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Father Involvement in the Care of Children born Small and Sick in Rwanda: Association with Children's Nutrition and Development
Abstract
Background
Little is known about father's involvement in the care of children born with perinatal risk factors. This study aimed to understand father's involvement in the care of children born preterm, low birthweight (LBW) and/or with hypoxic ischemic encephalopathy (HIE) in rural Rwanda and assess child and home environment factors associated with father involvement.
Methods
A cross‐sectional study of children born preterm, LBW or with HIE who were discharged from Kirehe District Hospital neonatal unit from May 2015‐April 2016 and those enrolled in a neonatal unit follow‐up program from May 2016‐November 2017. Interviews were conducted when the children were ages 24‐47 months in the child's home. Primary caregivers reported on father involvement in parenting, home environment, child disability, child development outcomes, and children's nutritional status were directly measured. Only children whose fathers were living in the home were included in the sample. Bivariate analyses were conducted using Fisher's exact test and Wilcoxon Rank Sum test.
Results
236 children aged 24‐47 months were included in this study, 66.4% were born preterm or LBW with a mean age of 33.3 months. 73.5% of children were at risk of disability, 77.7% had potential delay in overall child development. 15.5% of fathers reported engaging in four or more activities with their child. Factors associated with father involvement included smaller household size (p=0.004), mother engaged in decision making (p=0.027), being on‐track in developmental milestones for problem solving (p=0.042) and mother's involvement in learning activities (p=0.043); also the number of activities a father engaged in was significantly associated with the child's overall developmental status on the ASQ‐3 (p=0.032).
Conclusion
We found that father involvement in activities to support learning was low among children born preterm/LBW and/or with HIE. Program interventions should encourage fathers to engage with their children given the benefits for children's development
... First, we reviewed existing qualitative studies from sub-Saharan Africa regarding fathers' caregiving roles in the lives of young children [12,21,[34][35][36] and developed initial survey items based on these qualitative themes. Next, we reviewed existing survey measures that have been used to quantify fathers' caregiving broadly for young children < 2 years of age in settings across sub-Saharan Africa [11,[37][38][39][40]. We compiled items from across all survey tools and prioritized a shortlist of unique and relevant paternal caregiving behaviors. ...
Background
Globally, there is mounting evidence about the importance of father involvement for improving child and family wellbeing. However, there are limited measurement tools available for assessing father involvement in low-resource settings globally. The objective of this study was to develop and validate a scale for measuring fathers’ engagement in caregiving activities for young children and families in rural Kenya.
Methods
We used baseline data collected in February–March 2023 from a cluster-randomized controlled trial of a parenting intervention aimed at improving early child development in Nyamira and Vihiga counties in Western Kenya. The analytic sample comprised 460 primary caregivers of children under 18 months of age (91.3% mothers) who were in a relationship with a male caregiver of the young child (i.e., father). The primary caregiver reported on the 25-item father involvement scale. We conducted exploratory and confirmatory factor analyses to determine the dimensionality of the measure and estimated latent variable regression models to assess construct and predictive validity in terms of associations with sociodemographic factors, other paternal and maternal psychosocial measures, and early child development outcomes.
Results
The scale had a four-factor structure representing father involvement in (1) childcare activities, (2) play and affection, (3) household chores, and (4) early learning activities. Each factor showed good internal consistency reliability and evidence of multiple forms of validity. The four factors were associated with child and household sociodemographic characteristics and more positive paternal and maternal psychosocial outcomes. Father involvement across all four domains was associated with higher early child cognitive, language, motor, and socioemotional development scores.
Conclusions
Our findings highlight the multidimensional nature of fathers’ caregiving roles in the lives of young children and their families. We establish a valid tool for assessing father involvement in rural Western Kenya that has potential for use in other similar contexts.
... ment, HIV infection, and vaccination status. Several studies reported better health outcomes for children in families having supportive partner.[108][109][110][111][112][113][114][115][116][117][118] (Supporting Information S1:Table 4) For example, infants born to women with poor partner ANC attendance had an increased risk of death or infection due to HIV compared to those ...
Background and Aims
East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that the involvement of male partners in reproductive health can benefit maternal and child health (MCH). This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal, reproductive, and child well‐being.
Methods
Ten databases were searched to identify quantitative data on male's involvement in East Africa. Studies reporting qualitative data, “intention to use” data or only reporting on male partner's education or economic status were excluded. Studies were organized into five a priori categories: antenatal care (ANC), human immunodeficiency virus, breastfeeding, family planning, and intimate partner violence with further categories developed based on studies included.
Results
A total of 2787 records were identified; 644 full texts were reviewed, and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners. Most of the studies (n = 83) were reported from four countries Ethiopia (n = 49), Kenya (n = 14), Tanzania (n = 12) and Uganda (n = 10). The evidence indicates that male partner involvement and support is associated with improved reproductive, MCH across a wide range of outcomes. However, the studies were heterogeneous, using diverse exposure and outcome measures. Also, male partners' lack of practical and emotional support, and engagement in violent behaviors towards partners, were associated with profound negative impacts on MCH and well‐being.
Conclusions
The body of evidence, although heterogeneous, provides compelling support for male involvement in reproductive health programs designed to support MCH. To advance research in this field, an agreement is needed on a measure of male partner “involvement.” To optimize benefits of male partners' involvement, developing core outcome sets and regional coordination are recommended.
