A qualitative study was conducted to explore mothers’ insights on the growth of schoolage children in a rural Health and Demographic site of Limpopo Province, in South Africa. The participants were selected using purposive sampling. Data were collected from seven focus group discussions, which were audio-taped and transcribed verbatim. NVivo10 was used to analyse interview transcripts, following qualitative thematic analysis. Fifty-four mothers aged between 27 and 52 years were interviewed. Unfavourable sociodemographic status with poor living conditions of mothers were observed, particularly in terms of unemployment, minimal tertiary education, and rural locality. The perceptions of mothers on child growth linked growth of their children to various factors such as poverty and socioeconomic status, genetic/family heredity, and household environment. Mothers further related child growth to purchasing power and decisions regarding types of food, food unavailability, affordability issues, feeding beliefs and practices; and child food preferences, school feeding schemes, and maternal and societal cultural beliefs and practices. Despite their concerns, mothers perceived that their children were growing well, but differently. It is worth noting that the views of mothers on child growth were up to their aptitude level and might have been restricted due to their level of education and rural locality. Hence, there is a need for novel information, education, and communication strategies to effectively reach mothers, especially in rural areas, regarding the importance of identifying children with growth failure and its prevention. Mothers should be able to identify when a child is affected by growth failure and to seek healthcare, in order to prevent children from progressing to severe forms. This study informs on the timing of nutritional interventions for children and context-specific health promotion and health education programs to improve the knowledge of mothers on child growth.
The current study was nested within a larger study that investigated growth patterns (i.e., malnutrition) and sociocultural beliefs and practices in Dikgale, Limpopo Province: A mixed method study of primary school children and their mothers (Doctoral thesis) [51]. This paper reports on a qualitative strand, which explored the mothers’ influence and views on growth and nutrition of school-age children in the study site. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) [52,53]. The importance of using various approaches to analyse the drivers of growth failure, ranging from household surveys to qualitative approaches and mixed methods research has been recognized [54], but there is a gap in literature regarding qualitative insights of mothers on the growth of school-age children. Hence, use of a qualitative approach as one of the methods in a larger study enabled us to produce an in-depth understanding of mothers’ opinions on growth of school-age children from a rural context [55]. Papers on a quantitative strand from a larger study have been published [56,57,58]. The study was conducted in a rural Dikgale Health and Demographic Surveillance System Site (Dikgale HDSS site or DHDSSS) described in detail by Alberts et al. [59]. Briefly, Dikgale HDSS site is situated approximately 40 km north-east of Polokwane, the capital city of the Limpopo Province, in South Africa. The area comprises of communities clustered in 16 villages with a population of approximately 36,000 and has poor infrastructure [59]. There are 19 public primary schools under the Dimamo Education Circuit in the villages forming part of the Dikgale HDSS site [39]. Fifty-four mothers of school-age children who participated first in the quantitative strand participated in seven focus group discussions (FGDs). Mothers of school-age children were recruited telephonically, using the contact details they provided during a quantitative component, and interviewed about the growth of their school-age children. This is because mothers spend considerably more time with their children than fathers do, hence, in most cases, they are held more accountable for the health, nutrition, growth, and development of their children [60,61,62]. A semistructured interview guide (see Supplementary Materials) was self-developed and informed by the conceptual framework, which combined the UNICEF framework of child malnutrition and the Bronfenbrenner’s socioecological model, as explained earlier, to address the objectives of the larger study. The discussions were focused on the mothers’ insight on growth and nutrition of school-age children. The interview guide was developed in English and translated into a local language (i.e., Sepedi). The interview schedule consisted of open-ended questions covering topics such as understanding about growth of school-age children and opinions on how food and feeding practices affect child growth. Further questions were on the adequacy of food on a daily basis at home or at school, opinions on types of foods, the beliefs that influence which foods to eat, and the views on the way culture prescribes the kinds of foods for children. The tool was pretested, revised, and translated back to English. The guide consisted of seven questions, which were modified as the data collection proceeded. The enquiry exchange between the researcher and the participants was well-managed. In addition, follow-up questions and predefined probes were asked in response to the responses given by the participants. Each FGD consisted of 6–12 members, took approximately 60–90 min, and was recorded with the consent of the participants, which was obtained before the interviews took place. A facilitator moderated the discussion while a notetaker took handwritten notes. Data saturation was reached when there was enough information obtained from the FDGs to replicate the study, when the ability to obtain additional new information was attained, and when further coding was no longer feasible, as we frequently obtained repeat/identical information The FGDs were conducted in school classrooms or quiet places allocated by the school. In case the school had no free classroom, FGDs were conducted at the kraal of the local chief, where there was a community building with quiet rooms. In addition, sociodemographic variables included age, marital status, education level, unemployment status, income, access to social grants, and household information. An experienced transcriptionist transcribed verbatim all the interviews from the audio files that used the language of the participants to best represent the dynamic nature of the living conversation. Transcripts were translated into English and reviewed by the researcher to ensure their accuracy and that no meaning was lost between the transcription and the translation. Thematic analysis was used to analyse data [63]. First, transcripts were read by the researcher to familiarize and immerse herself with the data to the extent of being familiar with the depth and breadth of the content. Second, the initial codes were generated from the data using manual coding of a few transcripts. Then followed the development of the codebook, where the themes were reviewed, refined, and named. The themes were given definitions that determined the essence of what each theme was about and determined what aspect of the data each theme captured. Once the codebook had been developed, consensus about the themes was reached between the researcher and the supervisor. Then, the transcripts were imported into NVivo QSR version 11 (QSR International, Melbourne, Australia), for storage and organization of files such as interview transcripts, field notes, and interview summaries. The findings were presented in themes and quotations that reflected mothers’ views regarding the growth and nutrition of school-age children. To ensure rigor, data was analysed by the author and a qualitative expert to reduce the effect of researcher bias, and to ensure that the interpretations were free from bias and the conclusions were credible. The study employed investigator triangulation, whereby the FGDs were facilitated by the researcher, the supervisor, and the moderator—who is an experienced qualitative researcher. Further strategies were used to ensure that the results were credible, and the researcher maintained a reflective attitude throughout the data collection and analysis process [64]. This study received ethical clearance from Sefako Makgatho Health Sciences University Research and Ethics Committee (SMUREC) (SMUREC/H/161/2016: PG). Participation was voluntary and the participants provided written informed consent. The researcher used pseudonyms to report the data and maintained confidentiality at all times.
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