Public Health Nutrition: 14(5), 923–930 doi:10.1017/S1368980010003319 Diverging opinions of supplementation programmes between mothers of small children and staff at primary health clinics in the Western Cape Province of South Africa Per O Iversen 1,2, *, Elisabeth A Høisæther 2 , Marianne Morseth 2 and Marietjie Herselman 1 1 Faculty for Health Sciences, Division of Human Nutrition, Tygerberg Academic Hospital, Stellenbosch University, Tygerberg, South Africa: 2 Department of Nutrition, University of Oslo, PO Box 1046, Blindern, 0317 Oslo, Norway Submitted 22 June 2010: Accepted 20 October 2010: First published online 4 January 2011 Abstract Objective: Nutritional status has remained inadequate among disadvantaged mothers and small children in South Africa. Several supplementation programmes are administered through primary health clinics (PHC). The present study examined the perceptions of mothers who attend PHC and of the PHC staff on the purpose, management and eligibility of the vitamin A and nutritional supple- mentation components of the Nutrition Supplementation Programme (NSP). Design: Observational study based on anthropometry and questionnaires. Setting: Random selection of ten urban and ten rural PHC from the Western Cape Province of South Africa. Subjects: Mothers (n 176) and their children (n 179) aged ,5 years, and various PHC staff categories. Results: Half (56 %) of the households were classified as food insecure and about one-third of the children were malnourished, as evidenced by stunting, wasting or underweight. A majority of mothers complained about poor information related to the programmes. More than half of the children who were eligible for NSP were not included. In contrast, the staff felt that they managed both programmes well and problems with implementation were mostly attributed to clients. Conclusions: In general, the mothers expressed more dissatisfaction and ignor- ance about the vitamin A programme and the NSP than was perceived by the staff. This apparent discrepancy might, at least in part, explain why these programmes do not work optimally. Keywords Children Mothers Supplementation Primary health clinics Vitamin A Marked social differences and inequalities in health care continue to affect children’s nutritional status in post- apartheid South Africa. Three nationwide surveys have shown marked deficiencies in the dietary intake of energy and micronutrients (1–3) . The prevalence of stunt- ing, reflecting chronic malnutrition, and underweight is high, particularly within the black and coloured popula- tions. Moreover, hunger and food insecurity affected about 50 % and 25 % of households, respectively, in 1999 (2) . Similar findings have been reported in smaller studies conducted in various regions of the country (4,5) . To combat vitamin A deficiency, a curative vitamin A supplementation protocol was implemented in the Western Cape Province targeting high-risk mothers and children. From 2002, this strategy has been combined with a preventive component. In 1994, the Integrated Nutrition Programme (INP) was established to replace previous fragmented nutrition programmes with a more integrated approach, also sup- ported by the fact that sound nutrition is considered a basic human right according to the South African Constitution. The Nutrition Supplementation Programme (NSP) was later incorporated into the INP, and aims to correct undernutrition by providing nutrition supple- ments/products (e.g. breast milk substitutes, cereals and energy drinks), as well as nutrition education and counselling. The main providers of the vitamin A programme and the NSP are the primary health clinics (PHC), usually localised adjacent to or within suburbs, townships and informal settlements. Both Hendricks et al. (6) and Du Plessis et al. (7) have identified several shortcomings in the administration of the vitamin A programme. However, a concomitant evaluation of the vitamin A programme and the NSP from the perspective of mothers and PHC staff members has not been performed. *Corresponding author: Email p.o.iversen@medisin.uio.no r The Authors 2011