Abstract The Baby-Friendly Community Initiative (BFCI) is recognized to offer a unique platform for integration of counseling on early childhood development (ECD) with existing messages on maternal and child health and nutrition. To understand how to efficiently deliver such a program, this study determined the feasibility of integrating counseling on child stimulation into the Kenyan BFCI. Qualitative interviews among users, stakeholders and service providers provided extensive information on their understanding regarding ECD, beliefs around caregiving, needs at the different levels and potential barriers and facilitators. The most important facilitator was the existence of a robust community health strategy. Contextual influences and existing health system infrastructure are important considerations when designing integrated interventions to improve the nurturing care of young children.
Patricia Kitsao-Wekulo, Emma Haycraft, Teresa Bitengo Mwoma et al.
Group-based parent training programmes present an affordable means to influence the early experiences of children at scale. This paper reports evidence on the effectiveness of a practice-led intervention piloted in rural Tanzania evaluated through a matched control study design. The core of the programme is an 8–10 week caregiver training course led by local facilitators, built around early stimulation and nurturing care. After two years of implementation, the intervention led to improvements in the development of 3-year olds of 0.29 standard deviations. Detailed data on caregivers indicates that these improvements are due to changes in the type and frequency of caregiver-child interactions for both mothers and fathers, as well as the quality of play materials in the home.
Margaret Leighton, Anitha Martine, Julius J. Massaga
Abstract Background: This study was part of a project funded by the Hilton Foundation in partnership with Episcopal Relief and Development to conduct implementation research in rural communities in Kenya and Zambia. This involves testing the feasibility and effectiveness of community-based parenting empowerment in improving nurturing care of young children in rural communities in Zambia and Kenya. Few studies have investigated fathers’ roles in nurturing care of young children (birth-age to 3), particularly responsive care and stimulation (i.e. providing opportunities for early learning) in sub-Saharan Africa (SSA). Fathers are often perceived to be mainly responsible for the provision of the family's economic needs. However, past studies have demonstrated that fathers’ involvement in parenting has great significance for the child’s holistic growth and development.Methods: Qualitative interviews and discussions with caregivers (primary caregivers and secondary caregivers) with children below three years, program volunteers (ECD Promoters and faith leaders), Moments That Matter Program implementers and government officials involved in the program implementation. The study reported in this paper aimed to establish the effects of the parenting empowerment program on more gender-equal attitudes about gender roles in parenting and actual caregiving practices by fathers (who are not the primary caregivers), after participating in the Moments That Matter (MTM) Program in Kenya and Zambia for 24 months. Qualitative data were collected at three-time points (baseline, midline and endline). Results: The findings show that the MTM Program resulted in improved gender-equal parenting attitudes and practices among mothers/other primary caregivers and fathers. Study participants reported that most fathers were actively involved in parenting and caregiving due to their participation in the MTM Program. Conclusion: The study findings provide evidence that targeted parenting programs can influence changes in perceived gender roles in parenting.
Kenneth Okelo, Silas Onyango, Dawn E. Murdock et al.
Introduction: In 2010, the World Health Assembly urged all member states, including those of high income, to implement disaster plans in line with the Operational Guidance for Infant and Young Child Feeding in Emergencies (OG-IFE). However, analyses of infant and young child feeding in emergencies (IYCF-E) planning across Europe, the United States of America (USA) and Australia have indicated a lack of such planning. This study aimed to identify challenges, lessons and solutions in infant and young child feeding and care in disasters in high-income countries to inform improved emergency planning in Australia and other high-resource settings. Method: Semi-structured interviews were conducted with 39 emergency responders from Australia and 20 emergency responders from Canada, Croatia, Iceland, Ireland, Italy, Japan, New Zealand, Poland, the United Kingdom, Ukraine, and the USA. Data was collected on the challenges of providing emergency response to infants and young children and their caregivers, as well as successful interventions and facilitators of intervention uptake. Interviews were recorded, transcribed and then analysed using reflexive thematic analysis. Through the analysis process, the OG-IFE and the World Health Organization's nurturing care in emergencies brief assisted understanding regarding challenges, gaps and response appropriateness. Results: Challenges to support infants and young children in emergencies were consistent between countries and involved lack of prioritisation, planning, and data collection regarding infants and young children; lack of planning, knowledge and appropriate support for IYCF-E; and the donation of infant formula. Interventions to support mothers and caregivers of infants and young children were more variable between countries and included making support needs and gaps visible, providing tailored evacuation centre support, implementation of IYCF-E interventions, and supporting responsive caregiving. Intervention uptake was facilitated via training staff and volunteers, support of community members, involvement of government agencies and UNICEF, and collaboration between health agencies and emergency organisations. Family resilience was promoted at individual and community levels. Conclusion: Infants and young children are vulnerable in emergencies globally. This research has identified challenges and a range of strategies to strengthen disaster planning in high-income countries, including the appropriate development and implementation of IYCF-E plans aligned with the OG-IFE.
