Factors affecting the choices made by primary caregivers during the complementary feeding transition period, KwaZulu-Natal, South Africa

Background: Complementary foods are required to be given timeously, in adequate amounts, prepared safely and must be nutritious. Caregivers play a vital role in ensuring that the complementary feeding transition and beyond happens optimally to achieve normal growth and development in their children. Objective: The aim was to explore what factors influenced the primary caregivers’ choices during the complementary feeding transition period. Methods: A cross-sectional qualitative study was conducted using focus-group discussions and interviews with caregivers of children enrolled in the Optimal Child Growth and Development (OrCHID) study, which included participants from the Mother and Child in Environment (MACE) cohort and SONKE mother and child cohort. Results: During the analysis of the focus-group discussions (FGDs) and interviews, nine themes were identified including: (i) starting complementary feeding; (ii) food choices; (iii) family meals; (iv) food preparation methods; (v) meal composition; (vi) texture; (vii) education source; (viii) food source; and (ix) nutrition knowledge. These themes and the key concepts associated with them were categorised into timing and transition, meal preparation, and knowledge and choices. Conclusion: The caregivers relied largely on advice from family members who advised on their customs and cultural belief systems, which then impacted when the caregivers started complementary foods, food choices, texture, meal composition and transition to family meals. The caregivers sourced complementary foods based on accessibility, convenience and affordability. The caregivers described having a responsive feeding style, where their decisions were influenced by their sensitivity to how their child was responding emotionally and/or physically to the foods they were receiving. Keywords: focus group discussion, complementary feeding practices, caregivers