Childcare can be considered an infrastructure component akin to transportation. Without reliable, affordable sources, workers cannot regularly get to work or stay there. In the short term, early care and education settings support the productivity of two types of workers: employed parents and childcare workers. Research by University of Chicago economist and Nobel Laureate James Heckman and others suggests that many early childhood programs pay for themselves before children begin kindergarten via increased maternal employment, which generates both household income and tax revenue.20 Further, research from the early 2000s suggests that investments in childcare have strong local economic development effects, or multiplier effects, because much of those dollars are spent on childcare worker wages that they, in turn, spend locally.21
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Child level factors including sex and birth weight are independently and strongly associated with stunting. While the association between birth weight and nutritional status has been well documented and understood in sub-Saharan Africa [31, 32], few studies have documented gender difference with regards to malnutrition in young children particularly in sub-Saharan Africa [17, 33]. It has been argued that such differences occur in low socio-economic status settings [34]. Despite the strong significance of these child level factors in influencing child stunting, our study concludes that they do not substantially alter the effect of education on child stunting.
Inclusion of health knowledge skills in school curricula may lead to substantial improvement in child nutritional status by directly enabling the girls who are future mothers to have an improved health knowledge, practices, and health seeking behavior [19]. This study indicates that among children born in the slums, a substantial proportion was born at home or with the assistance of a TBA. This therefore indicates that many mothers do not adequately benefit from the baby-friendly hospital initiative being implemented in Kenya. The aim of the initiative is to enhance optimal breastfeeding and young child feeding practices, thus improving infant and child nutritional status [36]. The study therefore calls for awareness creation to enhance delivery at health facilities. Policies targeted at improving livelihoods of the urban poor may result in reduced malnutrition and ultimately alter the poverty cycle.
Elizabeth Wambui Kimani-Murage is an Associate Research Scientist with the African Population and Health Research Center and a Wellcome Trust Fellow. Her current research interests include maternal and child health issues, malnutrition including obesity and food security.
For example, in a jubilant rendition, Miles and Carmen share a toy drum and a tambourine as they dance to a popular song heard in their communities. The song promotes unity, friendship, and love. Through group music making, children can express feelings and connect with the feelings of others, promoting positive social and emotional development.
Our findings demonstrate a positive association between both the frequency of caregiver child interactions and knowledge of adequate dietary diversity, and ECD outcomes. This aligns with global evidence that promoting early stimulation, play and learning opportunities, and dietary diversity can improve developmental outcomes. Further study is needed to establish causal relationships and assess the impact of ECD programming in Zanzibar.
One in ten children aged 2 years in Zanzibar exhibit significant concerns for developmental delay. Our research shows that the frequency of early stimulating activities between the caregiver and child and caregiver knowledge of adequate dietary diversity are associated with improved developmental outcomes. Increased focus on supportive home environments and positive parenting practices may support children to reach their full cognitive and linguistic potential.
Interventions aimed at improving early childhood development (ECD) in LMICs can have a significant impact, although timing and implementation characteristics are important components determining program success [7]. Reviews suggest that programs providing nutritional supplementation or education have variable and generally smaller impact on ECD outcomes [8]. Programs that promote caregiver stimulation or integrate stimulation with nutritional interventions have been more successful in improving ECD outcomes [9], although questions about optimal implementation at scale remain [10,11,12]. To make interventions impactful and sustainable, current recommendations emphasize implementing the Nurturing Care Framework as a multisectoral package, addressing health, nutrition, caregiver stimulation and early learning, and psycho-social threats to child development across the life course [13].