... RNP é apontada como fator contribuinte para a manutenção da integridade da pele do bebê.Sua posologia concerne em aplicá-los em toda a superfície corporal, exceto couro cabeludo e face, pelo menos três vezes ao dia(Ahmed et al., 2007).O envolvimento da criança em algodão e mantas, bem como monitoramento da temperatura com o termômetro são prática efetivas utilizadas pelos cuidadores para controle e manutenção da temperatura corporal do RNP. Cuidadores apontam a prática do Método Canguru (MC), ou mesmo posição canguru sob livre demanda, como uma alternativa efetiva e eficaz para promoção do vínculo e manutenção da temperatura(Nyondo-Mipando et al., 2020;Oryono et al., 2021;Enlow et al., 2017).primitivamente é feito de couro almofado que protegia a cabeça do bebê com mantas térmicas, colocando-o perto da cama, onde eles iriam estar dormindo(Mathiolli et al., 2020; Castillo- Duarte;Enlow et al., 2017; Frota et al.,2013). ...
Sintetizar evidências científicas sobre as competências e necessidade de pais e familiares no cuidado ao recém-nascido prematuro no domicílio. Trata-se de uma revisão de escopo realizada nas bases de dados Medical Literature Analysis and Retrieval System Online via PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Literatura Latino-americana e do Caribe em Ciências da Saúde, Scopus Elsevier, Biblioteca virtual em Saúde do Ministério da Saúde,Google escholar ,repositórios e em listas de referências dos estudos para identificar estudos originais, manuais e protocolos sobre os cuidados ao recém-nascido pré-termo no domicílio. Dois revisores independentes realizaram a triagem, extração dos dados, análise do material e sumarização do conteúdo.Um total de 935 documentos foram encontrados e 18 artigos incluídos na amostra final. Várias competências de cuidados de pais e familiares de recém-nascido prematuro no domicílio foram identificadas, bem como necessidades relacionadas à implementação do plano de cuidados. Elencaram-se os principais temas (fragilidades no processo da alta hospitalar, dificuldades, insegurança e apoio aos familiares no seguimento do recém-nascido prematuro para os cuidados domiciliares). O presente estudo contribui por tornar clara as competências de pais e familiares no cuidado prestado ao recém-nascido prematuro e aponta temas a serem explorados em futuros estudos empíricos, bem como para melhorar a prática clínica através da promoção de cuidado e prevenção de agravos.
... Work and other responsibilities have been reported in the current study as impeding fathers' involvement in the care of hospitalized preterm newborns. This is consistent with findings from other studies [19,[47][48][49][50], which reported that multiple responsibilities prevented the fathers from being engaged in caregiving activities. It is worth noting that at the time of the study, the Malawi labour laws were not allowing for paternal leave for those formally employed, and also the majority of the participants were not in formal employment which meant they still needed to work to earn something for the families. ...
Background
Malawi has one of the highest incidences of premature birth, with twice the mortality compared to full-term. Excluding fathers from preterm newborn care has negative consequences, including father feeling powerless, missed bonding opportunities with the newborn, additional strain on the mother, and negative family dynamics such as breakdown in communication, reduced trust, and strained relationships. In Malawi, there is no deliberate policy to have fathers involved in preterm care despite having high incidence of preterm birth and neonatal mortality. There is also limited literature on the factors that influence fathers’ involvement in the care. The aim of the study was to explore factors influencing fathers’ involvement in the care of hospitalized preterm newborns.
Methods
A descriptive qualitative study design was used, guided by Theory of planned behaviour and the model proposed by Lamb on male involvement. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively and conveniently sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were organized and analyzed using Nvivo software and thematic analysis approach was used because the approach allows deeper understanding of the data, identification of patterns and themes, and provides rich insights into participants’ experiences and perspectives.
Results
The barriers and facilitators that influence a father’s involvement in the care of preterm newborn babies include: perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby’s physical appearance/nature and health status, feedback from the baby, multiple births, and hospital’s physical environment and provision of basic needs.
Conclusion
The study found that fathers value their involvement in caring for hospitalized preterm newborns but face barriers. Evidence-based interventions like education programs, training sessions, and support groups can help fathers overcome barriers and promote better outcomes for infants and families.
... In addition to the effects of the paternal style on the development of regulation, the "rough-and-tumble" father-child play continues as children's motor skills mature. The father's more challenging style may support cognitive development and flexibility in unique ways and the paternal style that focuses attention on the outside world coincides with the toddler's or preschooler's emerging curiosity and may help support an attitude of flexibility, problem solving, and excited exploration (Ahnert et al., 2017;Amodia-Bidakowska et al., 2020;Anderson et al., 2017;Carson & Parke, 1996;Freeman & Robinson, 2022;Oryono et al., 2021;Stgeorge & Freeman, 2017). ...
Fathers have been an important source of child endurance and prosperity since the dawn of civilization, promoting adaptation to social rules, defining cultural meaning systems, teaching daily living skills, and providing the material background against which children developed; still, the recent reformulation in the role of the father requires theory-building. Paternal caregiving is rare in mammals, occurring in 3-5% of species, expresses in multiple formats, and involves flexible neurobiological accommodations to ecological conditions and active caregiving. Here, we discuss father contribution to resilience across development. Our model proposes three tenets of resilience - plasticity, sociality, and meaning - and discussion focuses on father-specific contributions to each tenet at different developmental stages; newborn, infant, preschooler, child, and adolescent. Father's style of high arousal, energetic physicality, guided participation in daily skills, joint adventure, and conflict resolution promotes children's flexible approach and social competence within intimate bonds and social groups. By expanding children's interests, sharpening cognitions, tuning affect regulation, encouraging exploration, and accompanying the search for identity, fathers support the sense of meaning, enhancing the human-specific dimension of resilience. We end by highlighting pitfalls to paternal contribution, including absence, abuse, rigidity, expectations, and gender typing, and the need to formulate novel theories to accommodate the "involved dad."
... Work and other responsibilities have been reported in the current study as impeding fathers' involvement in the care of hospitalized preterm newborns. This is consistent with ndings from other studies [13,[44][45][46][47], which reported that multiple responsibilities prevented the fathers from being engaged in caregiving activities. It is worth noting that at the time of the study, the Malawi labour laws were not allowing for paternal leave for those formally employed, and also the majority of the participants were not in formal employment which meant they still needed to work to earn something for the families. ...
