A Qualitative Study of Maternal and Caregiver Perceptions of Dietary Practices Contributing to Undernutrition Among Children Under Five in Ngqeleni, Eastern Cape

Background: Undernutrition among children under five years remains a major public health challenge, particularly in low- and middle-income countries and rural communities where poverty, food insecurity, and limited access to health services persist. Maternal and caregiver perceptions play a critical role in shaping feeding practices and health-seeking behaviours that influence child nutritional outcomes. Objective: This study explored mothers’ and caregivers’ perceptions of factors contributing to undernutrition among children under five years in a rural community of Ngqeleni, Eastern Cape, South Africa. Methods: A qualitative descriptive study was conducted at a primary healthcare clinic in the Ngqeleni sub-district. Purposive sampling was used to recruit mothers and caregivers of children under five years. Data were collected through seven in-depth interviews and three focus group discussions involving a total of 25 participants. Interviews were conducted using a semi-structured guide and analyzed thematically. Results: Five major themes emerged: caregivers’ perceptions of nutrition, household food insecurity and unemployment, limited dietary diversity, culturally influenced feeding practices, and gaps in practical nutrition knowledge. Caregivers demonstrated concern for child nutrition but described constrained feeding choices shaped by poverty, reliance on social grants, environmental challenges, and limited access to diverse foods. Environmental challenges such as drought and lack of piped water further limited food production. Limited nutrition knowledge and reliance on informal information sources contributed to suboptimal feeding practices. Conclusions: Undernutrition in this rural setting is shaped by a complex interaction of economic hardship, environmental constraints, and limited caregiver knowledge. Community-based nutrition education, strengthened primary healthcare counselling, and multisectoral interventions addressing poverty, water access, and food security are essential to improve child nutrition outcomes.