Young children’s mental well-being in vulnerable South African settings: qualitative insights for Mazi Umntanakho co-design

Abstract As part of the co-design process for the development of the Mazi Umntanakho (‘know your child’) digital tool, this study aimed to capture community perspectives of the risks and protective factors for social emotional development and mental health of young children in vulnerable South Africa settings, through the lens of the nurturing care framework. Twenty focus group discussions (n = 154, 97% female) were held with staff of community-based organisations (CBOs) and community health worker (CHW) programmes in urban and rural sites from four geographical regions. Data was analysed thematically, and grouped according to components of nurturing care (responsive caregiving, safety and security, good health, adequate nutrition, opportunities for early learning) and risk and protective factors. Risks far outweighed protective factors, and the most dominant theme identified was risks associated with responsive caregiving from CBO and CHW perspectives. These related to caregivers’ attitudes, knowledge, beliefs, behaviours, and challenges not conducive to the provision of responsive caregiving. The most common risk to safety and security was substance abuse, along with economic challenges, neglect, abuse and violence. Basic needs not being met was the main risk to adequate nutrition and good health, followed by insufficient services. Limited resources and caregivers’ limited education and literacy were risks to early learning. These findings highlight the urgent need to mitigate risks and amplify protective factors for the social emotional development and mental health of young children in South Africa. It is critical that these are considered within the contextual realities of vulnerable communities.