Young Children In South Africa Research Articles

The reliability and validity of the isixhosa version of the euroqol toddler and infant populations (EQ-TIPS) health related quality of life instrument.

Considering the high burden of disease in young children measurement of Health-Related Quality of Life is needed to evaluate the burden of morbidity. This study aims to report on the validity and reliability of the isiXhosa EuroQol Toddler and Infant Populations (EQ-TIPS) measure for South Africa. A sample of 181 caregivers of children 0-36 months were recruited from a hospital in-patient (inpt) and outpatient (outpt) facility and crèches. The EQ-TIPS, Ages and Stages Questionnaire (ASQ), Faces, Leg, Activity, Cry, Consolability (FLACC) and dietary information were administered at baseline. EQ-TIPS was administered one week later in crèche children for test-retest reliability. Known groups showed significant differences for pain (X2=37.21, p<0.001), and EQ-TIPS level sum score (KWH=25.9, p<0.001) between health groups. The Visual Analogue Scale was unable to discriminate general health between groups (KW-H=3.92, p=0.141). Concurrent validity was weak to moderate and significant for all dimensions hypothesised to correlate. There was significant fair to moderate test-retest reliability for EQ-TIPS dimensions of movement, play, pain and eating. The isiXhosa EQ-TIPS is valid and reliable for very young children in South Africa and we suggest that it be included in the assessment of children with health conditions within this context.

Stories of Challenge in South Africa: changes in the enabling environment for nutrition among young children (1994–2021)

Despite important nutrition-related policy and programmatic improvements in South Africa, rates of stunting among young children remain unacceptably high, while rates of overweight and obesity in this same population group are simultaneously on the rise. This study sought to examine the changes in the enabling environment for nutrition aimed at young children in South Africa by drawing on a literature review, policy mapping, and stakeholder interviews, for the time period from the end of apartheid in 1994 to 2021. The study focuses on changes and drivers of change at national level but also in three provinces: Western Cape, North West, and KwaZulu-Natal. The study ultimately seeks to better understand the changes and challenges with regards to policy and commitment to nutrition, coordination structures at various levels, and how these led to or did not lead to implementation and impact in these provinces. The study ends with reflections on what these findings mean for food and nutrition security in South Africa going forward, as well as what they might mean for other countries with similar contexts.

The Impact of the COVID-19 Pandemic on Female Academics with Young Children in South Africa

Against the backdrop of an increase in research on the effects of COVID-19, this article uses the analysis of survey data of female academics from the 26 higher education institutions in South Africa to identify how female academics with young children coped with academic output during the pandemic-enforced lockdown. A growing body of research documents the influence of children and childcare on the careers of female academics. In this article, we see how female academics who stayed at home during the enforced lockdown period negotiated childcare and home-schooling, and how the lockdown influenced their academic output. An online survey questionnaire was administered, consisting of 12 Likert-scale questions followed by an open-ended section that solicited a narrative account of academic work and home life during the lockdown period. Data on female academics with children under the age of six years was extracted for this study. The quantitative and qualitative data that emerged from our study of 2,018 women academics at 26 universities across South Africa describes how academic mothers felt, and how they struggled to complete the academic work required by their educational institutions. Such academic work directly influences future career prospects. This study highlights the influence that the presence of young children in the home, the pressures of home-schooling, traditional gender roles, and household responsibilities have on the academic careers of women.

Exploring women’s exposure to marketing of commercial formula products: a qualitative marketing study from two sites in South Africa

ABSTRACT Background Regulating the marketing of commercial formula products is a long-term commitment required to protect breastfeeding. Marketing strategies of formula manufacturers, retailers and distributors evolve at a rapid rate. Objective The aim of this research was to describe exposure of pregnant women and mothers of young children in South Africa to marketing of commercial formula products, compared to international recommendations and national legislation. Methods Using mobile phone marketing diaries twenty participants in Cape Town and Johannesburg documented the formula marketing they were exposed to for one week. Ten mothers were interviewed to explore their perceptions towards marketing exposure in more depth. Results Women reported limited infant formula advertising, but an abundance of strategies used to market growing-up formula and powdered drinks for children over 36 months. Strategies included product packaging, in-store displays, online distribution channels and educational material about product ranges. Online strategies were reported, namely social media marketing (sponsored adverts and support groups), websites and mobile phone applications providing infant and young child feeding information and price discounts, print and TV advertisements, and competitions. Products for children over 36 months are cross-promoted with products prohibited to be advertised by national legislation. Conclusions South African women are being exposed to covert marketing of infant, follow-up, and growing-up formula. Explicit marketing of products for children over 36 months of age allows formula companies to provide messages about branding and use of commercial formula products to mothers. National legislation should be updated and effectively implemented to address changing marketing strategies.

A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study.

BackgroundThe COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries.ObjectiveThe study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa.MethodsWe used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey.ResultsMore than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2% (11,178/15,912) of respondents and fathers comprised 29.8% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8% (11,907/15,912) at the start of the survey to 50.3% (8007/15,912) at completion. A total of 82.0% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost.ConclusionsData-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children.

Perspectives of rehabilitation professionals on assistive technology provision to young children in South Africa: a national survey

Purpose Various factors influence the selection of assistive technology for young children within a context with limited resources, such as South Africa. Rehabilitation professionals are required to weigh up different factors as part of their professional reasoning process when making assistive technology (AT) selections. Insight into the perceived influence of different factors may assist in understanding how professionals make decisions about AT in this context. Materials and methods An online survey with questions designed using best–worst scaling was distributed to rehabilitation professionals throughout South Africa. Factors influencing assistive technology selection included in the best–worst survey were identified in previous phases of a larger project. A total of n = 451 rehabilitation professionals completed the survey by selecting the factors that were most and least influential on their assistive technology provision. Results Results of the survey were obtained by calculating the number of times each factor was selected as most influential across the entire sample, and across all questions, enabling the researchers to sort the items in terms of the frequency of selection. Conclusions Even though the rehabilitation professionals that participated in the study provide services in a context with limited resources, assessment and factors pertaining to the assistive technology itself were generally perceived to be of greater influence than environmental factors. It is recommended that these factors be reflected in frameworks and models of AT selection. IMPLICATIONS FOR REHABILITATION The family’s ability to support the implementation of AT is an important resource that is perceived to influence the selection of AT by an RP. Insight into the mind-set of professionals that are used to selecting AT within settings with limited resources may provide RPs in well-resourced contexts with guidance on how to do more, with less. RPs should aim to determine child preference and attitude towards AT during the AT selection process. RPs should be aware of their own influence on AT selection. Existing AT Selection models should be adapted to clearly reflect the influence of the recommending professional.

Overview of field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines amongst mothers/caregivers of children aged 0–5 years in the Western Cape and Mpumalanga, South Africa

Background: This paper provides an overview of a series of studies undertaken to assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–5 years. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: Qualitative methods were used to collect data from 38 focus-group discussions (isiXhosa = 11, Afrikaans = 11, English = 10 and siSwati = 6) resulting in 268 participants. Setting: Breede Valley sub-district (Worcester), Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) and Northern Metropole (Atlantis, Witsand, Du Noon and Blouberg), City of Cape Town, Western Cape province, as well as Ehlanzeni District (Kabokweni) in Mpumalanga province. Subjects: Mothers/caregivers older than 18 years who provided informed consent to participate. Results: The majority of participants had previous exposure to guidelines with similar messages to the SA-PFBDGs. Information sources included nurses, local clinics, family, friends and media. Possible barriers to following the guidelines included limited physical and financial access to resources; cultural/family practices, poor social support and time constraints. Outdated information, misconceptions, inconsistent messages and contrasting beliefs were evident. The vocabulary of some messages was not well understood. Education on infant and young child feeding and visual portrayal of the guidelines could aid understanding. Conclusion: A degree of rewording should be considered for improved understanding of the revised, draft SA-PFBDGs. Once adopted, the guidelines can be used to educate various stakeholders, including parents, caregivers, healthcare providers and educators, on the correct nutritional advice for children aged 0–5 years ensuring the healthy growth and development of young children in South Africa.

