Abstract The Nurturing Care Framework recognises infants’ embeddedness in broader networks. However, given gender norms and socio-structural features, key actors responsible for child well-being may misrecognise complex care dynamics and reinscribe parental (usually maternal) responsibility. The paper offers a South African example, tracing the emergence of ‘parenting’ as a remedy for colonial violence and its enduring social and affective infrastructures. Close assessment of several research trials for parenting interventions that seek to prevent violence raises questions about the methodological and conceptual assumptions that produce the evidence base. I argue that, given gender norms and the devastating and enduring effects of the colonial-apartheid shaping of family life, women are made responsible for inculcating the values presumed to reduce violence. Despite the potential of a culturally responsive idea of nurture, the Framework prioritises ‘universalist’ ideas about development, bypassing local ontologies and missing the opportunity to materialise a fully redressive model of social well-being.
Over 250 million children under age 5 y in low-and middleincome countries are at risk of not reaching their developmental potential, resulting in long-term negative consequences that undermine subsequent health, well-being, and productivity (1).The loss of developmental potential is a global crisis that has led to calls for action from leaders of international agencies (2) and recommendations for the Nurturing Care Framework to serve as a model for the care and services that promote young children's healthy growth and development.The Nurturing Care Framework includes policies, programs, and services that create an enabling environment for families and communities to ensure that their children receive health care, adequate nutrition, responsive caregiving, opportunities for early learning, and safety and security (1).In this issue of The Journal of Nutrition, the Malnutrition and Enteric Disease (MAL-ED) study authors make a unique contribution by systematically examining how enteric pathogens, nutrition, and the home environment during the first 2 y of life relate to children's development at age 5 y across multiple low-income sites in Africa, Asia, and South America (3).A study conducted when the children were age 2 y found that they experienced high rates of adversities during the first 2 y of life, including monthly detection of enteropathogens in nondiarrheal stools, frequent illnesses, and low micronutrient intakes (4).Enteropathogens, mediated by frequent illnesses and low hemoglobin concentration, were associated with low cognitive skills at age 2 y, suggesting that the malnutritionenteric infection cycle, which has been associated with poor health and is exacerbated by oral-fecal contamination often found in unhygienic environments (5), extends to children's cognitive development.In the current study (3), cognitive development was measured by the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III), which was developed and normed in the United States (6).As recommended, the investigators addressed cultural and linguistic issues across sites through adaptations and excluding verbal subtests from the analysis.Using statistical procedures at the item level to examine measurement equivalence across sites, they identified 3 subtests Supported by National Institute of Diabetes and Digestive and Kidney Diseases grant R01 DK106424 (to MMB).
Adequate nurturing care behaviours, including feeding practices, health-seeking and psychosocial stimulation, are crucial for the optimal health, growth and development of young children. However, several factors, recognised as maternal 'capabilities for care', can influence a mother's capability to provide adequate care, namely knowledge/beliefs, physical health and nutritional status, mental health, autonomy, reasonable workload/time availability and social support. As part of the Khula birth cohort study, we aimed to investigate if maternal capabilities for care are associated with nurturing care behaviours among mother-child dyads in Malawi (n = 122) and South Africa (n = 206). When children were 10-16 months of age, mothers competed a series of self-reported sociodemographic, child diet and health and psychosocial questionnaires. Six maternal capabilities for care were considered: haemoglobin concentration, mental health, employment, decision-making autonomy, support for childcare and social support. The nurturing care behaviours were feeding practices, complete immunisation status appropriate to chid age and psychosocial stimulation within the home environment. Regression modelling assessed associations between maternal capabilities for care and each care behaviour, adjusting for child sex, maternal age and education level and household socioeconomic status. Associations between maternal capabilities for care and nurturing care behaviours differed by care behaviour and setting. Maternal employment and decision-making as measures of autonomy, support with childcare as a measure of reasonable workload and reported social support were the maternal capabilities most consistently associated with feeding practices, complete immunisation status and stimulation practices, although the direction of associations differed between settings. Maternal haemoglobin and mental health were associated with one care behaviour each (stimulation and feeding practices, respectively). Measuring and understanding how various maternal capabilities influence caregiving across contexts is essential for empowering caregivers to provide optimal care. Interventions, programmes and policies that seek to improve child health, growth and development through enhanced nurturing care practices should strengthen multiple maternal capabilities.
