article · F1000Research
Caregivers in rural Mount Fletcher, South Africa, recognise core child-survival interventions such as immunisation, exclusive breastfeeding, hygiene, nutrition, and regular clinic visits. While mothers and primary caregivers express positive attitudes towards healthcare staff and health promotion services, significant obstacles hinder consistent uptake. These include poverty, the cost and distance of travelling to facilities, long waiting times, and shortages of clinic personnel. Traditional and cultural beliefs also continue to shape health-seeking practices. Although basic understanding of biomedical advice is present, practical barriers prevent families from fully using available services. Improving uptake of child mortality reduction strategies in such rural settings requires targeted community health worker outreach, remedies for operational clinic constraints, and direct engagement with traditional and community leaders alongside formal health education.
Preventable child mortality remains high in under-resourced rural areas despite existing public health campaigns. Demonstrating that caregivers already understand and value key health practices highlights that awareness alone does not ensure uptake. Identifying practical bottlenecks, such as transport costs, clinic delays, and cultural factors, helps public health authorities design realistic interventions that make essential maternal and child services genuinely accessible.
The abstract does not describe a commercial product or technology pathway, focusing instead on public health delivery and policy in rural communities. However, the findings can inform the design of healthcare delivery programmes, community health worker communication tools, and rural clinic workflow management systems. Potential users include regional health departments, non-governmental organisations, and public health programme planners seeking to adapt maternal and child health interventions to resource-constrained rural settings.
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Background Child mortality remains a major public health challenge in low- and middle-income countries, with Sub-Saharan Africa carrying a disproportionate share of the global burden. In South Africa, rural and under-resourced areas such as Mount Fletcher in the Eastern Cape continue to record high rates of preventable under-five deaths. The effectiveness of national and provincial health promotion strategies depends heavily on local awareness, acceptance, and participation, yet little is known about how caregivers in rural communities such as Mount Fletcher understand and experience these interventions. Objective To explore the awareness and perceptions of health promotion strategies among caregivers to reduce child mortality in Mount Fletcher, and to identify the barriers and facilitators influencing their uptake. Methods A qualitative descriptive study was conducted among 20 mothers and primary caregivers of children under five years attending Taylor Bequest Clinic in Mount Fletcher, Elundini Local Municipality. Participants were selected through purposive sampling and took part in semi-structured, audio-recorded interviews conducted in isiXhosa or English. Data were transcribed verbatim and analysed thematically using ATLAS.ti (version 8), guided by the Health Belief Model. Results Participants demonstrated good awareness of core child-survival interventions, including immunisation, exclusive breastfeeding, nutrition, hygiene, and clinic attendance, and generally held positive attitudes toward health promotion services and healthcare workers. However, participants identified substantial barriers to the uptake of these strategies, including poverty, transport costs and distance to health facilities, long clinic waiting times and staff shortages, and the continued influence of traditional and cultural beliefs on health-seeking behaviour. Conclusion Caregivers in Mount Fletcher are broadly aware of, and hold favourable attitudes toward, child health promotion strategies, but structural, economic, and cultural barriers continue to limit their consistent use. Strengthening community health worker outreach, addressing health system constraints, and engaging traditional and community leaders alongside biomedical health education may help translate existing awareness into more consistent uptake of child mortality reduction interventions in similar rural South African settings.
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DOI: 10.12688/f1000research.187010.1
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