Background
Malawi has one of the highest incidences of premature birth, and preterm newborns are twice likely to die compared to full-term newborns. Fathers’ involvement could help with the situation because it is associated with positive outcomes. However, there is limited literature on the factors that influence fathers’ involvement in the care of preterm newborns in Malawi.
Methods
A phenomenological study was conducted at Balaka District Hospital guided by the components of the model proposed by Lamb on male involvement and the Theory of planned behaviour to explore factors that influenced fathers’ involvement in the care of preterm infants. The district was selected due to its high infant mortality rate, which is above the national average. Sixteen in-depth interviews were conducted with fathers of preterm infants purposively sampled in June 2021. Interviews were digitally recorded and transcribed verbatim. Data were analyzed using thematic analysis guided by the Theory of Planned Behaviour.
Results
Several factors influence fathers’ involvement. These are perceived difficulty with care activities and benefits of involvement, gender roles and socio-cultural beliefs, work and other family responsibilities, social support, baby’s physical appearance/nature and health status, feedback from the baby, multiple births, and hospital’s physical environment and provision of basic needs. These were reported as being barriers and facilitators to fathers’ involvement in the care of their hospitalized preterm newborns.
Conclusion
Fathers’ involvement in the care of hospitalized preterm newborns can be improved by finding ways of resolving the barriers. This could be through education, awareness, and encouragement of the fathers and their communities.
Stunting is still one of the most pressing global health problems. Father involvement in childcare is needed to ensure optimal child growth and development and free the child from stunting problems. Based on transcultural nursing theory, this study analyzes factors related to father involvement in preventing toddler stunting. The study used a cross-sectional approach with a multistage random sampling technique in Jember Regency with a sample of 852 respondents. A questionnaire was used to collect data. The study was conducted for 2 weeks, from August 1, 2024, to August 15, 2024. Statistical tests were carried out using Spearman Rho with a significance of 95% (α <0.05). Statistical analysis showed that technology factors (p-value=<0.001, r score=0.297), religion, spirituality, and philosophy (p-value=<0.001, r score= 0.170; kinship and social (p-value=<0.001, r score= 0.378), cultural values, beliefs, and lifestyles (p-value=<0.001, r score=0.204); politics and law(p-value=<0.001, r score=0.360); economics (p-value=<0.001, r score=0.370)—were positively correlated with father involvement in preventing stunting in toddlers. Meanwhile, biological variables (p-value=0.054, r score=0.237) and education level (p-value=-0.067, r score=0.052) did not correlate significantly with the father's involvement in preventing toddler stunting. Current research shows that father involvement in preventing stunting in toddlers is beneficial. Public health nurses can use these results to create health promotion initiatives that encourage fathers to be more involved in child care and prevent childhood stunting. The results of this study can be used to develop health promotion programs to increase father involvement in improving stunting prevention.
Background: East African countries have high rates of maternal and child mortality and morbidity. Studies have shown that involvement of male partners in reproductive health can benefit maternal and child health. This scoping review aims to provide an overview of the evidence across East Africa that describes male partner involvement and its effect on maternal and child wellbeing in reproductive, maternal or child health.
Methods: Ten databases were searched to identify quantitative data on male’s involvement in East African countries. Studies reporting qualitative data, non-East-African samples, ‘intention to use’ data or only reporting on male partner’s education or economic status were excluded. Studies were organised into five a priori categories: antenatal care (ANC), human immunodeficiency virus (HIV), breastfeeding, family planning, and intimate partner violence (IPV) with further categories developed based on studies included.
Results: A total of 2787 records were identified, 644 full-texts were reviewed and 96 studies were included in this review. Data were reported on 118,967 mothers/pregnant women and 15,361 male partners (typically reported by their female partners or coparents). Most of the studies (n=83) were reported from four countries Ethiopia (n=49), Kenya (n=14), Tanzania (n=12) and Uganda (n=10). The evidence indicates that male partner involvement and support is associated with improved reproductive, maternal and child health across a wide range of outcomes. However, the studies were heterogenous, using diverse exposure and outcome measures and reporting varying effect sizes, levels of men’s involvement and types of support. As well, male partners’ lack of practical and emotional support, and engagement in violent behaviours towards partners, were associated with profound negative impacts on maternal and child health and wellbeing.
Conclusions: The body of evidence, although heterogenous, provides compelling support for male involvement in reproductive health programs designed to support maternal and child health. To advance research in this field, agreement is needed on a measure of male partner 'involvement'. To optimise benefits of male partner’s involvement, developing core outcome sets and regional coordination across health conditions are recommended.
This chapter reviews recent research concerning the levels, origins. and consequences of paternal involvement. Its focus is restricted to adult lathers in heterosexual two-parent families, as other chapters in this volume consider other important paternal groups. Investigations conducted in the United States provide most of the data discussed here, but some research from other industrial countries is included.
Several themes guide the chapter. Data on fathers' average level of involvement are of great interest to many people, but these assessments vary considerably according to many factors, not least the measures used. Descriptive results on fathers' average levels of involvement are actually far more variable than is generally realized. Nonetheless there is a tendency to think that the question "How involved are U.S. fathers?" should have a simple answer.
Further conceptualization is needed of the origins and sources of paternal involvement. Lamb. Pleck, Charnov, and Levine (1985: Pleck, Lamb, & Levine 1986) proposed a four-factor model for its sources: motivation, skills and self-confidence. social supports. and institutional practices. This framework needs to be integrated with other available models for the determinants of fathering, and with more general theoretical perspectives on parental functioning. Because the construct of paternal involvement called attention to an important dimension of fathers' behavior neglected in prior research and theory. it was an important advance. However, the utility, of the construct in its original. content-free sense now needs to be reconsidered. The critical question is: How good is the evidence that fathers' amount of involvement, without taking into account its content and quality, is consequential for children, mothers, or fathers themselves?