Flexible modelling of risk factors on the incidence of pneumonia in young children in South Africa using piece-wise exponential additive mixed modelling

IntroductionRecurrent episodes of pneumonia are frequently modeled using extensions of the Cox proportional hazards model with the underlying assumption of time-constant relative risks measured by the hazard ratio. We aim to relax this assumption in a study on the effect of factors on the evolution of pneumonia incidence over time based on data from a South African birth cohort study, the Drakenstein child health study.MethodsWe describe and apply two models: a time-constant and a time-varying relative effects model in a piece-wise exponential additive mixed model’s framework for recurrent events. A more complex model that fits in the same framework is applied to study the continuously measured seasonal effects.ResultsWe find that several risk factors (male sex, preterm birth, low birthweight, lower socioeconomic status, lower maternal education and maternal cigarette smoking) have strong relative effects that are persistent across time. When time-varying effects are allowed in the model, HIV exposure status (HIV exposed & uninfected versus HIV unexposed) shows a strong relative effect for younger children, but this effect weakens as children grow older, with a null effect reached from about 15 months. Weight-for-length at birth shows a time increasing relative effect. We also find that children born in the summer have a much higher risk of pneumonia in the 3-to-8-month age period compared with children born in winter.ConclusionThis work highlights the usefulness of flexible modelling tools in recurrent events models. It avoids stringent assumptions and allows estimation and visualization of absolute and relative risks over time of key factors associated with incidence of pneumonia in young children, providing new perspectives on the role of risk factors such HIV exposure.

Addressing the interaction between food insecurity, depression risk and informal work: findings of a cross-sectional survey among informal women workers with young children in South Africa

BackgroundThere is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability.MethodsA cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata.ResultsInterviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned < US$70 per month, and few earned > US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p < 0.001).ConclusionsInformal women workers were shown to be vulnerable with low incomes and high rates of food insecurity, thus increasing the risk for poor maternal health. However, levels of depression risk were low compared to previous estimates in South Africa, suggesting that informal workers may have high levels of resilience. Interventions to improve social protection, access to health services, and support for safe childcare in the workplace could improve the health and wellbeing of these mothers and support them to care for their children.

South African parents’ view of their role in the education of their young children in South Africa as democratic citizens

This study addressed the knowledge gap regarding South African parents’ view of their role in the education of young children as democratic citizens. The study was conducted with parents of children younger than 8 years in 2 multicultural primary schools in Gauteng, South Africa. The explanatory sequential mixed methods research design was used to collect data from parents in order to answer the research question. The quantitative data were gathered first by means of a questionnaire, and afterwards the qualitative data were gathered by means of semi-structured interviews. The research results showed that when educating their young children to democratic citizenship, participating parents consider various values of a democratic citizen as important including responsibility, respect, participation, norms and values, peacebuilding, love, loyalty, deliberations, kindness, commitment, non-racism, non-sexism, equality, reconciliation, self-control, forgiveness, compassion, tolerance, open-mindedness, a sense of belonging, rule of law and social justice. Participating parents also regard their example as democratic citizens, respect, participation and the creation of a safe, proud and free democratic society as important. They did, however, consider the media and other bad role models as challenges when educating their young children towards democratic citizenship. The most important finding of the study is the influence of negative societal and political factors on the attitudes and opinions of the participating parents. New insights that emerged from the study includes that these parents want to do their best to educate their children as democratic citizens in South Africa, in the best interest of their children as future democratic citizens, but are hindered by certain societal and political factors.

Food Insecurity and Poor Complementary Feeding Practice Among Young Children in South Africa

Food Insecurity and Poor Complementary Feeding Practice Among Young Children in South Africa

Development for children's environmental health in South Africa: Past gains and future opportunities

ABSTRACTIn poorly resourced countries children may face multiple health risks associated with environmental hazards and under-development. It is estimated that exposure to harmful environmental factors (e.g. air pollution, poor water quality and harmful chemicals) accounts for 33% of the global burden of disease, with the highest burden being borne by children. While accelerated housing and settlement development over the past two decades has benefitted hundreds of thousands of young children in South Africa, large numbers continue to face major environmental threats to their health, some of which have hitherto been neglected. Such children are likely to be particularly vulnerable to the unfolding ramifications of climate change. In this light greater urgency and momentum is needed to improve living conditions and other socio-environmental determinants of children's health in South Africa and other under-resourced countries. Children should be a central focus for policy and development as our global society strives to meet the Sustainable Development Goals.

