Linking Care and Support Systems to Improve Childhood Malnutrition: Early Childhood Development Practitioners’ Perceptions of Integrating Multisectoral Systems in South Africa

Introduction: Child malnutrition is a persistent global challenge. It is the cause of nearly 45% of global child mortalities. To ensure positive child health outcomes, integrated multisectoral approaches among families, communities, and government systems to ensure positive child health outcomes are neccesary. Objectives: This study identifies how different care support systems can be linked to ensure optimal childhood nutrition outcomes in South Africa. This is through multisectoral approaches from the early childhood development (ECD) practitioners' perspective. Materials and Methods: We integrated the components of the different support systems and multisectoral approaches. The conceptional framework of the causes of malnutrition by The United Nations Children's Fund (UNICEF) recognizes that malnutrition is due to inadequate care services, diet, and care practices influenced by individual, household, community, and structural determinants. While the Nurturing Care Framework, which looks at how policies and services can support families, parents, and other communities in providing nurturing care. Design: A sequential mixed methods approach was used. For the quantitative method, we did a cross-sectional descriptive analysis of 2 966 children who were under-five years' old in the 2017 South African National Income Dynamics Study (NIDS) between July and August 2022, we conducted five in-depth interviews with ECD practitioners using this qualitative method, and the data was analyzed using thematic analysis. Data was triangulated to understand the factors influencing children’s nutritional outcomes and to provide the narratives of ECD practitioners. This enabled us to highlight challenges and opportunities in linking children to services they need. Results: This study showed that 22.16% of children were stunted, 16.40% were overweight, and 5.04% were underweight. ECD practitioners reported a lack of support received at health facilities and other social services when making referrals, a lack of parental support in nutrition programmes, systemic challenges experienced in getting ECD centers registered, and the ECD's inability to qualify for subsidized nutrition grants. Conclusion: It is critical for us to understand the challenges and opportunities for multisector collaboration. This understanding will enable strategies and policies aimed at providing efficient and effective service referral and service delivery to improve childhood malnutrition in South Africa.