The World Health Organization identified the promotion of "Nurturing Care Environments" as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.
Kerry A. Shea, Tyra P. Sellers, Sandra G. Smith et al.
The United Nations Children's Fund (UNICEF) Community Infant and Young Child Feeding Counselling Package (C-IYCF CP) is used globally for infant and young child feeding (IYCF) counseling. With the C-IYCF CP last updated 8 y ago, mapping existing nurturing care content, identifying gaps, and documenting current country-level changes offers a unique opportunity to guide recommendations to strengthen the nurturing care content of this package. The primary study aims were to: 1) identify and map existing nurturing care content within UNICEF's C-IYCF CP, 2) identify gaps related to nurturing care or feeding elements within the C-IYCF CP, 3) identify country-level nurturing care adaptations to the C-IYCF CP, and 4) identify best practices and lessons learned from country adaptations that can be recommended for inclusion in the C-IYCF CP. The assessment included 4 phases: 1) conduct an iterative process to identify and map nurturing care elements within the C-IYCF CP using a codebook explicitly developed for this assessment; 2) identify gaps in the C-IYCF CP; 3) apply the codebook to IYCF packages from 11 countries, revise, then finalize the codebook; and 4) identify and interview key informants from 4 countries whose IYCF packages had the most comprehensive nurturing care content plus 1 country where health care professionals make routine mother–child home visits. The C-IYCF CP contained limited nurturing care content, especially around safety/security and early learning. All 5 countries interviewed had systematically identified and included priority nurturing care content in each package, yet content level varied. Two countries were also incorporating information technology into the training and delivery of the C-IYCF CP. Existing country-level best practices can address nurturing care elements missing from UNICEF's C-IYCF CP. Sharing these practices can allow countries to make context-driven, evidence-informed decisions on the nurturing care content to prioritize.
Amber J. Hromi‐Fiedler, Rafael Pérez‐Escamilla, Sofía Segura‐Pérez et al.
This article examines intersections between schooling, child marriage, and adolescent pregnancy in a longitudinal, mixed-methods study of Honduran girls. It explores (a) girls’ enrollment and dropout of school patterns and how these relate to timing of marriage and/or childbirth, (b) the factors associated with dropout, early marriage, and/or early childbearing, and (c) reenrollment patterns after marriage/childbirth. We find that household income in early adolescence predicts school dropout, early union, and early childbearing. Most girls discontinued their studies due to lack of financial resources or no longer wanting to be a student rather than due to marriage or motherhood. Only a small percentage return to school. This study can inform the timing and nature of efforts to protect girls and increase their chances of successfully completing secondary school, delaying marriage, and preventing early pregnancy.
Erin E. Murphy-Graham, Alison Klebanoff Cohen, Diana Pacheco-Montoya
Investing in early childhood programs such as Brazil's Criança Feliz Program (PCF) to support low-income families in providing a nurturing care environment is critical to ensure that children reach their full developmental potential. We aimed to analyze the influence of the PCF on the nurturing care environment provided by families enrolled in the program in the Federal District, Brazil. A qualitative case study was conducted based on in-depth interviews with a purposive sampling of 22 caregivers enrolled in the PCF for at least six months. Eighteen subthemes emerged from the thematic analysis following the five components of the Nurturing Care Framework (i.e., good health, adequate nutrition, responsive care, early learning, and security and safety). Caregivers recognized the benefits of the PCF on children's mental health (good health) and reported challenges in providing adequate nutrition due to food insecurity (adequate nutrition). A bond between the home visitor and families was identified as critical to promote responsive parenting practices (responsive care). Caregivers appreciated the early stimulation activities provided during PCF home visits (opportunities for early learning). Access to social welfare programs, such as conditional cash transfer and food assistance, were facilitated through PCF multisectoral actions (safety and security). On the other hand, families reported not receiving support from PCF for issues such as breastfeeding, maternal mental health, and disciplinary practices. In summary, PCF enhanced the components of the nurturing care environment provided by families. However, their vulnerabilities and contextual implementation barriers may prevent families from fully benefiting from PCF activities.
Laura Mendes Toledo Dal’Ava dos Santos, Lídia Godoi, Beatriz de Andrade e Guimarães et al.
Early inequities in Early Childhood Development (ECD) are linked to inequalities across the five regions and within the 5570 municipalities in Brazil. We aimed to operationalize an index (IMAPI) to assess and monitor the enabling environment for nurturing care at the regional and municipal level in Brazil using existing national databases. We followed three steps to operationalize IMAPI. I) Selection of indicators. The literature review guided the identification of existing indicators to translate each domain of the Nurturing Care Framework (Good Health, Adequate Nutrition, Opportunities for Early Learning, Responsive Caregiving, and Safety and Protection). Subsequently, meetings with experts and key Brazilian stakeholders informed the identification and selection of existing data in the national databases. II) Consultation with experts. Weights for the selected indicators were defined through a process based on the SMART approach. III) Analyzing IMAPI. Statistical and machine learning methods were used to compute an overall IMAPI as well as an index for each nurturing care domain that ranges from 0 (lowest score) to 100 (highest score). Means were calculated for each region of Brazil-based on municipalities indexes. IMAPI summarizes a set of 29 indicators: good health (14 indicators), adequate nutrition (4), early learning (7), responsive caregiving (0), and security and safety (4). Adequate nutrition domain presented the lowest median indexes (ranging from 32 to 22) and it was one of the most challenging to get reliable indicators due to the low coverage of national nutritional databases. The biggest difference means (DM) between regions with the best and worst indexes were found for early learning (DM = 17, ranging), good health (DM = 15) and security and safety (DM = 11), respectively. Responsive caregiving indicators were not identified at the municipal level within the existing national databases. A final version of IMAPI for each of the 5570 Brazilian municipalities incorporating sensitive analysis is being tested. IMAPI discriminates regional and municipal enabling and constraining environments to promote ECD in Brazil which can facilitate informed policy decisions to address early inequities. Bill and Melinda Gates Foundation, CNPq, FAPDF.
Gabriela Buccini, Marcos Ennes Barreto, Alberto Sironi et al.
Key messages There is a dearth of indicators and management information systems to assess early childhood nurturing care environments. The Brazilian Early Childhood Care Friendly Municipal Index (IMAPI) is a robust tool to assess nurturing care environments at the local level. IMAPI was able to detect nurturing care inequities within and across regions. Further validation work is needed to confirm the utility of IMAPI for policymaking.
Rafael Pérez‐Escamilla, Sônia Isoyama Venâncio, Gabriela Buccini
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).
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.
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.
