Caregiver perceptions of child development in rural Madagascar: a cross-sectional study

Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar

BACKGROUND

The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region.

METHODS

Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents.

RESULTS

Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05].

CONCLUSIONS

The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

Assessing Parenting Interactions With Children: Spanish Validation of PICCOLO With Fathers

Background/Objective: To gain knowledge about mothers' and fathers' interactions with their sons and daughters, we need reliable and valid tools to assess parental behaviors that can be used for different caregivers and in a variety of cultural contexts. The aim of this study was to analyze the psychometric properties of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) to assess fathers' interaction with their children at early ages. PICCOLO is an observational tool originally developed in the United States for mothers and fathers and previously validated in Spain with a sample of mothers. Methods: One hundred and ninety-one father-child dyads were observed during free-play situations at home when the children were between 10 and 47 months of age (55.0% male). The fathers auto recorded 8-10 minutes of interaction and trained evaluators assessed the recordings with PICCOLO. Results: Confirmatory factor analysis (CFA) confirmed the dimensional structure of the original version of the scale: four first-order factors (Affection, Responsiveness, Encouragement and Teaching) and one second-order factor (Parenting). The tool was found to have high inter-rater reliability at domain and total score level. Ordinal alpha and omega coefficients for each domain ranged between 0.79 and 0.85, and 0.64 and 0.79, respectively. No statistically significant differences were found in any PICCOLO domain or in the total score according to the child's gender. In assessments of the child's development with the Bayley-III scales, moderate positive correlations were found between Encouragement and receptive language (r = 0.32), and between Teaching and expressive (r = 0.34) and composite language (r = 0.31). Conclusion: The Spanish version of PICCOLO can be used to assess fathers' parenting. As PICCOLO is clearly linked to intervention goals, it is of particular interest for practitioners in early intervention and family programs.