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals

: Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group.Method: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context.Data analysis: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes.Discussion: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa.Implications for rehabilitationAssistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process.Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources.Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals.Home and school visits during assessment ensure a good match between assistive technology and users within the particular context.Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

Hierarchies of knowledge, incommensurabilities and silences in South African ECD policy: Whose knowledge counts?

AbstractPolicy for young children in South Africa is now receiving high-level government support through the ANC’s renewed commitment to redress poverty and inequity and creating ‘a better life for all’ as promised before the 1994 election. In this article, I explore the power relations, knowledge hierarchies and discourses of childhood, family and society in National Curriculum Framework (NCF) as it relates to children’s everyday contexts. I throw light on how the curriculum’s discourses relate to the diverse South African settings, child rearing practices and world-views, and how they interact with normative discourses of South African policy and global early childhood frameworks. The NCF acknowledges indigenous and local knowledges and suggests that the content should be adapted to local contexts. I argue that the good intentions of these documents to address inequities are undermined by the uncritical acceptance of global taken-for-granted discourses, such as narrow notions of evidence, western child development, understanding of the child as a return of investment and referencing urban middle class community contexts and values. These global discourses make the poorest children and their families invisible, and silence other visions of childhood and good society, including the notion of ‘convivial society’ set out in the 1955 Freedom Charter.

Adenovirus-associated pneumonia in South African children: Presentation, clinical course and outcome.

Viruses have emerged as important aetiological agents of childhood pneumonia. To investigate the clinical presentation, severity and outcome of adenovirus-associated pneumonia (AVP) in children. A retrospective analysis of AVP cases over 12 months was performed, including demographic, clinical course and outcome (death, persistent lung disease (PLD)) data. Two hundred and six AVP cases (median age 12 months, interquartile range 6 - 24) were identified; 70 children (34.0%) were malnourished and 14 (6.8%) were HIV-infected. Twenty-nine children (14.1%) developed PLD, which was associated with hypoxia at presentation in 26 cases (89.7%; p=0.01) and necessitated admission to the intensive care unit (ICU) in 18 (62.1%; p&lt;0.01); 18/206 children (8.7%) died. Admission to the ICU (odds ratio (OR) 8.3, 95% confidence interval (CI) 2.3 - 29.0) and a positive blood culture (OR 11.2, 95% CI 2.3 - 54.1) were independent risk factors for mortality. Adenovirus is a potential cause of pneumonia and PLD in young children in South Africa. ICU admission and a positive blood culture were associated with poor outcome.

Exposure to violence predicts poor educational outcomes in young children in South Africa and Malawi.

BackgroundViolence during childhood may affect short and long-term educational factors. There is scant literature on younger children from resource poor settings.MethodsThis study assessed child violence experiences (harsh punishment and exposure to domestic or community violence) and school enrolment, progress and attendance in children attending community-based organisations in South Africa and Malawi (n=989) at baseline and at 15 months' follow-up, examining differential experience of HIV positive, HIV affected and HIV unaffected children.ResultsViolence exposure was high: 45.4% experienced some form of psychological violence, 47.8% physical violence, 46.7% domestic violence and 41.8% community violence. Primary school enrolment was 96%. Violence was not associated with school enrolment at baseline but, controlling for baseline, children exposed to psychological violence for discipline were more than ten times less likely to be enrolled at follow-up (OR 0.09; 95% CI 0.01 to 0.57). Harsh discipline was associated with poor school progress. For children HIV positive a detrimental effect of harsh physical discipline was found on school performance (OR 0.10; 95% CI 0.02 to 0.61).ConclusionViolence experiences were associated with a number of educational outcomes, which may have long-term consequences. Community-based organisations may be well placed to address such violence, with a particular emphasis on the challenges faced by children who are HIV positive.