Background
Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings.
Objective
The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD)
Methods
We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study at birth from Iganga hospital between May and July 2018. We followed up the babies at an average age of 7 months (adjusted for prematurity) and assessed 211 preterm and 187 term infants for neurodevelopmental outcomes using the Malawi Developmental Assessment tool. Mothers were interviewed on care practices for the infants. Data were analyzed using STATA version 14.
Results
The study revealed a high incidence of NDD of 20.4% (43/211) among preterm infants compared to 7.5% (14/187) among the term babies, p < 0.001, of the same age. The most affected domain was fine motor (11.8%), followed by language (9.0%). At multivariate analysis, malnutrition and Kangaroo Mother Care (KMC) at home after discharge were the key factors that were significantly associated with NDD among preterm babies. The prevalence of malnutrition among preterm infants was 20% and this significantly increased the odds of developing NDD, OR = 2.92 (95% CI: 1.27–6.71). KMC practice at home reduced the odds of developing NDD, OR = 0.46, (95% CI: 0.21–1.00). Re-admission of preterm infants after discharge (a sign of severe illness) increased the odds of developing NDD but this was not statistically significant, OR = 2.33 (95% CI: 0.91–5.94).
Conclusion
Our study has shown that preterm infants are at a high risk of developing NDD, especially those with malnutrition. Health system readiness should be improved to provide follow-up care with emphasis on improving nutrition and continuity of KMC at home.
Background
Despite the increasing trend of paternal engagement in caregiving, fathers remain underrepresented in studies on parenting and childhood obesity.
Objectives
This study examined the association between father involvement in caregiving and child's weight status within a longitudinal dataset from Japan.
Methods
The data were obtained from a population‐based cohort study in Japan (N = 29 584). The association between father's involvement in child caregiving (age 18 months) on the weight status of the same children at age 3.5 years was examined by logistic regression and linear regression analysis. Furthermore, we checked the interaction between maternal employment & father involvement by creating four mutually exclusive groups of families.
Results
Children whose fathers were highly involved in caregiving were less likely to be overweight (OR = 0.90, 95% CI, 0.85‐0.96). Employed mothers with high paternal involvement in caregiving were 30% less likely to have children with overweight or obesity compared to those with low paternal involvement (95% CI, 0.55‐0.90).
Conclusions
Father involvement in caregiving is associated with the development of overweight or obesity in early childhood, and may also modify the association between maternal employment and child's weight status. Social policies to support shared child‐rearing such as expanding paid parental leave could help families to raise children with healthy weight.
Parental stimulation and responsiveness are associated with improved early child development outcomes. However, the majority of studies have relied on maternal-reported measures of only mothers’ parenting practices. The purpose of this study was to assess the agreement between fathers’ and mothers’ reports of their own and their partner’s engagement in stimulation and assess the degree to which parents’ reported stimulation correlated with their observed responsive caregiving behaviors. Data were collected from 33 couples (33 fathers and 32 mothers) who had a child under 5 years of age in rural Pakistan. Paternal and maternal stimulation were measured based on reports of their own and their partner’s practices in play and learning activities with the child. Paternal and maternal responsiveness were observed in a subsample of 18 families. Moderate agreement was found between paternal and maternal reports of their own and their partner’s practices. Moderate associations were also found between self-reported measures of stimulation and observed responsive caregiving for both fathers and mothers. The strengths of agreement and associations were greater among couples who had higher quality coparenting relationships. Findings highlight the feasibility, reliability, and promise of assessing fathers’ parenting in a low-resource setting, using similar methods as for mothers’ parenting, to triangulate measures between reported and observed parenting and gain a deeper understanding of fathers’ and mothers’ unique caregiving contributions.
Evidence that gender inequalities and restrictive norms adversely affect health is extensive; however, far less research has focused on testing solutions. We first comprehensively reviewed the peer-reviewed and grey literature for rigorously evaluated programmes that aimed to reduce gender inequality and restrictive gender norms and improve health. We identified four mutually reinforcing factors underpinning change: (1) multisectoral action, (2) multilevel, multistakeholder involvement, (3) diversified programming, and (4) social participation and empowerment. Following this review, because little research has investigated the effects of national-level law and policy reforms, we conducted original quasi-experimental studies on laws and policies related to education, work, and income, all social determinants of health in which deep gender inequalities exist. We examined whether the laws and policies significantly affected health outcomes and gender norms, and whether law-induced and policy-induced changes in gender norms mediated the health effects, in areas for which longitudinal data existed. Laws and policies that made primary education tuition-free (13 intervention countries with the law and/or policy and ten control countries without) and that provided paid maternity and parental leave (seven intervention and 15 control countries) significantly improved women's and their children's health (odds ratios [OR] of 1·16–2·10, depending on health outcome) and gender equality in household decision making (OR 1·46 for tuition-free and 1·45 for paid maternity and parental leave) as a proxy indicator of gender norms. Increased equality partially mediated the positive effects on health outcomes. We conclude by discussing examples of how improved governance can support gender-equitable laws, policies, and programmes, immediate next steps, and future research needs.
Background:
Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets.
Methods:
We sought to identify all available LBW input data for livebirths for the years 2000-16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level.
Findings:
We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4-17·1) compared with 17·5% (14·1-21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4-24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%).
Interpretation:
Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle.
Funding:
Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
Parenting preterm infants is a unique experience distinct from parenting full-term infants, characterized by a delayed transition to parenthood and limited caregiving opportunities. This study explored mothers' and fathers' lived experiences of parenting during infancy in the context of preterm birth. Semistructured qualitative interviews were conducted with 13 parents (6 fathers, 7 mothers) of preterm infants. Data were analyzed using interpretative phenomenological analysis. Four superordinate themes emerged: (a) An unnatural disaster: The traumatic nature of preterm birth, (b) The immediate aftermath: Disconnected and displaced, (c) Breaking the ice: Moving from frozen to melted, and (d) Aftershocks: Transitioning home. Both parents experienced preterm birth as traumatic. Similarities and differences in mothers' and fathers' experiences were identified. Preterm birth posed challenges for nurturant and social caregiving and resulted in anxiety, hypervigilance, and overprotective parenting behavior. The results highlight the need for trauma-informed care and further research developing and testing empirically based interventions.
