Development of an acceptable indigenous food diet for Pedi children under five years in early childhood development centers in rural Limpopo, South Africa.

BACKGROUND The use of indigenous food (IF) such as green leafy vegetables and fruits in rural communities has been the primary source of their diet despite being replaced by food high in sugar and fats. South Africans are over-reliant on maize and should diversify their diets to include more indigenous fruits and vegetables to improve nutrition. Early Childhood Development (ECD) centers positively influence healthy eating among children under five years. This study aimed for ECD stakeholders to co-create an IF diet for children under five in ECD centers. METHOD A sequential explanatory mixed-method design was employed. We conducted focus group discussions with stakeholders using the community-based participatory research (CBPR) approach and the nominal group technique ranking method to develop children's acceptable indigenous food diet. Data were analyzed using both qualitative and quantitative methods. We employed a thematic approach to analyze data using a Consolidated Framework for Implementation Research (intervention characteristics, inner setting, outer setting, individuals involved in implementation, and the implementation process. We used statistical analysis to analyze quantitative data collected through surveys. RESULTS Participants developed an IF diet. Participants were six ECD stakeholders (ECD managers, social workers, and dieticians) aged 34-52. Participants identified and voted for Ditokomane, Oranges, Mabele soft porridge, Dithotse, and Dinawa as components of an IF that are suitable and acceptable for children under five years as an IF diet appropriate and adequate for children under five years ECD centers will implement. CONCLUSION Implementation of the developed IF diet can be considered an intervention towards achieving the United Nations Sustainable Development Goal 2 to end hunger, achieve food security and improve nutrition and sustainable agriculture. The study suggests that the IF diet could scale up the use of IF to fulfill dietary requirements for children under five years and preserve indigenous knowledge.