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.
Scientific and policy advances are putting early childhood development (ECD) at the center of efforts to improve human development. This study was undertaken to understand what knowledge and attitudinal barriers exist that hinder the full-scale roll-out of services for the youngest children and their families. We used anthropological methods honed by the Frame works Institute to plumb beliefs about early childhood development among members of the public and implementation and policy stakeholders,and compare those with the findings from ECD research. While members of the public and stake holders agree on the importance of ECD, as demonstrated in other country settings, a major barrier to directing services to the youngest children is a perceptual tendency to ‘age up’. That is, to consider learning and other important skills as being acquired in the pre-school rather than infancy period. Communication strategies that incorporate debate are needed to give full effect to the ECD and related policies, especially around the topics of prioritizing the youngest children, physical punishment, child rights, and the pervasiveness of threats to ECD arising from poverty and disadvantage.
Linda Marleine Richter, Mark Tomlinson, Kathryn Watt et al.
Introduction: Caregivers play an integral role in their child's development. Many caregivers from low resource communities within sub-Saharan countries face challenges in providing early childhood development (ECD) and stimulation. In South Africa, there are policies in place that aim to provide caregivers with child-care support and services; however, systemic factors often negatively impact the service delivery of early childhood development at a community level. This integrative review aimed to analyse, appraise, and synthesise the literature concerning the published evidence of caregivers' perception on their role in early childhood development and stimulation programmes for children within the ECD phase. Method: The integrative review followed the five steps highlighted by Whittemore & Knafl. The literature search was conducted by electronic searching through ScienceDirect, Taylor & Francis, PubMed, JSTOR, Lancet, Google Scholar and Research Gate. Literature was included from 01 January 2010 to 31 December 2020, that were published in sub-Saharan Africa, regarding early childhood development and stimulation. A total of 22 records were included in the review. The data was qualitatively analysed through thematic analysis. The findings are presented according to the Bronfenbrenner's Ecological Systems Theory. Findings: Findings highlight that caregivers' facilitation of early childhood development in their children is influenced by daily practices of child-care and rearing. Caregivers perceived their role as nurturing and disciplining their children. The educational aspect of child development was the role of the school/ECD facility. Among these influences are contextual factors, culture, and poverty, which impact the practices that caregivers implement during early childhood development. There are policies and stimulation programmes in place to support and assist caregivers/parents in facilitating early childhood development. Conclusion: Caregivers' form an integral component in a child's early childhood development and stimulation. The caregiver role is impacted by several factors which include context, culture, awareness of services, knowledge on child development, stimulation and resources. There is poor implementation and knowledge of support structures, policies, and stimulation programmes at a community level. This, therefore, suggests that government departments need to advocate and promote for easier access to facilities to assist caregivers/parents further. Keywords: early childhood development, family support, policies, stimulation programmes, low resource contexts, stimulation.
INTRODUCTION: In South Africa, early childhood development (ECD) in rural areas is challenged by the lack of a centre-based programme and because the ECD practitioners are inadequately trained. The Crosstrainer Programme (CTP) may be a centre-based early childhood development programme that could address this challenge. Consequently, the aim of this study is not to prove, but to determine the level of efficacy of the CTP on the development of three to four year old children in the rural Mahikeng areas METHOD: An experimental trial was conducted. The ECDC (Early Childhood Development Criteria) were used to test the children (49 from 17 ECD centres RESULTS: Both Section A: Cognitive SRRA (School Readiness Risk Areas) and Section B: Fine Motor Coordination were improved by the CTP. However, Section C: Gross Motor Coordination showed no improvement by the CTP CONCLUSIONS: The CTP proved valuable in the improvement of the Cognitive SRRA and even more so on the fine motor development of the population group. It is recommended that activities directed at gross motor development should be increased and amplified in the programme. Further studies on the CTP regarding the development of the children and the occupational enablement of the ECD practitioners are recommended Key words: Early childhood development; ECD; Crosstrainer Programme; CTP; occupational therapy; early learning programme; rural ECD centres; ECD practitioners
Danette de Villiers, Adeleigh Homan, Cornel van Rooyen