© 2019 Michigan Association for Infant Mental Health.
Background
Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods
Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis.
Results
Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers’ coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community.
Conclusions
Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers’ direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.
Background
Hypoxic Ischemic Encephalopathy carries high case fatality rates ranging between 10–60%, with 25% of survivors have an adverse long-term neurodevelopment outcome. Despite the above, there is paucity of data regarding its magnitude and short term outcomes in a low resource setting like Uganda. Therefore we set out to determine the incidence and short term outcomes of Newborns with Hypoxic Ischemic Encephalopathy at St.Francis Hospital, Nsambya.
Methods
This was a Prospective Cohort study conducted between October 2015 and January 2016 at St. Francis Hospital, Nsambya, Kampala- Uganda. Term Newborn babies were enrolled. Umbilical cord arterial blood gas analysis was done for Newborns with low Apgar scores at 5 min. Clinical examination was done on all newborns within 48 h of life, for features of encephalopathy. Neonates with Hypoxic Ischemic Encephalopathy were followed up by a daily clinical examination and a short term outcome was recorded on day seven.
Results
The incidence of Hypoxic Ischemic Encephalopathy was 30.6 cases per 1000 live births. The majority, 10 (43.5%) had mild Hypoxic Ischemic Encephalopathy, followed by 8 (34.8%), 5 (21.7%) that had moderate and severe Hypoxic Ischemic Encephalopathy respectively. A total of (6) 26% died, and (15) 65.2% were discharged within 1 week. Lack of a nutritive suckling reflex (nasogastric feeding), poor Moro reflex, and requirement for respiratory support (oxygen therapy by nasal prongs) were the common complications by day seven.
Conclusions
The burden of Hypoxic Ischemic Encephalopathy is high with a case fatality rate of 26%. There is need to conduct a longitudinal study to determine the long term complications of HIE.
Background:
Undernutrition among children less than 5 years is still a public health concern in most developing countries. Fathers play a critical role in providing support in improving maternal and child health. There is little studied on male involvement and its measurement in child nutrition; therefore, this paper explores the level of male involvement in child feeding and its association with the nutritional status of the children less than 5 years of age.
Methods:
A cross sectional study among 346 households, 3 focus group discussions, and 4 key informant interviews were conducted in one rural district in Uganda. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) of associated factors were estimated and focus group discussions and in-depth interviews were conducted and summarized into themes.
Results:
The study revealed the highest percentage of the males provided money to buy food for the children (93.6%), and only 9.8% have ever accompanied mothers to young child clinics.
Conclusion:
In this study, most males were involved in buying food for their children, and providing money for transport to young child clinics was associated with normal nutritional status of children less than 5 years in the study area.
This paper explores two key norms that underpin intimate partner violence in Rwanda: men’s roles as economic providers and decision-making authorities in the household. It describes the political, legal and socio-economic factors affecting these norms and how they create opportunities and barriers to ‘undoing’ restrictive gender norms. Findings are drawn from an evaluation of Inadshyikirwa, an intimate partner violence prevention programme operating in Rwanda. Across three intervention sectors, 24 focus groups were conducted with unmarried and married men and women residing in intervention communities. Thirty interviews with couples and nine interviews with opinion leaders were conducted before they completed programme training designed to shift gender norms underlying intimate partner violence. The data indicate a strong awareness of and accountability to Rwandan laws and policies supporting women’s economic empowerment and decision-making, alongside persisting traditional notions of men as household heads and primary breadwinners. Transgression of these norms could be accommodated in some circumstances, especially those involving economic necessity. The data also identified increasing recognition of the value of a more equitable partnership model. Findings highlight the importance of carefully assessing cracks in the existing gender order that can be exploited to support gender equality and non-violence.
Background
As care for preterm and low birth weight (LBW) infants improves in resource-limited settings, more infants are surviving the neonatal period. Preterm and (LBW) infants are at high-risk of nutritional and medical comorbidities, yet little is known about their developmental outcomes in low-income countries. This study evaluated the health, nutritional, and developmental status of preterm/LBW children at ages 1–3 years in Rwanda. Methods
Cross-sectional study of preterm/LBW infants discharged between October 2011 and October 2013 from a hospital neonatal unit in rural Rwanda. Gestational age and birth weight were gathered from hospital records to classify small for gestational age (SGA) at birth and prematurity. Children were located in the community for household assessments in November–December 2014. Caregivers reported demographics, health status, and child development using locally-adapted Ages and Stages Questionnaires (ASQ-3). Anthropometrics were measured. Bivariate associations with continuous ASQ-3 scores were conducted using Wilcoxon Rank Sum and Kruskal Wallis tests. ResultsOf 158 eligible preterm/LBW children discharged from the neonatal unit, 86 (54.4%) were alive and located for follow-up. Median birth weight was 1650 grams, median gestational age was 33 weeks, and 50.5% were SGA at birth. At the time of household interviews, median age was 22.5 months, 46.5% of children had feeding difficulties and 39.5% reported signs of anemia. 78.3% of children were stunted and 8.8% wasted. 67.4% had abnormal developmental screening. Feeding difficulties (p = 0.008), anemia symptoms (p = 0.040), microcephaly (p = 0.004), stunting (p = 0.034), SGA (p = 0.023), very LBW (p = 0.043), lower caregiver education (p = 0.001), and more children in the household (p = 0.016) were associated with lower ASQ-3 scores. Conclusions
High levels of health, growth, and developmental abnormalities were seen in preterm/LBW children at age 1–3 years. As we achieve necessary gains in newborn survival in resource-limited settings, follow-up and early intervention services are critical for ensuring high-risk children reach their developmental potential.
