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Ahun MN, Bliznashka L, Karuskina-Drivdale S, Regina G, Yousafzai AK, Jeong J. A qualitative study of maternal and paternal parenting knowledge and practices in rural Mozambique. BMC Public Health 2024; 24:1778. [PMID: 38961411 PMCID: PMC11223379 DOI: 10.1186/s12889-024-19291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/27/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers' nurturing care practices and sources of parenting knowledge in rural Mozambique. METHODS This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers' and fathers' daily caregiving experiences. Data were analyzed using thematic content analysis. RESULTS Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child's health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers. CONCLUSIONS These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, H4A 2S5, 5252 boulevard de Maisonneuve, 2nd Floor, Canada.
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA, MA.
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Canada, QC.
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA, MA
- International Food Policy Research Institute, Washington D.C., USA
| | | | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA, MA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA, MA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA
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Ahun MN, Ali NB, Hentschel E, Jeong J, Franchett E, Yousafzai AK. A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Ann N Y Acad Sci 2024; 1533:99-144. [PMID: 38354095 DOI: 10.1111/nyas.15110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nazia Binte Ali
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Franchett
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Buccini G, Kofke L, Case H, Katague M, Pacheco MF, Pérez-Escamilla R. Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001542. [PMID: 37556418 PMCID: PMC10411826 DOI: 10.1371/journal.pgph.0001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Abstract
Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.
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Affiliation(s)
- Gabriela Buccini
- Department of Social and Behavioral Health, University of Nevada Las Vegas School of Public Health, Las Vegas, Nevada, United States of America
| | - Lily Kofke
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Haley Case
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Marina Katague
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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Gurgel RB, Silva JLPD, Monteiro EMLM, da Silva SL, Lima TRDME, Coriolano-Marinus MWDL. Parenting of mothers of children in early childhood during the COVID-19 pandemic: qualitative research. Rev Bras Enferm 2023; 76Suppl 1:e20220478. [PMID: 37531482 PMCID: PMC10389648 DOI: 10.1590/0034-7167-2022-0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/06/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES to understand practices of mothers of children in early childhood who live in contexts of poverty in the face of the COVID-19 pandemic. METHODS an exploratory, descriptive and qualitative study. Participants were selected in the community context, composing an intentional sample to be collected through semi-structured online interviews. Data were analyzed inductively and anchored in the Bioecological Model of Human Development. RESULTS eight mothers participated in the research. Mothers highlighted pleasure in taking care of their children, although they were overloaded with activities and comprehensive care at the time of the pandemic. Children, in mothers' perception, showed a higher frequency of challenging behaviors, which may be related to negative parenting practices, such as punishment and physical violence. FINAL CONSIDERATIONS interventions to support parenting become urgent in the face of changes brought about by the COVID-19 pandemic in families living in a context of poverty.
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Affiliation(s)
| | | | | | - Suzana Lins da Silva
- Instituto de Medicina Integral Professor Fernando Figueira. Recife, Pernambuco, Brazil
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Kirkwood BR, Sikander S, Roy R, Soremekun S, Bhopal SS, Avan B, Lingam R, Gram L, Amenga-Etego S, Khan B, Aziz S, Kumar D, Verma D, Sharma KK, Panchal SN, Zafar S, Skordis J, Batura N, Hafeez A, Hill Z, Divan G, Rahman A. Effect of the SPRING home visits intervention on early child development and growth in rural India and Pakistan: parallel cluster randomised controlled trials. Front Nutr 2023; 10:1155763. [PMID: 37404861 PMCID: PMC10315474 DOI: 10.3389/fnut.2023.1155763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs. Methods The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat. Results 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups. Discussion The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.
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Affiliation(s)
- Betty R. Kirkwood
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Reetabrata Roy
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Child Development Group, Sangath, New Delhi, India
| | - Seyi Soremekun
- Department of Infection Biology, Faculty of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sunil S. Bhopal
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bilal Avan
- Department of Infection Biology, Faculty of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Raghu Lingam
- Population Child Health Research Group, School of Clinical Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Lu Gram
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Sindh, Pakistan
| | - Sarmad Aziz
- Department of Anthropology, University College London, London, United Kingdom
| | - Divya Kumar
- Child Development Group, Sangath, New Delhi, India
| | | | | | | | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | - Neha Batura
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Gauri Divan
- Child Development Group, Sangath, New Delhi, India
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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Hill Z, Zafar S, Soremekun S, Sikander S, Avan BI, Roy R, Aziz S, Kumar D, Parveen N, Saleem S, Verma D, Sharma KK, Skordis J, Hafeez A, Rahman A, Kirkwood B, Divan G. Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan. Front Nutr 2023; 10:1152548. [PMID: 37404854 PMCID: PMC10315833 DOI: 10.3389/fnut.2023.1152548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. Methods and materials We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. Results Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. Discussion Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility.
