Strategies to Promote the Integration of Fermented Foods in the Daily Diet to Improve Children's Health in Capricorn District, South Africa: A Mixed Method Study Protocol.

Child health remains a critical global public health concern, with malnutrition, diarrhea and pneumonia consistently driving high morbidity and mortality rates among children under the age of five. The World Health Organization (WHO) estimates that malnutrition accounts for approximately 3.1 million child deaths annually. In South Africa, persistent challenges such as stunting, micronutrient deficiencies, and food insecurity remain prevalent, particularly in rural communities, despite the existing interventions. Fermented foods present a culturally acceptable, affordable, and sustainable strategy to address malnutrition and improve gut health, potentially reducing stunting and diarrheal diseases. This article presents a protocol for a future four-phase mixed-method study that will be conducted to develop and validate strategies to promote the integration of fermented foods into children's daily diets. The researchers will employ an exploratory sequential mixed methods design in three phases for the purpose of the envisaged study: bibliometric analysis, qualitative inquiry through in-depth interviews with caregivers and nurses, and a quantitative survey developed from qualitative findings. By combining qualitative and quantitative data, the study seeks to generate evidence-based, context-specific strategies for policy and programmatic integration. The anticipated outcome is a framework to support the inclusion of fermented foods in child nutrition programs to ensure the improved child health and progress toward the United Nations Sustainable Development Goals (UN SDGs).