Abstract Background As more high-risk newborns survive the neonatal period, they remain at significant medical, nutritional, and developmental risk. However, no follow-up system for early intervention exists in most developing countries. In 2014, a novel Pediatric Development Clinic (PDC) was implemented to provide comprehensive follow-up to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Methods At each PDC visit, children undergo clinical/nutritional assessment and caregivers participate in counseling sessions. Social assessments identify families needing additional social support. Developmental assessment is completed using Ages and Stages Questionnaires. A retrospective medical record review was conducted to evaluate the first 24 months of PDC implementation for patients enrolled between April 2014–December 2015 in rural Rwanda. Demographic and clinical characteristics of patients and their caregivers were described using frequencies and proportions. Completion of different core components of PDC visits were compared overtime using Fisher’s Exact test and p-values calculated using trend analysis. Results 426 patients enrolled at 5 PDC sites. 54% were female, 44% were neonates and 35% were under 6 months at enrollment. Most frequent referral reasons were prematurity/low birth weight (63%) and hypoxic-ischemic encephalopathy (34%). In 24 months, 2787 PDC visits were conducted. Nurses consistently completed anthropometric measurements (age, weight, height) at all visits. Some visit components were inconsistently recorded, including adjusted age (p = 0.003), interval growth, danger sign assessment, and feeding difficulties (p
Background
Most of child mortality and under nutrition in developing world were attributed to suboptimal childcare and feeding, which needs detailed investigation beyond the proximal factors. This study was conducted with the aim of assessing associations of women’s autonomy and men’s involvement with child anthropometric indices in cash crop livelihood areas of South West Ethiopia.
Methods
Multi-stage stratified sampling was used to select 749 farming households living in three coffee producing sub-districts of Jimma zone, Ethiopia. Domains of women’s Autonomy were measured by a tool adapted from demographic health survey. A model for determination of paternal involvement in childcare was employed. Caring practices were assessed through the WHO Infant and young child feeding practice core indicators. Length and weight measurements were taken in duplicate using standard techniques. Data were analyzed using SPSS for windows version 21. A multivariable linear regression was used to predict weight for height Z-scores and length for age Z-scores after adjusting for various factors.
Results
The mean (sd) scores of weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and BMI for age (BAZ) was -0.52(1.26), -0.73(1.43), -0.13(1.34) and -0.1(1.39) respectively. The results of multi variable linear regression analyses showed that WHZ scores of children of mothers who had autonomy of conducting big purchase were higher by 0.42 compared to children's whose mothers had not. In addition, a child whose father was involved in childcare and feeding had higher HAZ score by 0.1. Regarding age, as for every month increase in age of child, a 0.04 point decrease in HAZ score and a 0.01 point decrease in WHZ were noted. Similarly, a child living in food insecure households had lower HAZ score by 0.29 compared to child of food secured households. As family size increased by a person a WHZ score of a child is decreased by 0.08. WHZ and HAZ scores of male child was found lower by 0.25 and 0.38 respectively compared to a female child of same age.
Conclusion
Women’s autonomy and men’s involvement appeared in tandem with better child anthropometric outcomes. Nutrition interventions in such setting should integrate enhancing women’s autonomy over resource and men’s involvement in childcare and feeding, in addition to food security measures.
Objectives:
As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birth-weight neonates (LBW, <2500 grams). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments, and nutritional status of LBW children.
Methods:
Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012.
Results:
Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age=27 months), at least one developmental-impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n=100), very-low-birth-weight (VLBW, < 1500 grams, n=7) children had a significantly higher risk of impairments (intellectual - P=0.001), needing constant supervision and creating a household burden (P= 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P=0.02).
Conclusions:
Reassuringly, most children were thriving two years after discharge. However, malnutrition was prevalent and one-in-three manifested developmental-impairments (particularly VLBWs) echoing the need for support programs. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge. This article is protected by copyright. All rights reserved.
Background
Father–child interactions are associated with improved developmental outcomes among infants. However, to the best of our knowledge, no study has addressed the effects of paternal involvement on the neurodevelopment of infants who are less than 6 months of age, and no study has reported how maternal parenting stress mediates the relationship between paternal involvement and infant neurodevelopment during early infancy. This study investigates the direct and indirect relationship between paternal involvement and infant neurodevelopment at 3–4 months of age. The indirect relationship was assessed through the mediating factor of maternal parenting stress. Methods
The participants were recruited through the Sesalmaul Research Center’s website from April to June 2014. The final data included 255 mothers and their healthy infants, who were aged 3–4 months. The mothers reported paternal involvement and maternal parenting stress by using Korean Parenting Alliance Inventory (K-PAI) and Parenting Stress Index (PSI), respectively. Experts visited the participants’ homes to observe infant neurodevelopment, and completed a developmental examination using Korean version of the Ages and Stages Questionnaire II (K-ASQ II). A hierarchical multiple regression analysis was used for data analysis. ResultsInfants’ mean ages were 106 days and girls accounted for 46.3%. The mean total scores (reference range) of the K-PAI, PSI, and the K-ASQ II were 55.5 (17–68), 45.8 (25–100), and 243.2 (0–300), respectively. Paternal involvement had a positive relationship with K-ASQ II scores (β = 0.29, p < 0.001) at 3–4 months of age, whereas maternal parenting stress was negatively related with K-ASQ II scores (β = −0.32, p < 0.001). Maternal parenting stress mediated the relationship between paternal involvement and early infant neurodevelopment (Z = 3.24, p < 0.001). A hierarchical multiple regression analysis showed that paternal involvement reduced maternal parenting stress (β = −0.25, p < 0.001), which led to positive infant outcomes (β = 0.23, p < 0.001). Conclusions
Paternal involvement is significantly associated with infant neurodevelopment during early infancy, and maternal parenting stress partially mediates that association. This result emphasizes the importance of fathers’ involvement and mothers’ parenting stress on early infant neurodevelopment.