Karleen D. Gribble, Alexandra Shanks, Michelle Hamrosi
Importance: Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children's potential to thrive. Objectives: To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors. Design, Setting, and Participants: This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024. Exposure: Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics. Main Outcomes and Measures: Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither. Results: In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only. Conclusions and Relevance: This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.
BACKGROUND: Health inequities among children in Sweden persist despite the country's well-developed welfare system and near universal access to the national child health care programme. A multisectoral extended home visiting intervention, based on the principles of proportionate universalism, has been carried out in a disadvantaged area since 2013. The present study investigates the content of the meetings between families and professionals during the home visits to gain a deeper understanding of how it relates to a health equity perspective on early childhood development. METHODS: Three child health care nurses documented 501 visits to the families of 98 children between 2013 and 2016. A qualitative data-driven conventional content analysis was performed on all data from the cycle of six visits per child, and a general content model was developed. Additional content analysis was carried out on the data from visits to families who experienced adverse situations or greater needs. RESULTS: The analysis revealed that the home visits covered three main categories of content related to the health, care and development of the child; the strengthening of roles and relations within the new family unit; and the influence and support located in the broader external context around the family. The model of categories and sub-categories proved stable over all six visits. Families with extra needs received continuous attention to their additional issues during the visits, as well as the standard content described in the content model. CONCLUSIONS: This study on home visiting implementation indicates that the participating families received programme content which covered all the domains of nurturing care as recommended by the WHO Commission on Social Determinants of Health and recent research. The content of the home visits can be understood to create enabling conditions for health equity effects. The intervention can be seen to represent a practical example of proportionate universalism.
Madelene Barboza, Asli Kulane, Bo Burström et al.
Why is protecting children from tobacco important? Tobacco poses risks to children’s survival, health and development. Protecting children from tobacco smoke is essential to help them to survive and thrive. Children exposed to tobacco smoke are at an increased risk of a range of diseases and are more likely to take up smoking themselves. Enabling children to grow up free from the dangers of tobacco exposure is a key aspect of providing clean, safe and secure environments. Providing such environments is central to achieving Sustainable Development Goal 3 on good health and wellbeing. It is also essential for nurturing care. This brief summarizes the health risks that tobacco poses to children, particularly to infants and young children, and the strong protective effect of tobacco control measures. The aim is to raise awareness among practitioners and policy-makers about the importance of strong tobacco control measures for protecting the health and development of children. The brief gives examples of actions needed to advance tobacco control in countries and local settings and to align child health and tobacco control goals.
Filippos T Filippidis, Anthony A Laverty, Christopher J. Millett et al.
In complex humanitarian emergencies, infants and young children are exposed to a higher risk of malnutrition, morbidity, delayed development and mortality. As shown by earlier research, maternal mental health and capacity for nurturing are of fundamental importance in child health and development. Since 2006, the international nongovernmental organisation, Action Contre la Faim, has been implementing a holistic approach to interventions for pregnant and lactating women and their young children to prevent child mortality and developmental delay in contexts affected by war and natural disasters. The experience presented here of ‘Baby Friendly Spaces’ refers to a programme in Cameroon, implemented with Central African refugees. The activities comprised in this model are focused on maternal mental health, parental skills, early child stimulation and infant and young child feeding practices. Results show a positive and significant (p < 0.01) impact on maternal wellbeing, breastfeeding practices and mother–child relationships. These findings reinforce previous evidence highlighting the necessity of implementing programmes, within complex humanitarian contexts, to reinforce the mother’s psychological wellbeing and increase capacity to provide nurturing care to guarantee the child’s health status and development.
Elisabetta Dozio, Karine Le Roch, Cécile Bizouerne
BACKGROUND: Community health workers (CHWs) play significant roles in improving health practices in under- resourced communities. This study evaluated an early childhood development (ECD) project in Tanzania assessing the effect of mobile video use, supervision and mentorship to improve quality of CHW counseling skills. METHODS: CHWs participating in the Malezi Project in Tabora Region were enrolled in a mixed methods pre-post evaluation. CHWs previously trained in UNICEF's Care for Child Development package were further trained in counselling caregivers on nurturing care and father engagement using videos. Health providers were trained to provide ECD-focused supervision/mentorship of CHWs in facilities and during home visits. At baseline and endline, CHWs completed interviews and trained study staff observed and scored CHW counseling sessions using a structured checklist which were reduced into six dimensions through principal component analysis: introduce, educate, ask, plan/problem solve, interact/encourage, and responsive care. Twenty-five in-depth interviews were completed with caregivers and four focus group discussions with CHWs were conducted. RESULTS: Almost all (n = 107; 95%) 119 enrolled CHWs completed the expected eight observations (n = 471 baseline; n = 453 endline). At endline, more CHWs reported having one-on-one meetings with their supervisors (51% increasing to 75%; p < .0002) and that supervisors accompanied them to households for mentoring (60% increasing to 89%; p < .0001). We observed a shift in CHW counselling skills in clinic and home sessions. Scores in the categories of introduce, plan/problem solve, and interact/encourage significantly improved between baseline and endline; scores for ask and educate remained unchanged or decreased at both timepoints. Two-thirds of caregivers interviewed reported that father's involvement with their child increased due to CHW visits. Male participation increased in home observation sessions from 5.6% at baseline to 17.6% at endline (p < .0001). CONCLUSION: Use of videos, supervision, and mentorship were associated with CHW performance improvements in providing nurturing care counselling and in father engagement, especially in home settings.
Josephine Pascal Ferla, Michelle M. Gill, Teopista Komba et al.
To take care of children to have well-being including physical, psychological, social, emotional, and intellectual health. Caregivers must have child healthcare literacy, be able to seek information, and apply the knowledge of child health care to promote the well-being of children. The purposes of this survey study were 1) to analyze components of caregivers’ child healthcare literacy and 2) to develop and validate the quality of the instrument for caregivers’ child healthcare literacy with empirical data. Samples were 345 child caregivers who worked in nurseries. Data was collected by using a caregivers’ child healthcare literacy questionnaire. The reliability of the questionnaire was tested by the omega coefficient yielding a value of .976. The confirmation factor analysis was performed by using the Mplus program to analyze the data. The research results and confirmatory factor analysis revealed that caregivers’ child healthcare literacy consisted of two main components: 1) Health literacy, which included accessing information and service, health knowledge and understanding, communication skill, self-management skill, decision skill, and media literacy; and 2) Nurturing care, which consisted of good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning. The caregivers’ child healthcare literacy components were fit to the empirical data (2 (343, N = 345) = 446.23, p = .0001, CFI = .979, TLI = .974, SRMR = .051, RMSEA = .030, AIC = 14556.473, BIC = 15140.692, 2 /df = 1.30). The standard weights of each main health literacy factor were between .552 and .955, and each main nurturing care factor was between .446 and .971. The results of this research confirmed that the questionnaire could be utilized to assess caregivers’ child healthcare literacy, which indicates caregiver strengths and weaknesses, leading to the designing of a quality system supporting caregivers for child development centers in the future.
