Feeding practices, growth and micronutrient status (iron, vitamin A and iodine) among breastfed infants younger than 12 months in Thulamela Municipality, South Africa: a cross-sectional study protocol

Abstract

Background Adequate infant nutrition is essential for optimal growth, cognitive development, and overall health. Although breastfeeding is the recommended source of nutrition during infancy, micronutrient deficiencies, particularly iron, vitamin A, iodine deficiencies, and anaemia, remain major public health concerns in developing countries. In South Africa, especially in rural communities, limited information exists on breastfeeding practices and the micronutrient status of breastfed infants and their mothers. This study aims to assess feeding practices, growth patterns, and the prevalence of iron, vitamin A, and iodine deficiencies among breastfed infants younger than 12 months in Thulamela Municipality, Limpopo Province. Methods A quantitative cross-sectional study will be conducted among breastfeeding mothers and their infants aged less than 12 months attending selected primary healthcare facilities in Thulamela Municipality. Based on a prevalence estimate of 13.1%, a 95% confidence level, and a 5% margin of error, a minimum sample size of 175 participants was calculated. After accounting for a 10% non-response rate, 193 mother-infant pairs will be recruited using a multistage sampling procedure. Data collection will include interviewer-administered questionnaires, anthropometric measurements, and biochemical analyses. Information on sociodemographic characteristics and breastfeeding practices will be obtained through structured questionnaires. Maternal and infant anthropometric measurements will be recorded, while haemoglobin concentration will be measured using the HemoCue® Hb 201+ Analyzer. Serum biomarkers of iron, vitamin A, iodine status, and inflammation will be analysed using the Q-Plex™ Human Micronutrient Array. Data will be analysed using SPSS. Results and Conclusion : The study is expected to determine the prevalence of iron deficiency, anaemia, vitamin A deficiency, and iodine deficiency, describe breastfeeding practices and growth patterns, and explore associations between maternal and infant nutritional status. Findings will provide evidence to guide nutrition interventions, breastfeeding promotion strategies, and public health policies aimed at improving maternal and child health in rural South African communities.