Peer-reviewed article
“It is the foundation for the child”: a qualitative study examining caregiver perspectives on the Nurturing Care Framework in Kenya and Botswana
Michelle Ann Bulterys, Sarah Garcia, Irene N Njuguna, Sara Schenkel, Kedibonye Thankane et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study explored how caregivers in Kenya and Botswana understand and experience the WHO/UNICEF Nurturing Care Framework, which describes five domains essential for child development. Researchers conducted focus group discussions with 101 caregivers, including both HIV-positive and HIV-negative parents. Caregivers identified physical and mental health as the most important domain, but faced different challenges by country—nutrition in Botswana and safety in Kenya. Caregivers living with HIV reported that stigma, isolation and treatment issues made it harder to provide good care.
Key points
- Caregivers identified physical/mental health as the most important domain for child well-being, noting the direct connection between caregiver and child health
- Adequate nutrition was the most challenging domain in Botswana, while security and safety was most challenging in Kenya
- Responsive caregiving was the easiest domain to fulfil in Botswana; opportunities for early learning was easiest in Kenya
- Kenyan caregivers emphasized that spiritual nourishment should be included in the Framework
- Caregivers living with HIV experienced similar priorities to those without HIV, but HIV-related stigma, social isolation and treatment disruption significantly impaired their ability to provide nurturing care
Limitations
The study is qualitative and exploratory, so findings cannot be generalized beyond the study populations or quantified. The research describes caregiver perspectives rather than measuring actual child outcomes or the effectiveness of interventions to support the Nurturing Care Framework.
Abstract
Introduction The WHO/UNICEF Nurturing Care Framework (NCF) features five domains necessary for child development—physical/mental health, responsive caregiving, adequate nutrition, security and safety and opportunities for early learning. We explored caregiver perspectives on the NCF in two African settings. Methods Between November 2023 and July 2024, 14 focus group discussions (FGDs) were conducted with caregivers living with and without HIV; eight with mothers in Gaborone, Botswana, and six with mothers and fathers in Nairobi, Kenya. FGDs were stratified by country, sex, HIV status and partnership status. Semi-structured interviews with interactive activities elicited caregiver perspectives on the NCF to identify the most ‘important’, ‘easiest’ and ‘challenging’ domains to fulfil. Thematic analyses identified key themes and compared perspectives. Results Our qualitative study included 101 caregivers, 55 from Kenya (30 mothers, 25 fathers) and 46 mothers from Botswana. Overall, caregivers identified physical/mental health as the ‘most important’ domain to fulfil for children and caregivers, noting how closely tied they were (“ If you have pain, that pain affects your child” ). The ‘most challenging’ domain was adequate nutrition in Botswana and security and safety in Kenya. The ‘easiest’ domains were responsive caregiving in Botswana and opportunities for early learning in Kenya. Kenyan caregivers noted that spiritual nourishment was also critical for well-being but missing from the NCF. Caregivers emphasised the importance of receiving social support with childcare. Caregivers living with HIV expressed similar views compared with caregivers without HIV, but mentioned that social isolation, stigma and treatment disruption impact their ability to provide adequate nurturing care. Conclusions Caregivers face unique parenting challenges depending on cultural environment. HIV disrupts caregivers’ health, which has important implications for raising children within families affected by HIV. Interventions that support caregivers’ abilities to fulfil all NCF domains and address challenges are essential to ensure children reach their developmental potential.