Taryn J. Smith, Emmie W. Mbale, Michal R. Zieff et al.
Globally, two in five children under the age of five are at risk of not reaching their full developmental potential. Investing in early childhood is essential to uphold every child’s right to survive and thrive. Nurturing care interventions have proven to be an effective means of improving early childhood outcomes. However, there is limited knowledge on how to enhance the integration and implementation of these interventions. This article explores interventions that enhance nurturing care during early childhood development, utilizing the RE-AIM framework review study design. The findings indicate that these interventions are a valuable investment in children’s health, well-being, education, and personal development, and they are highly effective in shaping children’s overall development.
The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is a population-based approach to monitor the nurturing care environment for early childhood development (ECD) using routine information system data. It is unknown whether IMAPI can be applied to document metropolitan urban territorial differences in nurturing care environments. We used Brasilia, Brazil's capital with a large metropolitan population of 2,881,854 inhabitants divided into 31 districts, as a case study to examine whether disaggregation of nurturing care data can inform a more equitable prioritization for ECD in metropolitan areas. IMAPI scores were estimated at the municipal level (IMAPI-M, 31 indicators) and at the district level (IMAPI-D, 29 indicators). We developed a quantitative prioritization process for indicators in each IMAPI analysis, and those selected were jointly mapped in the socioecological model for the role of indicators in relation to the enabling environment for nurturing care. Out of 28 common nurturing care indicators across IMAPI analysis, only four were prioritized in both analyses: one from the Adequate nutrition, two from the Opportunities for early learning, and one from the Responsive caregiving domains. These four indicators were mapped as enabling policies, supportive services, and caregivers' capabilities (socioecological model) and Effort, Coverage, and Quality (indicator's role). In conclusion, the different levels of nurturing care data disaggregation in the IMAPI can better inform decision-making than each one individually, especially in metropolitan areas where municipalities and districts within metropolitan areas have relative decision-making autonomy.
Gabriela Buccini, Juliana Lopes Pimentel, Jéssica Pedroso et al.
OBJECTIVES: to list educational elements in nursing with a focus on monitoring child development in the context of the Sustainable Development Goals and Nurturing Care. METHODS: qualitative report on an educational perspective for nursing undergraduates. The following stages emerged: key conceptual dimensions, simulated situation, clinical field, case study and assessment. RESULTS: educational elements were listed regarding child development monitoring prioritizing home visits. Contents and practices were anchored in scientific evidence from Nurturing Care and Sustainable Development Goals in their peculiarities of promoting child development, health and well-being, eradicating poverty and hunger, early childhood education and reducing inequalities. FINAL CONSIDERATIONS: the educational perspective presents itself as a triangulation between theoretical knowledge, simulation and clinical environment, with challenges in the face of circumstances, strengths and weaknesses in simulated situations and with families with children, allowing us to recognize the potential of existing practices and the barriers to be broken.
Débora Falleiros de Mello, Flávia Azevedo Gomes-Sponholz, Luciana Mara Monti Fonseca et al.
to analyze maternal parenting practices aimed at the development of children under one year of age in the home context, from the perspective of the Nurturing Care framework. a qualitative study, grounded in philosophical hermeneutics and the conceptual approach of Nurturing Care. In-depth, semi-structured interviews were conducted with 27 mothers, followed by inductive thematic analysis. maternal parenting practices involved interaction and engagement in play activities with the child, socialization with other children, early exposure to screens, relative paternal participation, and occasional book reading. Uncertainties emerged regarding setting limits, early childhood education enrollment, and perceptions of child development. The findings indicated a partial interrelation with Nurturing Care domains related to responsive caregiving, opportunities for early learning, and child security and safety. maternal parenting practices, analyzed through the lens of the Nurturing Care framework, reflected the child's care environment, highlighting both strengths and vulnerabilities in promoting child development in the home context. The Nurturing Care domains are useful for child care within Primary Health Care, reinforcing the relevance of parental responsiveness and the child's daily routine for their full development. This suggests a potential strategy to promote nursing care in child health. BACKGROUND: (1) Daily home routine reflects parenting practices for child development. BACKGROUND: (2) Maternal reports express strengths and weaknesses of the child care environment. BACKGROUND: (3) A nurturing and interactive environment provides opportunities of child learning. BACKGROUND: (4) Daily constraints expose children to developmental vulnerabilities. BACKGROUND: (5) The Nurturing Care framework offers analytical domains of child care at home.
