The objective of this study was to determine the nutritional status regarding vitamin A, iron and anthropometric indices and dietary intakes of children aged 2-5 years and their caregivers in a rural South African community. Micronutrient, haematological, anthropometric and dietary indicators were used to assess nutritional status during a cross-sectional survey. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. The subjects were children aged 2-5 years (n = 164), and their caregivers (n = 137). Of the preschool children, 50% had a low vitamin A status (serum retinol < 20 micrograms/dL), 54% were anaemic (Hb < 11 micrograms/dL), 33% had depleted iron stores (serum ferritin levels < 10 micrograms/L), and 21% were stunted (Z-score for height-for-age < -2SD). Of the caregivers, 30% had a low vitamin A status (serum retinol < 30 micrograms/dL), 44% were anaemic (Hb < 11 micrograms/dL), 19% had depleted iron stores (serum ferritin levels < 12 micrograms/L), and 40% and 26% were overweight (BMI > or = 24 and < 30) and obese (BMI > or = 30), respectively. The children and caregivers consumed a cereal-based diet, with phutu (a stiff porridge made with maize meal), rice and bread as staple foods. Quantitative dietary analysis showed that the dietary intakes were high in carbohydrates (approximately 70% of total energy), while fat intake was within the prudent dietary guideline of 30% of total energy intake. Median dietary intakes were below 50% of the RDA for calcium, zinc (children only), vitamin A, riboflavin, niacin (children only) and vitamin B12. These preschool children and their caregivers consumed a high carbohydrate diet deficient in most of the essential micronutrients. The poor quality of the diet was reflected in a poor vitamin A and iron status, and one-fifth of the children showed linear growth retardation. Nutrition education and intervention programmes should address micronutrient deficiencies, with the focus not only on quantity, but also quality of the diet.