Background and objective:
Few studies have examined the relationship between paternal stimulation and children's growth and development, particularly in low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of paternal stimulation and to assess whether paternal stimulation was associated with early child growth and development.
Methods:
Data from the Multiple Indicator Cluster Surveys rounds 4 and 5 were combined across 38 LMICs. The sample comprised 87 286 children aged 3 and 4 years. Paternal stimulation was measured by the number of play and learning activities (up to 6) a father engaged in with his child over the past 3 days. Linear regression models were used to estimate standardized mean differences in height-for-age z-scores and Early Childhood Development Index (ECDI) z-scores across 3 levels of paternal stimulation, after controlling for other caregivers' stimulation and demographic covariates.
Results:
A total of 47.8% of fathers did not engage in any stimulation activities, whereas 6.4% of fathers engaged in 5 or 6 stimulation activities. Children whose fathers were moderately engaged in stimulation (1-4 activities) showed ECDI scores that were 0.09 SD (95% confidence interval [CI]: -0.12 to -0.06) lower than children whose fathers were highly engaged; children whose fathers were unengaged showed ECDI scores that were 0.14 SD lower (95% CI: -0.17 to -0.12). Neither moderate paternal stimulation nor lack of paternal stimulation was associated with height-for-age z-scores, relative to high stimulation.
Conclusion:
Increasing paternal engagement in stimulation is likely to improve early child development in LMICs.
Despite numerous studies on parenting stress suggesting negative influences on parent-child interactions and children's development, the majority of these studies focus on mothers' parenting stress with little or no acknowledgement of fathers. Using data from the National Early Head Start Research and Evaluation Project, this study examined (i) the effects of fathers' parenting stress during toddlerhood on children's language and cognitive outcomes when children are 3years old (ii) whether the effects of fathers' parenting stress on children's language and cognitive development vary by child gender? Results from mixed linear models showed fathers' parenting stress predicted children's lower cognitive scores, but there were no gender differences in the effects of fathers' parenting stress on children's cognitive outcomes. In the language domain, boys, not girls, were found to be more susceptible to the effects of fathers' parenting stress. These findings indicated that fathers, in addition to mothers, should be included in early parenting research and interventions.
This study investigated longitudinal relationships between fathers’ involvement, as measured by reading, and child socioemotional behavior between infancy and age 7 in 9,238 intact two-parent families from the U.K. Millennium Cohort Study, a national cohort of British children born between 2000 and 2002. Once a variety of covariates and the potential bidirectional nature of relationships were taken into account, a path model showed that fathers’ involvement with their children in infancy significantly predicted better socioemotional behavior at age 3, although the relationship was not strong. Fathers’ reading with their children between ages 3 and 7 was not significantly associated with child socioemotional behavior, but mothers’ reading with their children at age 3 was significantly associated with improved child socioemotional behavior at ages 3 and 5. Results also suggested that parenting in the 21st-century British context remains fairly gendered. Both mothers and fathers were more likely to engage in physical activities with their sons and artistic activities with their daughters. Fathers’ reading was socially patterned in predicted directions.
The developing world accounts for 99% of global maternal deaths. Men in developing countries are the chief decision-makers, determining women's access to maternal health services and influencing their health outcomes. At present, it is unclear whether involving men in maternal health can improve maternal outcomes. This systematic review and meta-analysis aimed to investigate the impact of male involvement on maternal health outcomes of women in developing countries.
Four electronic databases and grey literature sources were searched (up to May 2013), together with reference lists of included studies. Two reviewers independently screened and assessed the quality of studies based on prespecified criteria. Measures of effects were pooled and random effect meta-analysis was conducted, where possible.
Fourteen studies met the inclusion criteria. Male involvement was significantly associated with reduced odds of postpartum depression (OR=0.36, 95% CI 0.19 to 0.68 for male involvement during pregnancy; OR=0.34, 95% CI 0.19 to 0.62 for male involvement post partum), and also with improved utilisation of maternal health services (skilled birth attendance and postnatal care). Male involvement during pregnancy and at post partum appeared to have greater benefits than male involvement during delivery.
Male involvement is associated with improved maternal health outcomes in developing countries. Contrary to reports from developed countries, there was little evidence of positive impacts of husbands' presence in delivery rooms. However, more rigorous studies are needed to improve this area's evidence base.
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Purpose: The study investigated maternal experiences of caring for a child affected by neurological impairment after neonatal encephalopathy (NE) (“birth asphyxia”) in Uganda. Methods: Between September 2011 and October 2012 small group and one-on-one in-depths interviews were conducted with mothers recruited to the ABAaNA study examining outcomes from NE in Mulago hospital, Kampala. Data were analysed thematically with the aid of Nvivo 8 software. Findings: Mothers reported caring for an infant with impairment was often complicated by substantial social, emotional and financial difficulties and stigma. High levels of emotional distress, feelings of social isolation and fearfulness about the future were described. Maternal health-seeking ability was exacerbated by high transport costs, lack of paternal support and poor availability of rehabilitation and counselling services. Meeting and sharing experiences with similarly affected mothers was associated with more positive maternal caring experiences. Conclusion: Mothering a child with neurological impairment after NE is emotionally, physically and financially challenging but this may be partly mitigated by good social support and opportunities to share caring experiences with similarly affected mothers. A facilitated, participatory, community-based approach to rehabilitation training may have important impacts on maximising participation and improving the quality of life of affected mothers and infants.
Implications for Rehabilitation
Caring for an infant with neurological impairment after NE in Uganda has substantial emotional, social and financial impacts on families and is associated with high levels of emotional stress, feelings of isolation and stigma amongst mothers.