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Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Iqbal Avan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Reetabrata Roy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Sarmad Aziz
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nazia Parveen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shumaila Saleem
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Betty Kirkwood
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ahun MN, Aboud F, Wamboldt C, Yousafzai AK. Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews. Front Public Health 2023; 11:1140843. [PMID: 36875409 PMCID: PMC9978394 DOI: 10.3389/fpubh.2023.1140843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction In the last decade, there has been increased global policy and program momentum to promote early childhood development. The Care for Child Development (CCD) package, developed by UNICEF and the WHO, is a key tool responding to the global demand. The CCD package comprises two age-specific evidence-based recommendations for caregivers to 1) play and communicate and 2) responsively interact with their children (0-5 years) and was designed to be integrated within existing services to strengthen nurturing care for child development. The aim of this report was to provide an up-to-date global review of the implementation and evaluation of the CCD package. Methods In addition to a systematic review of 55 reports, we interviewed 23 key informants (including UNICEF and WHO personnel) to better understand the implementation of CCD. Results The CCD package has been or is being implemented in 54 low- and middle-income countries and territories, and it has been integrated into government services across the health, social, and education sectors in 26 countries. Across these contexts, CCD has been adapted in three primary ways: 1) translations of CCD materials (mostly counseling cards) into local language(s), 2) adaptations of CCD materials for the local context, vulnerable children, or a humanitarian/emergency setting (e.g., including local play activities, using activities that are better suited to children with visual impairments), and 3) substantive modifications to the content of CCD materials (e.g., expansion of play and communication activities, addition of new themes, creation of a structured curriculum). While there is promising evidence and examples of good implementation practice, there has been mixed experience about implementation of CCD with respect to adaptation, training, supervision, integration into existing services, and monitoring implementation fidelity and quality. For example, many users of CCD found difficulties with training the workforce, garnering buy-in from governments, and ensuring benefits for families, among others. Discussion Additional knowledge on how to improve the effectiveness, implementation fidelity and quality, and acceptance of CCD is needed. Based on the findings of the review we make recommendations for future efforts to implement CCD at-scale.
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Affiliation(s)
- Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Frances Aboud
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Claire Wamboldt
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Dulal S, Saville NM, Merom D, Giri K, Prost A. Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001398. [PMID: 37115747 PMCID: PMC10146516 DOI: 10.1371/journal.pgph.0001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.
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Affiliation(s)
- Sophiya Dulal
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | | | - Dafna Merom
- Western Sydney University, School of Health Sciences, Sydney, Australia
| | - Kalpana Giri
- Health Research and Development Forum, Kathmandu, Nepal
| | - Audrey Prost
- UCL Institute for Global Health, London, United Kingdom
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Singh A, Torres KA, Maharjan N, Shrestha J, Agbozo F, Abubakari A, Abdul-Rahman L, Mukuria-Ashe A. Learning from health system actor and caregiver experiences in Ghana and Nepal to strengthen growth monitoring and promotion. PLoS One 2023; 18:e0282807. [PMID: 36893119 PMCID: PMC9997959 DOI: 10.1371/journal.pone.0282807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Globally, growth monitoring and promotion (GMP) of infants and young children is a fundamental component of routine preventive child health care; however, programs have experienced varying degrees of quality and success with enduring challenges. The objective of this study was to describe implementation of GMP (growth monitoring, growth promotion, data use, and implementation challenges) in two countries, Ghana and Nepal, to identify key actions to strengthen GMP programs. METHODS We conducted semi-structured key informant interviews with national and sub-national government officials (n = 24), health workers and volunteers (n = 40), and caregivers (n = 34). We conducted direct structured observations at health facilities (n = 10) and outreach clinics (n = 10) to complement information from interviews. We coded and analyzed interview notes for themes related to GMP implementation. RESULTS Health workers in Ghana (e.g., community health nurses) and Nepal (e.g., auxiliary nurse midwives) had the knowledge and skills to assess and analyze growth based on weight measurement. However, health workers in Ghana centered growth promotion on the growth trend (weight-for-age over time), whereas health workers in Nepal based growth promotion on measurement from one point in time to determine whether a child was underweight. Overlapping challenges included health worker time and workload. Both countries tracked growth-monitoring data systematically; however, there was variation in growth monitoring data use. CONCLUSION This study shows that GMP programs may not always focus on the growth trend for early detection of growth faltering and preventive actions. Several factors contribute to this deviation from the intended goal of GMP. To overcome them, countries need to invest in both service delivery (e.g., decision-making algorithm) and demand generation efforts (e.g., integrate with responsive care and early learning).
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Affiliation(s)
- Akriti Singh
- USAID Advancing Nutrition, Helen Keller International, New York, New York, United States of America
| | - Kelsey A. Torres
- USAID Advancing Nutrition, JSI Research & Training Institute, Inc., Arlington, Virginia, United States of America
- * E-mail:
| | - Nashna Maharjan
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Jyoti Shrestha
- Mother and Infant Research Activities, Kathmandu, Bagmati Province, Nepal
| | - Faith Agbozo
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Abdulai Abubakari
- Department of Global and International Health, University for Development Studies, Tamale, Northern Region, Ghana
| | | | - Altrena Mukuria-Ashe
- USAID Advancing Nutrition, Save the Children, Washington, DC, United States of America
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