Perspectives From South African Dietitians On Infant And Young Child Feeding Regulations

Objective:This study aimed to determine the knowledge, perceptions and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991).Design:A mixed methods, cross-sectional design was used.Setting:Quantitative data were collected using an online survey (n 282) and qualitative data by means of two focus group discussions (n 12).Participants:Participants were dietitians registered with the Health Professions Council of South Africa.Results:Dietitians' average knowledge score was 64 center dot 8 % +/- 12 center dot 5. Those working in infant and young child feeding had a 5 % higher knowledge score (95 % CI 1 center dot 4, 8 center dot 6, P = 0 center dot 01). Perceptions towards the Regulations were generally positive, and the majority of practices were compliant. Positive perceptions seemed to correlate with compliant practices. The most frequently selected enabler to the implementation of the Regulations was 'Increase in other initiatives which support, protect and promote breastfeeding', and the most frequently selected barrier was 'Lack of awareness of the Regulation among health care providers'. The major themes from the focus group discussions comprised: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other health care providers, the dietitians' role in support and enforcement, the discrepancy between practice in private and public sectors and a lack of enforcement.Conclusions:South Africa has taken a bold step in legislating the International Code of Marketing of Breast-milk Substitutes and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations.