To assess the nutritional status and dietary practices of 4–24-month-old children (under-twos) in a rural South African community.

Cross-sectional survey.

A low socioeconomic rural African community (Ndunakazi), approximately 60 km north-west of Durban, KwaZulu-Natal, South Africa.

Children (n = 115), 4–24 months old who attended growth monitoring posts in the area.

Of these under-twos, 37.3% had low vitamin A status (serum retinol < 20 μg dl−1), 65.2% were anaemic, 43.2% had serum ferritin levels < 10 μgl−1 (an indicator of low iron stores) and 15.3% were stunted. Breastfeeding was initiated by 99% of mothers. At the time of the survey, 80% of infants in the 4–12-month-old category and 56.9% of children in the 12–24-month-old category were being breastfed. Solid foods were introduced at 3.6 ± 0.8 months. Food intake reflected a high intake of carbohydrate-rich foods, and irregular intakes of fruit and vegetables, especially those rich in vitamin A. Foods of animal origin were not consumed regularly. Of these under-twos, 15.9% experienced an episode of diarrhoea during 2 weeks prior to the survey.

These under-twos had a poor vitamin A and iron status. Nutrition education, intervention programmes and feeding schemes should address micronutrient deficiencies, with the focus on the quality of the diet, rather than quantity.