Maternal caregiving capabilities are associated with child linear growth in rural Zimbabwe

Abstract

Between birth and 2 years, children's well-being depends on the quality of care they receive from caregivers, primarily their mothers. We developed a quantitative survey instrument to assess seven psychosocial characteristics of women that determine their caregiving ability ('maternal capabilities': physical health, mental health, decision-making autonomy, social support, mothering self-efficacy, workload and time stress, and gender norm attitudes). We measured maternal capabilities in 4,025 mothers and growth in their 4,073 children participating in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. We used generalized estimating equation models with exchangeable correlation structure to test the association between each maternal capability during pregnancy, and infant length-forage Z (LAZ) at 18 months, accounting only for within-cluster correlation and intervention arms in unadjusted analyses and for potential confounders in adjusted analyses to examine the association between each capability, assessed during pregnancy, with child LAZ at 18 months of age. In adjusted models, each unit increase in gender norm attitudes score (reflecting more equitable gender norm attitudes) was associated with

Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials

“…Among children in the control groups in this IPD, those whose mothers had lower scores for depressive symptoms had slightly higher mean LAZ and HCZ than those whose mothers were in the top quartile for depressive symptoms (a difference of ∼ −0.10 Z), suggesting that the former subgroup was less vulnerable, which is inconsistent with a greater potential to benefit. However, in the SHINE trial in Zimbabwe ( 91 ), the effect of the intervention on LAZ was greater among children of mothers who scored ≥12 on the Edinburgh Postnatal Depression Scale [a cutoff validated against clinically diagnosed major depression in Zimbabwean women ( 61 )], such that the difference in mean LAZ between children of depressed and nondepressed mothers observed in the control group was not evident in the intervention group. This may reflect amelioration by SQ-LNSs of the adverse influence of maternal depression on growth.…”

The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation

“…Our initial motivation for evaluating the Friendship Bench in rural Zimbabwe stemmed from the SHINE trial (Humphrey et al ., 2019 ), which identified a substantial burden of depression in pregnancy and a lack of locally available interventions (Tome et al ., 2020 ). Previous studies have shown that maternal depression contributes to child undernutrition (Surkan et al ., 2011 ), and the UNICEF framework highlights the central role of maternal caregiving in promoting healthy growth and development.…”

“…Previous studies have shown that maternal depression contributes to child undernutrition (Surkan et al ., 2011 ), and the UNICEF framework highlights the central role of maternal caregiving in promoting healthy growth and development. In SHINE, we found that the randomised infant feeding intervention ameliorated the adverse impact of depression on child growth (Tome et al ., 2020 ). However, we did not explicitly include an intervention to tackle maternal depression.…”

“…SHINE enrolled a cohort of pregnant women and evaluated the impact of improved infant nutrition and/or improved water, sanitation and hygiene on child growth and development. In SHINE, 343/3941 (8.7%) of women had clinically significant depression during pregnancy (Tome et al ., 2020 ) using locally validated tools (Chibanda et al ., 2010 ), but no community-based treatment interventions were available.…”

“…Depression was assessed in SHINE during pregnancy, then at 1, 6, 12 and 24 months postpartum using a Shona version of the Edinburgh Postnatal Depression Scale (EPDS), which has previously been validated in urban Zimbabwe (Chibanda et al ., 2010 ). Women scoring ⩾12 on the EPDS, or answering ‘Yes, quite often’ or ‘Sometimes’ to the question ‘Has the thought of harming yourself occurred to you?’ at 24 months and/or an earlier timepoint were categorised with clinically significant depression (Tome et al ., 2020 ). From this group of 272 women, 30 were purposively sampled for the current study if they resided in the catchment area of six rural health centres (Gundura, Makusha, Mazivisa, Tana, Tongogara and Zvamabande; Fig.…”