Worldwide, neglect is the most common form of child maltreatment. Data on neglect are scarce in low- and middle-income countries, and almost no qualitative research includes the voices of children.
The main objective was to understand community perceptions of the social determinants of child health. The study was also intended to test the feasibility of health professionals undertaking qualitative studies of the social determinants of child health which can be used to inform clinical care and policy.
The target population was people living in deprived circumstances in rural South Africa. Data collected included focus group discussions with children and adults, children's drawings, semi-structured in-depth interviews, documentary review and transect drives. Purposive sampling of poorer households was done. Recurring themes were explored using a continuous repetitive process. Data were examined using framework analysis.
The main finding was that neglect owing to substance abuse was a major predictor of poor child health and wellness. This sensitive topic was introduced by children, who created a platform for discussion with and among adult participants. Adults attributed neglect to a breakdown in family structure and changing norms regarding the responsibilities of parents. Community programmes were cited by children as a source of support, while some adults felt they undermined parental responsibility.
Understanding social arrangements and community support structures is best achieved at community level through a participatory, qualitative approach. These methods also enable the views of children to inform the findings. Children's input will help uncover neglect and other hidden predictors of challenges to child health, and promote a rights-based approach to care and research.