South African consumer knowledge of the current paediatric food-based dietary guidelines

The co-existence of undernutrition, overnutrition, and micronutrient deficiencies constitutes what is known as the Triple Burden of Malnutrition. While the perception may persist that this phenomenon predominantly affects lower-income communities within developing nations, it is crucial to acknowledge its impact on consumers across all settings. Contributing factors extend beyond resource scarcity, often related to lower-income groups, and also encompass a lack of awareness of proactive measures. Within the framework of the United Nation’s second Sustainable Development Goal (SDG) the “Zero Hunger” initiative strives to reduce the Triple Burden of Malnutrition by 2023. However, this goal will largely be missed if current consumer ignorance toward proactive measures endures. The Paediatric Food-based Dietary Guidelines (PFBDGs) are available to caregivers as an educational tool that has the potential to make targets, such as the second SDG, more realistic. Among the most vulnerable to the Triple Burden of Malnutrition are young children aged 0-5 years, whose nourishment directly depends on their caregiver’s competence toward feeding. Although there are various proactive measures in place, such as the abovementioned guidelines, caregivers often put the health of young children at risk due to overestimating their abilities. The situation is described by the Dunning-Kruger Effect (DKE), which is a cognitive bias whereby people with low capability regarding a certain domain tend to overestimate their abilities or knowledge. The DKE theory suggests that overconfidence gradually decreases as one’s accurate knowledge of a specific topic of interest increases. A threshold is eventually reached, where confidence and competence increase in a favourable direction and limitations are recognised and admitted. DKEs can be harmful, especially in the light of young, vulnerable children. Such occurrences will consequently contribute to the country’s prevalence of the Triple Burden of Malnutrition. This study therefore aims to investigate the possibility of DKEs amongst South African caregivers when it comes to young child feeding by comparing their subjective knowledge with objective knowledge (i.e. the PFBDGs). If the subjective evaluation surpasses objective criteria, a DKE is recognised, which underscores the need for consumer education of proactive measures, such as the PFBDGs, in this context. A structured, self-administered questionnaire was designed and distributed to consumers electronically through a link that could be accessed on an internet-connected device. Data was conveniently collected throughout Gauteng by strategically focusing on areas with a significant concentration of participants meeting the predefined inclusion criteria. The inclusion of the sample was driven by the prerequisites of being a caregiver of one or more children under the age of five, residing in Gauteng, and being over 18 years old. Overall findings indicate that the vast majority of consumers were largely unaware of the PFBDGs. A significant 61% of consumers reported their unfamiliarity with the PFBDGs, highlighting a crucial requirement for heightened awareness efforts. It is essential to make this proactive approach better available to ensure all consumers can fully capitalise on its benefits. Retailers bear a corporate responsibility of assisting consumers in making well-informed decisions. An effective strategy is to enhance the accessibility of the PFBDGs to consumers by incorporating direct links to the guidelines on the packaging of food intended for young children. Subjective knowledge scores were collected with a 5-point Likert scale, and consumers were asked to rate their level of knowledge out of five for each dimension of the PFBDGs. The objective knowledge of the PFBDGs was tested with a 5-point ‘true’ or ‘false’ questionnaire. This approach enabled the calculation of total mean scores i.e. subjective knowledge and percentage scores i.e. objective knowledge which received a rating ranging from poor to excellent. The outcomes facilitated a comprehensive comparison to determine whether an overall DKE existed. The investigation delved into each dimension of the PFBDGs, allowing for a detailed comparison between subjective and objective knowledge to pinpoint specific areas where DKEs may be present. Interferential statistics strengthened these results through ANOVAs and Multiple Comparison tests. This analytic approach not only facilitated the identification of possible influential factors or predictors of consumers’ subjective and objective knowledge but also enabled the precise identification of demographic groups with a heightened requirement for education on proactive measures. Overall, the subjective knowledge outcome (M = 3.2) was aligned with the objective criteria (58.9%), and both knowledge fields across all dimensions were of average quality. The key findings from the subjective knowledge assessment indicated that a significant number of respondents held an inflated perception of their knowledge. Respondents seemed to rate their knowledge of the Feeding Practices (M = 3.26) and Hygiene (M = 3.6) dimensions of the PFBDGs as higher than average. Nonetheless, a contrast emerged when comparing the subjective evaluations with the objective knowledge scores. The latter provided an accurate reflection of the consumers’ actual knowledge which was of poor quality for Feeding Practices (46.23%) and average quality for Hygiene (52.08%), suggesting DKEs within these fields. In essence, even though an overall DKE was not determined, an overestimation of knowledge was particularly identified within the Feeding Practices and Hygiene fields. The study’s outcomes inspired focus toward policymakers to adhere to their corporate responsibility by focusing education on the identified fields most in need of intervention. By tackling concern areas in young child feeding, targets such as the Zero Hunger SDG can significantly be amplified. This can lead to a reduction in the harsh effects of the Triple Burden of Malnutrition among South Africa’s youngest and most vulnerable generation. Keywords • Dunning-Kruger Effect • Objective Knowledge • Subjective knowledge • Sustainable Development Goals (SDGs) • The Paediatric Food-based Dietary Guidelines (PFBDGs) • Triple Burden of Malnutrition