A community engagement approach for an integrated early childhood development intervention: a case study of an urban informal settlement with Kenyans and embedded refugees

Caregiving experiences and practices: qualitative formative research towards development of integrated early childhood development interventions targeting Kenyans and refugees in Nairobi's informal settlements

BACKGROUND

Evidence is needed to understand factors that influence child development and caregiving experiences, especially in marginalized contexts, to inform the development and implementation of early childhood development (ECD) interventions. This study explores caregiving practices for young children in an urban informal settlement with Kenyans and embedded refugees, and identifies factors shaping these caregiving experiences, to inform the design and development of potentially appropriate ECD interventions.

METHODS

A qualitative formative study, which included 14 focus group discussions (n = 125 participants), and 13 key informant interviews was conducted between August and October 2018. Purposive sampling approaches were used to select a diverse range of respondents including caregivers of children below three years of age and stakeholders of Kenyan nationality and refugees. Data were analysed using a thematic approach and the Nurturing Care Framework was used as an interpretative lens.

RESULTS

There was a fusion of traditional, religious and modern practices in the care for young children, influenced by the caregivers' culture, and financial disposition. There were mixed views/practices on nutrition for young children. For example, while there was recognition of the value for breastfeeding, working mothers, especially in the informal economy, found it a difficult practice. Stimulation through play was common, especially for older children, but gaps were identified in aspects such as reading, and storytelling in the home environment. Some barriers identified included the limited availability of a caregiver, insecurity, and confined space in the informal settlement, all of which made it difficult for children to engage in play activities. Physical and psychological forms of discipline were commonly mentioned, although few caregivers practiced and recognized the need for using non-violent approaches. Some overarching challenges for caregivers were unemployment or unstable sources of income, and, particularly for refugee caregivers, their legal status.

CONCLUSION

These findings point to the interplay of various factors affecting optimal caregiving for young children in an urban informal settlement with Kenyans and refugees. Integrated ECD interventions are needed for such a mixed population, especially those that strive to anchor along caregivers' social support system, co-designed together with community stakeholders, that ideally focus on parent skills training promoting nurturing care and economic empowerment.

Embodiment of structural vulnerability: illness experiences among Somali refugee women in urban displacement

OBJECTIVES

Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population.

DESIGN

Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya.

RESULTS

Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement.

CONCLUSIONS

Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.

The Transformative Impact of Community-Led Monitoring in the South African Health System: A Comprehensive Analysis

Objectives: Community-led monitoring (CLM) is an emerging approach that empowers local communities to actively participate in data collection and decision-making processes within the health system. The research aimed to explore stakeholder perceptions of CLM data and establish a CLM Data Value Chain, covering data collection and its impact. Methods: Qualitative data were collected from stakeholders engaged in health programs in South Africa. Data analysis involved a collaborative workshop that integrated elements of affinity diagramming, thematic analysis, and the systematic coding process outlined in Giorgi's method. The workshop fostered joint identification, co-creation of knowledge, and collaborative analysis in developing the data value chain. Results: The findings showed that CLM data enabled community-level analysis, fostering program advocacy and local collaboration. It enhanced program redesign, operational efficiency, and rapid response capabilities. Context-specific solutions emerged through the CLM Data Value Chain, promoting sustainable and efficient program implementation. Conclusion: CLM is a powerful tool for improving program implementation, quality, and advocacy in South African healthcare. It strengthens accountability, trust, and transparency by involving local communities in data-driven decision-making. CLM addresses context-specific challenges and tailors interventions to local needs.

The impact of public leadership on collaborative administration and public health delivery

BACKGROUND

This research depicts the linkage of public leadership on public health delivery (PHD) and collaborative administration. The research is also focused to examine the effect of public leadership on public health delivery through the intervening variable of collaborative administration by using both social information processing theory and collaboration theory.

METHODS

This research is based on quantitative method. Data was collected from 464 public hospital administration in the context of Pakistan. This study evaluated data using SPSS, AMOS, and PROCESS Macro.

RESULTS

Public leadership has a positive profound effect on public health delivery and collaborative administration, and that collaborative administration significantly promotes public health delivery. The outcomes also exposed that public leadership has substantial influence on public health delivery through intervening collaborative administration.

