empowerment of caregivers through knowledge dissemination and enhanced decision-making capacity. The second theme emphasised active parental participation in child health, including involvement in assessments, recognition of danger signs, and utilisation of the Road to Health booklet (RtHB). The third theme addressed barriers to effective caregiver engagement, notably the influence of traditional health beliefs and literacy challenges among grandmothers. Findings revealed the pivotal role of nurses in facilitating caregiver involvement and suggest that strengthening community-based strategies may contribute significantly to achieving UHC for children under five, particularly in low- resource settings. Tailored interventions addressing cultural and educational barriers are essential to optimise caregiver participation and improvement of child health outcomes.
Adolescent mental health is an urgent global priority, yet services remain severely inaccessible throughout Southern Africa. Zimbabwean youth are particularly vulnerable to mental health challenges from adverse childhood experiences including food insecurity, sexual and emotional violence, climate change-induced disasters, and national economic difficulties but research is extremely limited. To address this gap, this study examined trauma symptoms and resilience among a large school-based sample of urban and rural Zimbabwean adolescents. A cluster randomized controlled trial was conducted to evaluate the impact of Singing to the Lions, a biopsychosocial workshop for trauma-affected youth in Zimbabwe. Adolescents were randomized by school (n = 13) to an immediate intervention arm or waitlist control arm. Baseline data, including adolescents' demographics, trauma symptoms, and resilience characteristics were analyzed to investigate the prevalence of trauma symptoms and that association with resilience characteristics. The baseline sample (n = 1,342) ranged in age from 12-18 years (x-=14.8); the majority of children were girls (54.6%) and rural (52.4%). Of 18 possible trauma symptoms, youth endorsed an average of 7.6 trauma symptoms (SD = 4.5) with significantly higher rates among girls (t[1325]=3.39, p = .0007). Trauma symptoms were significantly inversely correlated with resilience characteristics including self-esteem (r = -.36, p < .001), hope (r = -.07, p = .01), self-calming (r = -.30, p < .001), and social support (r = -.23, p < .001); however, there was no association between symptoms and self-efficacy. No statistically significant differences in trauma symptom prevalence were found based on children's age, grade, or community (rural versus urban). The high prevalence of trauma symptoms and expressions of trauma found in this study are consistent with the limited previous adolescent mental health research from Sub-Saharan Africa. Results contribute to the sparse knowledge base on trauma-affected youth and adolescent mental health in Zimbabwe more broadly and highlight the need for evidence-based practices that are culturally grounded and contextually specific for the region.
Colleen M. Fisher, Roswitta Gatsi, Natasha Venables et al.
Climate-related disasters are becoming increasingly frequent and severe, posing major threats to child health and nutrition, particularly in low- and middle-income countries (LMICs). These events disrupt food systems, health services, water and sanitation infrastructure, and caregiving practices, increasing the risk of undernutrition among children under five years of age. This narrative review synthesised current evidence on the effects of climate-related disasters on child nutrition and infant and young child feeding (IYCF) practices in LMICs. A narrative review of peer-reviewed literature published up to June 2025 was conducted using PubMed, ScienceDirect, Web of Science, and Google Scholar. Studies were eligible if they examined the association between climate-related disasters including droughts, floods, cyclones, and climate variability and nutritional outcomes or feeding practices among children under five years in LMICs. Findings were synthesised narratively because of substantial heterogeneity in study designs, exposures, and outcome measures. Eleven studies met the inclusion criteria. Most were conducted in Sub-Saharan Africa and South Asia. Droughts and floods were the most frequently investigated climate-related disasters and were consistently associated with increased risks of stunting, wasting, and underweight. Several studies also reported disruptions to breastfeeding and complementary feeding practices, worsening household food insecurity, increased maternal psychological distress, and reduced access to essential health and nutrition services following disasters. Children living in rural and resource-constrained settings were consistently identified as the most vulnerable. Climate-related disasters adversely affect child nutrition through multiple interconnected pathways, including reduced food availability, increased infectious diseases, disruption of feeding practices, and weakened health systems. Strengthening climate-resilient nutrition programmes, protecting infant and young child feeding during emergencies, and integrating nutrition into disaster preparedness and climate adaptation policies are essential to improve child health outcomes in LMICs.
Nomagugu Ndlovu, Makhosi Mahlangu, Nomagugu Minenhle Sibanda et al.
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.
