**1. Introduction**

The significance of the first 1000 days as a time-period, is broadly asserted: "The first 1000 days of life—the time spanning roughly between conception and one's second birthday—is a unique period of opportunity when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established" [1].

The first 1000 days is believed to be the greatest development phase where children's physical, cognitive, and socio-emotional development will have a lifelong impact, later in their lives [2]. The infancy period, from birth to two years, is characterized by rapid development of the physical and nervous systems, influencing other domains of children's development. The characteristics infants acquire during this phase are, therefore, fundamental for their lives [3]. The developing brain is particularly vulnerable to prenatal influences during the prenatal period [4]. The brain architecture formed during this critical time-period lays either a strong or weak foundation for the health, learning, and behavior of children later in life [5]. Furthermore, brain development during infancy endures explosive growth, and forms the building blocks of the lives and future of children.

All children must not merely survive but thrive and reach their full potential. It is, therefore, critical to detect risk factors that impact the physical, mental, moral, spiritual, and social development of children [6]. In order for children to reach their full potential, they need nurturing care from birth up until they are two years old, which includes

**Citation:** van Zyl, C.; van Wyk, C. Exploring Factors That Could Potentially Have Affected the First 1000 Days of Absent Learners in South Africa: A Qualitative Study. *Int. J. Environ. Res. Public Health* **2021**, *18*, 2768. https://doi.org/10.3390/ ijerph18052768

Academic Editor: Verónica Schiariti

Received: 9 February 2021 Accepted: 26 February 2021 Published: 9 March 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

good healthcare, nutrition, security, safety, responsive caregiving, and early learning [7]. The absence of these nurturing care factors during the first 1000 days could result in physical, emotional, and social challenges in the future [8]. A disfavored first 1000 days could, therefore, affect children's neurological and biological adaptations throughout their lives [9].

In South Africa, the Western Cape Government acknowledged the importance of the first 1000 days of life by launching the First 1000 Days campaign, entitled 'Right Start Bright Future' in 2016. The aim of this campaign was to raise awareness regarding the importance of the first 1000 days among health workers, other professionals, as well as the general public, by means of workshops and social media. The intention was to further shift the perceptions of healthcare workers and other professionals, to consequently improve health and social services to children during this crucial time-period [10]. This campaign focused on three key areas, namely—(1) health and nutrition; (2) love and attention; and (3) play and stimulation. These three key areas play a fundamental role in the development of children's physical, social, emotional, and cognitive domains [11]. These distinct key areas respectively involve assorted factors. The first key area, health and nutrition, includes various factors like nutritional deficiency, malnourishment, the physical and mental health of both mothers and their children, and substance use/abuse during pregnancy. The second key area, love and attention, incorporates factors like support to both mothers and their children, nurturing care, and attachment. The last key area, play and stimulation, refers to the stimulation and protection of children [12].

The rational for concentrating on 'absent learners' was motivated by the author's work context at the Khula Development Group, a registered non-governmental organization (NGO), rendering services to absent learners and their families. In South Africa, school absenteeism is a huge concern with alarming statistics of 616,327 learners who were absent in the Cape Winelands District, Western Cape, in 2017 [13]. South African policies include various definitions in terms of absenteeism, including, 'absent' for any learner not in class or participating in school activities when the class register is marked, as well as 'continuous absenteeism' for learners absent from school for ten consecutive days without a valid reason [13]. In this study, the term 'absent learner' refers to any form of absenteeism, whether continuous or irregular. There are numerous reasons for school absenteeism, such as poverty, lack of transport, unsuitable housing, children taking care of their siblings, lack of health care, chronic diseases, disabilities, poor nutrition, children's lack of interest in the curriculum, bullying, lack of family support, working conditions of parents, negative role modeling of parents, parents' lack of understanding regarding the value of school attendance, parents' lack of education, as well as problems within the family structure like divorce or domestic violence [14–16]. In terms of South Africa, the following reasons for school absenteeism is highlighted, namely poverty, parents' inability to afford a school uniform or school fees, lack of transport, poor nutrition, child labor, dysfunctional families, gang violence, chronic illnesses of parents or children, learning disabilities, and psychological challenges [13,17]. The multi-level consequences of school absenteeism include poor academic performance, and an increased school drop-out rate with longterm outcomes, such as inadequate education, unemployment, financial instability, and health-related problems [18].

The authors were particularly interested in the Foundation Phase, as this is the first phase of formal schooling in South Africa. The Foundation Phase in South Africa refers to Grade R to 3, where learners might enroll for Grade R in the year that they turn six and be admitted to Grade 1 when they turn seven years old. [19]. During this first phase of formal schooling, which establishes the starting point for the academic growth of learners [20], children are expected to master the formal curriculum content, including reading, writing, counting, and calculating [21]. The ability of children to succeed in school is determined by their behavior, social engagement with others, and their capacity to obtain literacy and numeracy skills that are interrelated with their physical, motor, social, emotional, moral, and spiritual development [22]. Children struggle with the curriculum in higher phases if

they do not acquire basic reading skills during the Foundation Phase [23]. It is, therefore, of the utmost importance that the early development of children is promoted before they enter the formal school system [24].

From the literature, it is evident that there are many factors transpiring during the first 1000 days that can potentially affect the schooling of children later in life. These factors are—(1) nutritional deficiencies; (2) substance abuse during pregnancy; (3) toxic stress; (4) attachment; and (5) stimulation. Malnourishment, including iron deficiency during the first 1000 days, could lead to reduced cognitive abilities, insufficient school achievement, grade repetition, school absenteeism, and school dropout, later in life [25]. Although substance abuse during pregnancy might involve various substances, such as tobacco, alcohol, Marijuana, or other illicit drugs [26], the effects of alcohol are highlighted. Excessive alcohol abuse during pregnancy could lead to Fetal Alcohol Spectrum Disorder (FASD), a collection of physical, cognitive, and neurobehavioral abnormalities [27,28]. Children with FASD might struggle with learning and behavior challenges at school, such as hyperactivity, memory difficulties, problem solving, social problems, reading, lack of attention, disruptive behavior in class, disobeying school rules, absenteeism, suspension, and school dropout [29,30]. Toxic stress weakens the architecture of the developing brain that could result in long-term learning problems [31]. It is further confirmed that extreme exposure to stress during pregnancy could cause long-lasting emotional and cognitive problems, whereas stressful experiences after birth could alter the neurobiology of children that decreases their ability to succeed in school [32]. Secure attachment in infancy is associated with a positive relationship between children and their school teachers, higher self-esteem, and greater resilience, whilst disorganized attachment during infancy correlates with a series of developmental problems in school, including aggressive behavior, poor relations with peers, and cognitive immaturity [33,34]. Adequate stimulation during infancy results in better cognitive and educational performance later in life [35]. However, learning at school is influenced by the lack of learning, and stimulation in the early years [36].

The purpose of this study was to qualitatively explore and describe factors that could potentially have affected the first 1000 days of absent learners in the Foundation Phase in the Paarl-East community in the Western Cape of South Africa. The authors acknowledge the existence of many variables, besides the first 1000 days, that could influence schooling and absenteeism. For this reason, this paper does not aim to confirm a correlation between the first 1000 days and absenteeism, but solely to explore factors that could potentially have affected the first 1000 days of absent learners in the Foundation Phase.