Jeniffer Stephanie Marques Hilário, Letícia Pancieri, Regina Aparecida Garcia de Lima et al.
When most people think of early childhood development, what comes to mind is preprimary school learning; similarly, when they think about how best to ensure a child turns out well, their thoughts turn to adolescents. The FrameWorks Institute in Washington, DC, calls this “aging up,” a phenomenon that has been demonstrated as a bias in policy and public thinking in several countries, including South Africa (Richter, Tomlinson, Watt, Hunt, & Lindland, 2019). Yet it is the earliest period of life, from conception to two to three years of age, that most strongly regulates our trajectory across the course of our lives (Shonkoff, Richter, van der Gaag, & Bhutta, 2012) and that influences how children cope with early formal learning and the challenges of adolescence.
BACKGROUND: The majority of children with neurodevelopmental disorders (NDDs) reside in low- and middle-income countries (LMICs). NDDs are a public health concern in countries in sub-Saharan Africa (SSA). Nurturing care has been recommended as a pathway for addressing the developmental needs and unlocking the full potential of children, including those with NDDs. However, little information exists on the strategies to support children with NDDs using the Nurturing Care Framework in many countries in SSA. This review aims to synthesize information on nurturing care practices for children with NDDs in SSA. The review will also determine gaps in the provision of nurturing care for children with NDDs. Further, the review will highlight the drivers of care as well as the experiences of the caregivers. METHODS: The review will be implemented in six steps: specification of the research question, identification of relevant studies, selection of studies to be included, extracting, mapping, and charting the data, collating, summarizing, and reporting the results, and stakeholder consultation. We propose a database search followed by a manual search for the literature synthesis. We will search the following electronic databases: PubMed, ScienceDirect, Scopus, Open Grey and African Journals Online (AJOL). All studies published after May 2018 to May 2023 that include relevant terms will be identified and included. The research team will develop a data extraction form for use in capturing relevant information from each of the included studies. A patterning chart that will summarize and analyze the key findings of each article will be created. DISCUSSION: We anticipate that the study will provide evidence on the existing nurturing care practices and unearth gaps in the provision of nurturing care for children with NDDs. Key determinants of care and the experiences of the parents/caregivers of children will also be identified. The study will provide key recommendations on interventions to improve the quality of care for children with NDDs. Through this study, awareness of the unmet nurturing care needs of these children will be increased. The evidence generated may assist policymakers and stakeholders in addressing the needs of children with NDDs.
Silas Onyango, Margaret Nampijja, Paul Otwate et al.
Introduction: The importance of nurturing care for child development is well-established, and parents play a central role in providing this care. However, cultural values and traditions can influence child-rearing practices, and there are gaps in child welfare in Ecuador. Two research questions delve into caregivers' definitions of nurturing care for children aged 0-5 and its alignment with World Health Organization's concept. Methods: A qualitative methodology was applied to comprehensively explore caregivers' perspectives and application of nurturing care across diverse cultural contexts in rural areas of Cotopaxi and Loja in Ecuador. Using snowball sampling primary caregivers, healthcare professionals, childcare workers, and community leaders were interviewed and participated in focus groups, examining its congruence with WHO's Nurturing Care Framework for Early Childhood Development. Results: While there is alignment with the WHO framework, the study reveals challenges such as a lack of awareness of the term "nurturing care" among participants. Findings also indicate issues in health communication, reliance on traditional medicine, and myths around nutritional practices. The role of technology in early learning is explored, noting both its advantages and disadvantages. Notably, preventive health activities were not mentioned, emphasizing a universal need for knowledge. Conclusion: This study urges tailored interventions for nurturing care, emphasizing success tied to robust healthcare and child protection. Urgency lies in cultural sensitivity, local adaptation, and targeted training for implementation. These insights contribute significantly to the global discourse, stressing the importance of context-specific approaches. Implications are crucial for policymakers, practitioners, and researchers dedicated to elevating care quality for vulnerable populations worldwide.
Betzabé Tello, Maria J. Mendoza-Gordillo, Marcelo Moreano et al.
