Given that mobile phone usage has increased rapidly throughout the world, one possibility to increase parental involvement in monitoring their children’s progression is to train parents or primary caregivers on the use of mobile phone technology to track their children’s developmental milestones. The current paper aimed to describe the development of a mobile phone application for use among primary caregivers and establish the feasibility and preliminary impact of caregivers using a mobile phone application to track the progression of their children’s development in a context where there is a paucity of similar studies. This study is a substudy that focusses on the intervention group only of a recently completed two-armed quasi-experimental study in an informal settlement in Nairobi. The mobile phone application which consisted of questions on children’s developmental progression, as well as stimulation messages, was developed through a step-wise approach. The questions covered five child developmental domains: communication; fine motor; gross motor; personal-social; and, problem-solving. Depending on the response received, the child would be classified as having ‘achieved a milestone’ or ‘milestone not achieved.’ If a child had achieved the milestone for a specific age, a caregiver would receive an SMS on how to stimulate the child to achieve the next milestone. Where the milestone was not achieved, the caregiver would get a message to enhance development in the area of delay. Caregivers with children aged between six months and two years were recruited into the study and received questions and messages regarding their children’s development (age-specific) on a monthly basis for 12 months. Caregiver adherence to the intervention was above 90% in the first three months of implementation. Thereafter, the response rate fluctuated between 76% and 86% across the subsequent months of the intervention. The high level and fairly stable caregivers’ rate of response to the 12 rounds of messaging indicated feasibility of the mobile technology. Further, in the first three months of intervention implementation, the majority of caregivers were able to keep track of how their children attained their developmental milestones. The intervention seems to be scalable, practical and potentially low-cost because of the wide coverage of phones.
<p class="abstract"><strong>Background:</strong> Investing in parents and children during the critical period between birth and five years of a child’s life can have long-lasting benefits in the life of the child. Recently, the 2016 Lancet Series estimated that 250 million children aged less than five years in low- and middle-income countries (LMICs) are at risk of not reaching their developmental potential. Over 66 % of these, who live in sub-Saharan Africa and are at risk due to poor nutrition, exposure to poverty, high HIV prevalence as well as under stimulation in the home environment.</p><p class="abstract"><strong>Methods:</strong> The study will employ a cluster-randomized control trial design and will use a mixed-methods approach combining quantitative and qualitative methodologies <strong>(</strong>Concurrent Triangulation Design).<strong> </strong>This will be a two-arm study, where the first arm will participate in the parenting empowerment program implemented by the faith-based organizations, while the second (control) will not receive the parenting interventions. A total of 510 mother/primary caregiver-child dyads will be recruited into this study. We will estimate the causal effect of the intervention using mixed linear models and the Difference-in-Differences (DID) estimator.</p><p class="abstract"><strong>Conclusions: </strong> This implementation research will provide greater scientific rigor and a deeper process and outcome evaluation including measurement of child development outcomes. The findings will be useful for early childhood practitioners, multilateral stakeholders and funders as they provide information on the factors to consider in the implementation of high quality ECD interventions.</p><p class="abstract"><strong>Trial Registration: </strong>Ethical approval: ESRC P467/2018 and IRB No.00005948).</p>
Background 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. Few studies have investigated fathers’ roles in the nurturing care of young children, particularly responsive care and stimulation, in sub-Saharan Africa. The study reported here was carried out as part of a larger study that sought to evaluate the effectiveness of the Moments That Matter (MTM) program in improving the nurturing care of young children in rural communities in Zambia and Kenya. The MTM program uses a parenting empowerment approach to promote bonding and interactions between caregivers and their children within the home, focusing on responsive care, early learning, and security and safety so that children reach their full developmental potential. Trained volunteers facilitated monthly primary caregiver support and learning groups and ECD home visits. Fathers were encouraged to participate in the home visits and to attend some of the group meetings on specific topics. The study reported in this paper aimed to establish the impact of the parenting empowerment program in promoting more gender-equal attitudes and practices on parenting among fathers (who were not the primary caregivers). Methods Qualitative data were collected at three time points (pre-intervention before the implementation began; mid-intervention after 6 months of implementation; and post-intervention, after 24 months). We conducted focused group discussions with primary caregivers (n = 72) and fathers (n = 24) with children below 3 years. In-depth interviews were conducted with ECD Promoters (n = 43) and faith leaders (= 20). We also conducted key informant interviews with the MTM program implementers (n = 8) and government officials (n = 5) involved in the program implementation. We employed thematic analysis to analyse the qualitative data. Results The findings showed 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 spent more time playing and interacting with their children and were more involved in household chores due to their participation in the MTM program. Conclusion The study findings provide evidence for policy formulation and a guide for implementation of policies that can influence changes in perceived gender roles in parenting.
IntroductionInvesting in children during the critical period between birth and age 5 years can have long-lasting benefits throughout their life. Children in Kenya’s urban informal settlements, face significant challenges to healthy development, particularly when their families need to earn a daily wage and cannot care for them during the day. In response, informal and poor quality child-care centres with untrained caregivers have proliferated. We aim to co-design and test the feasibility of a supportive assessment and skills-building for child-care centre providers.Methods and analysisA sequential mixed-methods approach will be used. We will map and profile child-care centres in two informal settlements in Nairobi, and complete a brief quality assessment of 50 child-care centres. We will test the feasibility of a supportive assessment skills-building system on 40 child-care centres, beginning with assessing centre-caregivers’ knowledge and skills in these centres. This will inform the subsequent co-design process and provide baseline data. Following a policy review, we will use experience-based co-design to develop the supportive assessment process. This will include qualitative interviews with policymakers (n=15), focus groups with parents (n=4 focus group discussions (FGDs)), child-care providers (n=4 FGDs) and joint workshops. To assess feasibility and acceptability, we will observe, record and cost implementation for 6 months. The knowledge/skills questionnaire will be repeated at the end of implementation and results will inform the purposive selection of 10 child-care providers and parents for qualitative interviews. Descriptive statistics and thematic framework approach will respectively be used to analyse quantitative and qualitative data and identify drivers of feasibility.Ethics and disseminationThe study has been approved by Amref Health Africa’s Ethics and Scientific Review Committee (Ref: P7802020 on 20th April 2020) and the University of York (Ref: HSRGC 20th March 2020). Findings will be published and continual engagement with decision-makers will embed findings into child-care policy and practice.
Over 66 per cent of children in sub-Saharan Africa remain affected by poor developmental outcomes, exacerbating early inequalities. UNICEF and WHO evolved the Care for Child Development package (CCD) as a community-based initiative to support caregivers to develop stronger relationships with young children and support nurturing care. The Baby Friendly Community Initiative (BFCI) is a global WHO strategy to promote optimal maternal, infant and young child nutrition at the community level. This paper provides insights into the feasibility and lessons learned from rural Kenya in providing CCD training and supporting its implementation alongside the BFCI. Findings from qualitative interviews with caregivers and implementers of the BFCI revealed that training community health volunteers on CCD, enabled them to deliver CCD messages alongside those of the BFCI during counselling sessions. However, a more integrated approach to training as well as practical training opportunities, refresher training and provision of materials that facilitate the programme will enable further support for nurturing care in Kenya.
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