For decades, child growth monitoring has been performed by measuring anthropometric indicators and comparing them against universal standards. Since the 1970s various efforts have been made to expand the focus from anthropometric indicators and include broader contextual and structural factors that influence children's growth. However, those efforts have so far not led to changes in the dimensions that are taken into account in child growth monitoring. In this paper we introduce the Capability Approach as an evaluative framework for growth monitoring of children under five years old. Applying the CA helps focusing on opportunities that are available to children to choose from in order to achieve healthy growth. By doing so, it helps analyzing their available resources (endowments), as well as the mechanisms that could enhance or restrict their access to those resources (conversion factors). In addition, children's growth could be assessed alongside the caregivers' capabilities that children rely on to achieve their full growth potential. We present a child growth evaluation framework as well as an analytical matrix, which has different categories of dimensions that interact with each other and ultimately shape children's growth. The framework is a flexible tool, and is thus broad enough to accommodate contextual differences.
Child malnutrition is an important cause of under-5 mortality and morbidity around the globe. Despite the partial success of (inter)national efforts to reduce child mortality, under-5 mortality rates continue to be high. The multidimensional approaches of the Sustainable Development Goals may suggest new directions for rethinking strategies for reducing child mortality and malnutrition. We propose a theoretical framework for developing a "capability" approach to child growth. The current child growth monitoring practices are based on 2 assumptions: (a) that anthropometric and motor development measures are the appropriate indicators; and (b) that child growth can be assessed using a single universal standard that is applicable around the world. These practices may be further advanced by applying a capability approach to child growth, whereby growth is redefined as the achievement of certain capabilities (of society, parents, and children). This framework is similar to the multidimensional approach to societal development presented in the seminal work of Amartya Sen. To identify the dimensions of healthy child growth, we draw upon theories from the social sciences and evolutionary biology. Conceptually, we consider growth as a plural space and propose assessing growth by means of a child growth matrix in which the context is embedded in the assessment. This approach will better address the diversities and the inequalities in child growth. Such a multidimensional measure will have implications for interventions and policy, including prevention and counselling, and could have an impact on child malnutrition and mortality.
Background Childhood stunting is an important public health problem in the haor region of Bangladesh. Haor areas are located in the north-eastern part of the country and are vulnerable to seasonal flooding. The key objective of this study is to identify the capabilities of the parents and their children that shape multidimensional child growth outcomes in the haor region in the first thousand days of life. Methods A qualitative study was conducted in two sub-districts of the haor region, including in Derai in the Sunamganj district and Baniachang in the Habiganj district. We facilitated eight focus group discussions with the parents of children under age two. To allow us to explore individual stories, we conducted in-depth interviews with four fathers and four mothers. A capability framework to child growth was used in shaping the interview guides and analysing the data. Results The findings were categorised at four levels: a) capabilities for the child, b) capabilities for the mother, c) capabilities for the father, and d) capabilities at the household level. At the child’s level, the parents discussed the capability to stay away from disease and to eat well, the capability to stay happy and playful, and the capability to be born with God’s blessings and the hereditary traits needed to grow in size. The mothers frequently mentioned the capability to stay healthy and nourished, to stay away from violence, and to practice autonomy in allocating time for child care. The fathers stressed the earning opportunities that are affected by long-term flooding and the loss of agricultural productivity. At the household level, they discussed the capability to live in a safe shelter, to be mobile, to overcome their struggles with the earth, and to have a source of safe drinking water. Conclusions The capability framework for child growth helped identify relevant capabilities in the haor region. These findings can guide discussions with communities and policy makers about developing programmes and interventions aimed at enhancing the identified capabilities for child growth in this vulnerable region.
Current policies on ageing in the global north emphasize that ‘ageing well’ is an individual responsibility, and tend to undervalue the social, economic and cultural context of ageing. The capability approach is well-suited to address the interplay between context and individual in later life. In this article, we therefore use the capability approach to explore how individual capabilities and contextual opportunities and restrictions contribute to being independent in later life. A qualitative methodology was adopted and we conducted in-depth interviews with 32 adults aged 65 and older, who lived independently and in sheltered housing. The study was carried out in two urban neighborhoods in the North of the Netherlands. Our findings underline that different pathways to independence are shaped by individual resources and capabilities, as well as by social and physical characteristics of the living environment. The three key capabilities that lead to being independent that we found were 1) to be comfortable at home and in the neighborhood; 2) to enjoy fulfilling social relations, and 3) to be mobile. The generated insights could be linked to policy initiatives with regard to age-friendly environments.
Climate-related disasters affect different dimensions of children’s health and well-being both directly and indirectly. Reducing children’s vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health.As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster’s risks.Main factors in shaping children’s behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that.So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness.
Background: There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one’s goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain. Summary and key Messages: In the past 5 years, the International Union of Nutritional Sciences Task Force “Towards a multi-dimensional index for child growth and development” has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child’s agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point.
The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers’ capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women’s control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers’ real opportunities for achieving healthy child growth.
School textbooks are one of the main sources for teaching and learning in an education system. This study aims to investigate the representation of disasters in school textbooks for the children with intellectual disabilities (ID) in the education system in Iran.This study uses a qualitative content analysis method. All school textbooks for students with ID in the education year 2019-2020 in Iran were collected. Among the whole 164 textbooks, 18 had content about hazards. Data were analyzed qualitatively by MAXQDA 2018 software.Textbooks in most grades cover the topic of disasters triggered by natural hazards including geophysical (earthquakes), hydrological (floods), climatological (extreme temperatures, and drought), meteorological (storms/wave surges) and biological (epidemics and insect/animal plagues). Moreover, there are various topics of disaster risk management in the textbooks including mitigation, preparedness, and response.Natural hazards are well covered in school textbooks for students with ID in Iran. However, more content about sheltering in disasters, reunification, as well as disasters' response and recovery will help children with ID in Iran to perform better during and after disasters. Moreover, the textbooks in several grades provide some debates on the prevention and the spread of infectious diseases for preparedness against epidemics. The COVID-19 pandemic and the significance of preparedness of vulnerable groups against pandemics evidence that school textbooks are a key means to transfer the information of preparedness in emergencies of all sorts to all children including children with ID.
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