While our study design limits our ability to attribute causation, we found a strong association between caregiver interactions, in the form of regular play and communication and early stimulation activities, and child development outcomes. This association is evident across all developmental domains, is dose-dependent on number of caregiver child activities and incremental increases in developmental outcomes, and strengthened when we adjusted for wealth, parental education, and geography. This finding is consistent with other ECD studies, which show the positive impact of coaching of caregiver stimulation on developmental outcomes [23, 24, 36], and strong positive associations between caregiver engagement, child stimulation, and higher CREDI scores. Our findings highlight the importance of testing the impact of interventions that incorporate strong and effective approaches to coach parents and caregivers to engage in more play and communication activities with their children on ECD outcomes, as this could contribute to an overall increase in CREDI scores in this population. However, while increases in parental engagement activity were significantly linked to developmental outcomes, the magnitude of this association was moderate, and suggests that other factors are also contributing to the variation in ECD outcomes, and therefore that complementary health and nutrition interventions should be linked to parent stimulation intervention to promote optimal early childhood development.
This study is the first known report of early developmental outcomes at the population level in Zanzibar. While many reports of developmental status in LMIC settings rely on proxy measures such as poverty or stunting, or utilize more complex measures (e.g., Bailey, MDAT) on a subset of the population, our use of the CREDI, an internationally-validated simple caregiver reporting tool in a nationally representative survey provides a unique first assessment of ECD status across Zanzibar. Our findings are novel to the Zanzibar context and can be used, along with best practices from the literature, to serve as an important baseline for evaluating the success of subsequent programs, developing and testing interventions to promote optimal child development in resource-constrained settings, and contributing to the limited ECD literature in this context.
Our findings show a positive association between quantity of early stimulating activities and ECD outcomes, as well as caregiver knowledge of adequate dietary diversity and ECD outcomes. In combination with existing supporting evidence, these findings provide a direction for developing and testing parenting interventions at the household and community-levels in the Zanzibari population, in combination with other health and nutrition interventions to improve child development.
In South Darfur, Sudan, World Vision is providing nutritional care for children diagnosed with malnutrition. As of March 2021, nearly 7,000 children below the age of 5 and 1,800 pregnant women and breastfeeding mothers have been treated with nutritional care for their acute malnutrition in Sudan. (2021 World Vision/photo by Sojoud Elgarrai)
Across East Africa, at least 12.8 million children are experiencing high levels of malnutrition. In South Darfur, Sudan, World Vision is providing nutritional care for children diagnosed with malnutrition. As of December 31, 2021, 69,269 children have received nutritional care for acute malnutrition.
Hunger can have devastating consequences for women and children, going beyond health and nutrition to include the risk of gender-based violence and sexual exploitation and abuse. The indirect impacts of the COVID-19 pandemic are exacerbating these concerns for children and their communities that lack safety nets.
The North Carolina Department of Health and Human Services will issue the first round of Child Care P-EBT benefits next week for nearly 220,000 children who were eligible during September and October 2021. These benefits will continue to be issued monthly through August 2022, covering food needs for children who were eligible from September 2021 to May 2022. Children are eligible if they were 5 years old or younger as of Sept. 1, 2021 and participated in Food and Nutrition Services (FNS). "The P-EBT program helps to ensure our youngest children have access to nutritious food that is essential to their growth, development and well-being," said NCDHHS Chief Deputy Secretary Susan Gale Perry. "These extra benefits will help families increase their food budgets and protect the health and well-being of young children."
Children in low-income families tend to have worse health outcomes than other kids, with even short stays in poverty being associated with higher rates of asthma, malnutrition, trauma, and other chronic diseases. Health care costs also drive millions of families into poverty, forcing them to make difficult financial trade-offs to afford care.72 Low-income families in employee-sponsored health plans use almost twice as much of their income on out-of-pocket medical expenses than other families.73 While 70 percent of low-income children (defined as living below twice the official poverty measure) are covered by Medicaid or other government-assisted plans, including for those with low incomes or disabilities, almost 8 percent of children across the country are uninsured. That percentage is higher than 15 percent in states such as Texas and Wyoming that have not chosen to expand Medicaid under the Affordable Care Act (ACA).74 2ff7e9595c
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