Due to its health benefits, Indigenous food (IF) plays an important role in people’s diets. Adequate intake of fruit and vegetables has been related to a reduced risk of many non-communicable diseases worldwide (1). Several studies conducted in Sub-Saharan Africa on the benefits of their intake has on nutrition reported that IF is a major source of nutrients, essential for proper growth and development of children and useful in treating micronutrient deficiencies (1–4). A 2014 quasi-experimental study conducted by Masuda in Zambia on the effectiveness of spirulina in child malnutrition revealed the effectiveness of its consumption on improving nutritional status, linear growth and addressing severe stunting in children (5). However, under nutrition persists, especially in rural Sub-Saharan Africa where one in three children are chronically malnourished and micronutrient deficiencies prevail (6). According to a 2018 Global Nutrition report, about a third (30,3%) of school-aged children do not eat any fruit daily (7). The same report revealed that in Africa 40% of children are stunted, 27% are wasted and 24% are overweight (8). The 2019 United Nations Children’s Fund (UNICEF) report revealed that one in three under-five children are not growing well. This is despite the national development plan (NDP 2030) target to eradicate micronutrient deficiencies through nutrition interventions for children (NDP 2030). Provision of adequate, diverse and nutritious food at an early age is crucial for malnutrition prevention (9).
South Africa experiences a malnutrition burden among its under-five population, showing that micronutrient deficiency is still rife despite concentrated efforts to curb it (10). Coinciding with the burden of under nutrition is the increasing prevalence of overweight and obesity as well as diet-related non-communicable diseases (11). Some studies show that the diet given to children in most South African rural areas lacks variety and falls short of recommended quantities of fruit and vegetables and other protein-rich food, resulting in poor nutrition (6, 12). It is important to note that a decline in the dietary use of IF and its replacement with westernized fatty foods has been linked to the increase in micronutrient deficiencies (13). The South African Food Based Dietary Guidelines (FBDG) report that in South Africa diets given to children are energy dense from highly processed, micronutrient-poor convenience foods and contribute to mordility and mortality (10).
Poor feeding practices with insufficient quantity and inadequate quality of nutritious food is a threat to the health and nutrition of children (14). This is contrary to the FBDG recommendation of daily consumption of a variety of fruit and vegetables among children (10). Verstraeten et al. (2014) also reported that taste and preparation methods of IF have an important impact on preference and consumption of IF among children (15). Indigenous knowledge is fast eroding and the skills of preparation, preservation, processing and storage of IF are diminishing (16). Given this loss of knowledge, preference for ready-to-eat-food has grown and is a significant barrier to healthy eating (15).
Food insecurity continues to put children in a vulnerable state of poor nutritional outcomes due to inadequate diets (17). Improving food security and improving nutrition is at the heart of the Sustainable Development Goals (SGDs) Food and Agriculture Organization (FAO, 2016B); SDG 2 seeks to end hunger, achieve food security, improve nutrition and promote sustainable agriculture; SDG 3 aims to ensure healthy lives and promote well-being for all ages (18). It is a challenge to achieve SDG 2 and 3 without addressing nutrition (Global report 2019). The UNICEF child and nutrition report, 2019, showed that poverty is at the heart of malnutrition; diets of poor people are missing whole grains, fruit and vegetables and omega-3 fatty acids. In 1995, the FBDG became part of the FAO/World Health Organisation (WHO) strategy to promote appropriate diets through recommendations of optimal dietary patterns and healthy lifestyles (10). Though the FBDG recommendations were made, little is known of their successes and failures (10). Furthermore, the analysis of sustainable diets and food systems has predominantly focused on high-income countries and overlooked the relevance of resource-limited settings (11). Given this background, our study seeks to assess the effects of an IF diet on nutritional outcomes for under-five children in rural ECD centres. Implementation of this diet will promote and scale up the frequent use of IF in rural ECD centres. This dietary menu will ease financial burdens for food for both ECD centres and the Department of Social Development, responsible as funders, as IF is less expensive and accessible.