Performance of South African children on the Communication and Symbolic Behavior Scales-Developmental Profile (CSBS DP).

Substantial development in social communication skills occurs in the first two years of life. Growth should be evident in sharing emotion and eye gaze; rate of communication, communicating for a variety of functions; using gestures, sounds and words; understanding language, and using functional and pretend actions with objects in play. A delay in these early social communication skills may be the first sign of a developmental delay in young children in nearly all categories of disabilities-including specific language impairment, autism spectrum disorder, HIV/AIDS, lack of environmental stimulation or institutionalization, and global developmental delays-and early detection of these delays is critical for enrolment in appropriate early intervention services. No standardized tests of early social communication skills exist for very young children in South Africa (SA). An existing evaluation tool that has the potential to be culturally fair for children from cultural backgrounds different to the standardization group is the Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS DP). This study aimed to document the performance of a group of English-speaking SA children ranging in age from 12 to 24 months on the CSBS DP and to compare this performance with the original standardization sample. Sixty-seven English-speaking SA children from a range of cultural and linguistic backgrounds were assessed on the CSBS DP Behaviour Sample. Group scores were compared with the original standardization sample using inferential statistics. The results provide preliminary support for the suitability and validity of the face-to-face Behaviour Sample as a measure of early social communication skills in this sample of English-speaking SA children from a range of cultural groups between 12 and 24 months of age. While further research in the SA population is needed, these findings are a first step towards validating a culturally appropriate measure for early detection of social communication delays in a sample of SA toddlers.

Early childhood development in South Africa – progress since the end of apartheid

In April 1994, South Africa held its historic first democratic election. The African National Congress overwhelmingly triumphed and Nelson Mandela became the first president of a free and democratic South Africa. In this review, the situation of South Africa's young children under apartheid and the context of young children in South Africa in 2012 are described. A situation analysis of early childhood development (ECD) in South Africa was undertaken using South African government ECD policy and programme implementation reports, and the main challenges affecting children and the ECD sector in South Africa was investigated. There has been progress since 1994, both quantitatively and qualitatively. Children now have access to a Grade R year, government education and social development budgets have increased and a per capita subsidy is available to qualifying children at ECD centres nationally. More children are in provision and in better-quality provision than before. However, much still remains to be done before we can say with confidence that the needs of our youngest children are being met. This study identifies infrastructure, nutrition, ECD programmes, teacher training, institutional capacity and funding as the major gaps in ECD provision.

Behavior and psychological functioning of young children of HIV-positive mothers in South Africa

Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications. Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they are HIV positive, although they may be asymptomatic. Presently, it is unclear whether the psychological functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill, that children suffer adverse effects. We, thus, aimed to compare the behavior and psychological functioning of young children (aged 6–10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n=509) and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for socio-demographic characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had been told their mothers were sick compared with children who had been told nothing had less internalizing and externalizing behaviors and improved daily living skills. This study, therefore, provides evidence that maternal HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV status was associated with improved behavior and psychological functioning among young children.

Field-testing of guidance on the appropriate labelling of processed complementary foods for infants and young children in South Africa.

There is a lack of formal guidance from international normative bodies on the appropriate marketing of processed complementary foods. Such guidance is necessary to protect and promote optimal infant and young child feeding practices. The aim of this study was to field-test, in South Africa, the interim guidance provided by the Maternal, Infant and Young Child Nutrition Working Group's Draft Guide for Marketing Complementary Foods as a potential tool for use by manufacturers and national governments for guiding the appropriate labelling (as a subset of appropriate marketing practices) of complementary foods. This guidance was used to develop a checklist of questions and criteria for each possible answer, which was tested using a comprehensive database of labels from products purchased in South Africa from June to August 2011. One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction while 37 (23%) used images of infants appearing younger than 6 months. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer's infant formula. Only 58 (36%) labels were easy to read. The majority (69% and 92%) of labels provided instructions for safe and appropriate preparation/use and storage, respectively. The Draft Guide for Marketing Complementary Foods was found to be a useful tool for guiding the appropriate labelling of complementary foods, although some changes and additions are recommended to improve understanding, ease of use and to minimise the subjective interpretation of the guidance.