OBJECTIVE: To estimate the effect of integrating responsive care, early learning and development monitoring into a community-based package of activities on nutrition, sanitation and hygiene, on improvements in early childhood development (ECD) outcomes. DESIGN: This was a quasi-experimental study with nonequivalent comparison groups. The study's primary outcome, ECD, was measured using the Ages and Stages Questionnaire (ASQ-3) and the Global Scales for Early Development (GSED). We also collected data on the early learning home environment, nutritional practices and caregiver depressive symptoms as secondary outcomes. SETTING: This study was conducted across twelve districts in Nampula Province, Mozambique. Half of the districts received holistic nurturing care with responsive care, early learning, nutrition, sanitation and hygiene packages (intervention) and the other half received only nutrition, sanitation and hygiene packages (comparison). PARTICIPANTS: We recruited an age-stratified random sample of 961 caregivers and their children, aged 0-23 months. RESULTS: = 0·004) in the intervention group than in the control. There were no measurable impacts on the remaining early stimulation activities or the primary outcomes of the ASQ and GSED developmental scores. CONCLUSIONS: We discuss the challenges in the integration of nurturing care interventions into existing programmes in high-vulnerability contexts, highlighting the aspects needed to achieve effective caregiver behavioural changes that can translate into improved ECD outcomes.
Filipa de Castro, Katija Momade, Jennifer Yourkavitch et al.
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.
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.
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.
In Malawi, 38% of children under five are stunted, and only 36% are developmentally on track. An ethnographic study using the Reality Check Approach was conducted in four villages in Ntcheu and Balaka districts in Malawi to understand caregiving-related drivers of malnutrition and poor child development. Researchers immersed themselves in 12 rural households with a pregnant woman or a child under 2 years for 4 days and nights, and gathered information through informal conversations, participation in daily activities, observations, and group sessions. They assessed current behaviours and the factors driving these behaviours in five recommended nurturing care domains essential for a child to both survive and thrive. The study revealed that children were not receiving the nurturing care they needed. Caregiving-related issues identified included poor maternal, child, and family diets; inadequate infant and young child feeding; poor hygiene environment and practices; low use of health and nutrition services; limited responsive care, stimulation and learning opportunities, and early pregnancies. Caregiving determinants included chronic poverty and food insecurity, climate and economic shocks, low access to quality health, nutrition and early childhood development services, poor maternal wellbeing, gender inequality and harmful social norms. The research underscores the need for a multi-sector approach to improve maternal and child nutrition and development. It also stresses the importance of understanding the contextual determinants of caregiving behaviours to inform multi-sector programmes and policies and meet Malawi's Sustainable Development Goals and World Health Assembly targets for maternal and child health, nutrition, and development.
The COVID-19 pandemic interrupted immunisation programs globally, undoing previous progress that had brought vaccine-preventable diseases under significant control. This research investigated how the pandemic influenced the uptake of routine child immunisation services in South Africa. A qualitative study was carried out through in-depth interviews with 51 parents or caregivers of children under five who had missed or postponed one or more scheduled immunisation doses between 2020 and 2022. Addi
Mokhantšo Makoae, Tholang Mokhele, Inbarani Naidoo et al.
BACKGROUND: The COVID-19 pandemic disrupted immunisation programs worldwide, reversing gains that had brought vaccine-preventable diseases largely under control. This study explored the impact of COVID-19 on the uptake of routine child immunisation services in South Africa. METHODS: We conducted qualitative research using in-depth interviews with 51 purposively selected parents/caregivers of children below the age of five who missed or delayed one or more scheduled immunisation doses in 2020-2022 and with 12 healthcare providers who provided public immunisation services during the pandemic. RESULTS: During the pandemic lockdowns, most caregivers perceived the risk of their child being infected with COVID-19 during a clinic visit as more salient than the risk of missing immunisation doses. Caregivers reported minimal exposure to routine immunisation communication, as well as shortages of routine vaccines for children at public health facilities, healthcare workers experienced anxiety and burnout. There was a post-pandemic shift to more active decision-making about immunisation, which had previously been an almost automatic behaviour, leading some caregivers to delay vaccinating their children. There was also evidence of a "bad vaccine" mental model among some caregivers regarding COVID vaccinations, which could lead to doubts about the safety of routine childhood vaccinations. DISCUSSION: The shift from default to active decision-making highlights a risk that routine immunisation will backslide in future pandemics. Governments should build resilient health systems at all levels and communicate clearly about the benefits and availability of RIs and the safety of vaccinations in general, alongside supply-side interventions. CONCLUSION: Routine immunisation is widely accepted in South Africa, driven by generational norms and provider recommendations. During the COVID-19 pandemic, many caregivers faced the dilemma of balancing COVID-19 exposure risk with the risk of their child developing a deadly VPD, leading to missed RI visits. This shift to active decision-making highlights a future pandemic risk. Governments should build resilient health systems and focus on understanding and engaging procrastinating and doubtful caregivers. Clear communication about RI benefits and vaccine safety is crucial, as misinformation can lead to distrust in new vaccines.
There is a growing interest in the teaching of science in early childhood development (ECD) classrooms the world over. This has led to some countries crafting and implementing policies that ensure the teaching of science process skills. This study explored the teaching of science process skills in ECD classrooms of Zimbabwe through an interpretive multiple case study. Data were collected using semi-structured interviews, lesson observations, still photographs and field notes from four purposively selected ECD teachers. Findings show that the participants had knowledge of science process skills namely, communication, observation, measuring, comparing, classifying, predicting and inferring. The study found that science process skills were best taught using child-centred approaches such as explorations, play, experiments and guided discovery because such methodology encourages an active participation of learners. Effective teaching of science process skills in prepared science environments lays a foundation of acquiring scientific knowledge, content and skills in young learners. The study concluded that participants' knowledge and experience of teaching science process skills afforded them a strong foundation for developing science skills in ECD learners. Hence, there is a need for parents and school administrators to support teachers through resource mobilisation, provision and allocation. The study recommends the ECD teachers to teach science process skills as a way of perpetuating the nation's goal of introducing STEM subjects in ECD classes.
South Africa's basic education system is dysfunctional. It scores last or close to last in a myriad of metrics and delivers learners with some of the worst literacy and numeracy competencies worldwide. A bimodal distribution in the results exists when learners from the richest socioeconomic quintile are performing adequately well, while learners from the poorest quintiles are failing. This paper presents a system dynamics simulation model to describe the causal linkages between improved early childhood and pre-school learning practices on the education system as a whole. The paper investigates the difference in performance between rich and poor communities. Three interventions explore the research question of whether it is the number of enrolments into early childhood development programs that increases a cohort's school readiness, or rather the quality of the early childhood development programs into which they were enrolled. The results answer the research question for the Western Cape province by showing that increasing the quality of the formal ECD programs leads to a greater percentage of school-ready five year olds than increasing the percentage of enrolled children, but that decreasing community poverty leads to better results than either intervention. The results show the simulation model to be a powerful tool to assist with policy setting and intervention testing for any other province or country by simply changing the input data and calibration.
