Meal provisioning at early childhood development (ECD) centres: Perceptions and practices of caregivers and ECD staff in Gauteng Province, South Africa

Abstract

Background
Early Childhood Development (ECD) centres serve as a strategic setting to stimulate young children's healthy eating habits. Discrepancies in food provisioning practices of caregivers at home and ECD staff can jeopardise efforts to eradicate malnutrition in young children.
Objective
To describe and compare caregivers’ and ECD staff perceptions of meals provided at ECD centres and feeding practices.
Methods
Design: Observational, cross-sectional descriptive study. Setting: ECD centres (N=15) in the City of Tshwane Region 1, Gauteng, South Africa. Subjects: Multistage sampling was used to select caregivers of children attending ECD centres (N=214) and ECD staff (N=45). Outcome measures: Perceptions of meals provided at ECD centres and child feeding practices were assessed by requesting participants to fill out self-administered questionnaires. Non-parametric Mann-Whitney tests compared the two groups of respondents at a significance level of 0.05.
Results
Only 40.7% of caregivers were aware of the specific foods served at ECD centres, yet all assumed the meals were healthy. ECD staff acknowledged their dual responsibility with caregivers for providing healthy meals (p= 0.011). Caregivers supported the idea of being involved in menu planning (p=0.031) and believed that ECD meals should provide at least half of a child’s daily nutrition (p=0.021). Healthy eating environments were promoted more by ECD staff than caregivers, some of whom indicated that they provided snacks whenever children asked for it (p<0.001), allowing children to eat or snack freely (p=0.002 and p<0.001 respectively); or gave food to soothe fussiness (p=0.003). Caregivers used food as a reward or punishment significantly more often by withholding sweets for bad behaviour (p=0.004) or offering favourite foods for good behaviour (p=0.013). ECD staff were more likely to discuss the importance of healthy eating with the children (p=0.026).
Conclusions
The findings suggest that there is poor communication between ECD centres and caregivers, resulting in differing views of ECD staff responsibilities. The use of different feeding practices at home and at ECD centres might confuse children. Some caregiver practices may put the child at risk of developing poor eating habits, possibly leading to obesity or malnutrition. Consistent feeding practices and the provision of a variety of foods to children, can be utilised to support healthy eating. Continuous training in the implementation of the ECD nutrition guidelines and particularly in the upscaling of interventions to educate caregivers is crucial to foster healthier eating habits among young children.