CONCLUSIONS

Whilst public leadership demonstrated positive outcomes on public health delivery and collaborative administration, there is a need for more rigor studies on collaborative governance leadership, collaborative ethics and collaborative norms in the public health service.

Addressing Cancer Disparities Through Community Engagement: Lessons and Best Practices

Cancer disparities continue to be a significant public health challenge, disproportionately affecting certain communities in terms of incidence, mortality, and access to quality care. Addressing these disparities requires a multifaceted approach that involves not only healthcare professionals and researchers but also the active participation and collaboration of the affected communities themselves. Community engagement has emerged as a promising strategy to reduce cancer disparities and promote health equity. This review article synthesizes the existing literature and examines the role of community engagement in addressing cancer disparities. It explores various approaches and best practices utilized in community engagement initiatives to empower and involve diverse populations in the fight against cancer. The review discusses key lessons learned from successful programs and identifies challenges faced in implementing such initiatives. The article highlights the importance of cultural competence, trust-building, and meaningful collaboration between stakeholders, including community leaders, healthcare providers, researchers, and policymakers. It emphasizes the significance of tailoring interventions to specific community needs, acknowledging cultural differences, and fostering a two-way exchange of knowledge and resources. Moreover, this review investigates the impact of community engagement on cancer prevention, early detection, treatment adherence, and survivorship outcomes. It sheds light on the role of community-based participatory research and other innovative strategies in generating evidence and facilitating the translation of research findings into real-world interventions. In conclusion, this review underlines the potential of community engagement in addressing cancer disparities and promoting health equity. By involving communities as active partners in cancer control efforts, healthcare systems can design more effective and sustainable interventions. This approach not only contributes to reducing cancer disparities but also fosters a sense of ownership and empowerment within the communities affected, paving the way for a more equitable and inclusive healthcare landscape.

Health seeking behaviors and childcare patterns in an informal settlement of Nairobi, Kenya: A cross-sectional study

Children in urban informal settlements experience high risks for poor health and development. Understanding health seeking behaviors and childcare patterns of caregivers in urban informal settlements is important for devising effective interventions. This study describes household characteristics and aspects of nurturing care among caregivers of children aged 0-2 years in Dagoretti informal settlement, Nairobi-Kenya. In this cross sectional study, data were collected on household socio-demographic characteristics, antenatal care and child delivery practices, infant and young child feeding practices, activities that promote play, learning and school readiness, and on childcare and protection practices. Descriptive statistics of proportions and means were used to summarize the data. The study covers a total of 458 Kenyan and 118 immigrant households. Caregivers from immigrant households, with low education and from the younger age-group (less than 20 years) were vulnerable to sub-optimal caregiving and health seeking practices, including relatively lower rates of age-appropriate breastfeeding and poor dietary diversity. Seventy-five percent of expectant mothers attended less than four antenatal care visits. Households surveyed had limited possession of children's books (2% with three or more books), limited access to play materials (43% had two or more play materials), and low paternal involvement in child stimulation and early learning activities (14%). One-third and half of the children were left with inadequate care and disciplined using both violent and non-violent methods, respectively. Our findings highlight the urgent need for contextually appropriate and integrated interventions anchored in the WHO's nurturing care framework. These interventions can benefit from extensive involvement of caregivers, facility and community-based healthcare workers, policy makers, and other relevant stakeholders.

Prosocial cascades: Understanding and nurturing the potential for positive developmental trajectories

Understanding the developmental cycles and mechanisms that nurture prosocial behavior can support our potential to build a kinder and more peaceful society. The current chapter explores positive developmental cascades, with a focus on the chain reactions that explain how prosocial behaviors manifest and evolve throughout childhood and adolescence. Specifically, we review the main issues, theories, and findings related to the study of children's prosocial trajectories. We focus on various socialization environments that span typical and adverse (e.g., trauma, poverty, maltreatment, exposure to violence) contexts. Furthermore, we highlight the evidence behind efforts and initiatives that aim to nurture prosociality in children and families. We conclude with future directions for how research on positive cascades can inform research-practice alliances work that aims to break harmful cycles and promote prosocial mechanisms of change.