Improved social support and the opportunity to share experiences with other similarly affected mothers are associated with a more positive maternal caring experience. High transport costs, lack of paternal support and poor availability of counselling and support services were barriers to maternal healthcare seeking.
Studies examining the feasibility, acceptability and impact of early intervention programmes are warranted to maximise participation and improve the quality of life for affected mothers and their infants.
http://www.fao.org/docrep/014/i1983e/i1983e00.htm
This interview-based study on middle-class Australian parents' involvement in young children's literacy found that reading to children (particularly in the pre-school years) is a routine part of family life, a task shared between mothers and fathers. However, there were patterns of gender difference in the accounts. Mothers were more likely than fathers to emphasise the importance of the child's early exposure to books. They were also often reported to take a supervisory role in relation to their partner's story reading. Men were more likely to undertake reading at bedtime than at any other time and also more likely to report using various strategies to shorten the time spent on story reading. Fathers reading to sons appeared to take on a special significance related to masculine bonding and modelling.
We present findings based on several of our recent studies that have shown that father engagement has significant effects on children's cognition and language at 24 and 36 months and their social and emotional development at 24, 36 months, and pre-Kindergarten. These studies are guided by the Dynamics of Paternal Influences on Children over the Life Course Model that stipulates the important contribution of parent characteristics, child and context to parenting and chil- dren's outcomes. Specifically, three research questions are addressed: (1) How do resident fathers engage with their young children at 24, 36, and 64 months (pre-K)? (2) How do fathers' human and financial resources and depressive symptoms, partner relationship quality and mother-child interactions, and chil- dren's characteristics predict the quality of fathers' engagements with their young children? And (3) how do fathers' engagements affect their young children's cog- nitive, language, and social and emotional outcomes across the three age groups? Educated fathers and fathers whose partners have supportive relationships with their children are more supportive and less intrusive. In contrast to mothers, fathers' supportiveness matters for children's language, cognitive, and language development across ages and emotional regulation at 24 months. On the other hand, maternal intrusiveness is negatively associated with emotional regulation at 24 and pre-K and language development at pre-K. Father intrusiveness had a small negative effect on language development only at pre-K and no effect at all on social emotional regulation. These findings suggest that programs that aim at increasing fathers' education and that promote and encourage fathers' positive parenting will yield large benefits for children.
Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quantitative analyses were conducted to examine the validity of candidate items in several country samples. Qualitative methods included the use of global expert panels to identify and evaluate the performance of each candidate item as well as in-country focus groups to test the content validity of the items. The quantitative methods included analyses of item-response distributions, using bivariate techniques. The selected items measured two family care practices (support for learning/stimulating environment and limit-setting techniques) and caregiving resources (adequacy of the alternate caregiver when the mother worked). Six play-activity items, indicative of support for learning/stimulating environment, were included in the core module of UNICEF's Multiple Cluster Indictor Survey 3. The other items were included in optional modules. This project provided, for the first time, a globally-relevant set of items for assessing family care practices and resources in epidemiological surveys. These items have multiple uses, including national monitoring and cross-country comparisons of the status of family care for development used globally. The obtained information will reinforce attention to efforts to improve the support for development of children.
This study examines whether levels of father engagement (e.g., verbal stimulation, caregiving, and physical play) vary by race/ethnicity using a model that controls for fathers' human capital, mental health, and family relationships. It also tests whether the models work similarly across race/ethnic groups. Its sample of N=5,089 infants and their families is drawn from the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B). We found that, after including controls, African American and Latino fathers had higher levels of engagement in caregiving and physical play activities than White fathers. There were no differences in verbal stimulation activities across race/ethnicity. Fathers' education (college level) predicted more verbally stimulating activities whereas fathers' report of couple conflict predicted less caregiving and physical play. Although levels of engagement differed across the groups, the overall models did not differ by race/ethnicity, except for physical play. African American mothers who reported high levels of depressive symptoms had partners who engaged in more physical play than White mothers with high levels of depressive symptoms.
Considerable evidence suggests that fathers' absence from home has a negative short- and long-term impact on children's health, psychosocial development, cognition and educational experience. We assessed the impact of father presence during infancy and childhood on children's height-for-age z-score (HAZ) at 5 years old. We conducted secondary data analysis from a 15-year cohort study (Young Lives) focusing on one of four Young Lives countries (Peru, n = 1821). When compared with children who saw their fathers on a daily or weekly basis during infancy and childhood, children who did not see their fathers regularly at either period had significantly lower HAZ scores (-0.23, P = 0.0094) after adjusting for maternal age, wealth and other contextual factors. Results also suggest that children who saw their fathers during childhood (but not infancy) had better HAZ scores than children who saw their fathers in infancy and childhood (0.23 z-score, P = 0.0388). Findings from analyses of resilient children (those who did not see their fathers at either round but whose HAZ > -2) show that a child's chances of not being stunted in spite of paternal absence at 1 and 5 years old were considerably greater if he or she lived in an urban area [odds ratio (OR) = 9.3], was from the wealthiest quintile (OR = 8.7) and lived in a food secure environment (OR = 3.8). Interventions designed to reduce malnutrition must be based on a fuller understanding of how paternal absence puts children at risk of growth failure.
Father-child and mother-child engagements were examined longitudinally in relation to children's language and cognitive development at 24 and 36 months. The study involved a racially/ethnically diverse sample of low-income, resident fathers (and their partners) from the National Early Head Start evaluation study (n=290). Father-child and mother-child engagements were videotaped for 10 min at home during semistructured free play, and children's language and cognitive status were assessed at both ages. Fathers' and mothers' supportive parenting independently predicted children's outcomes after covarying significant demographic factors. Moreover, fathers' education and income were uniquely associated with child measures, and fathers' education consistently predicted the quality of mother-child engagements. Findings suggest direct and indirect effects of fathering on child development.
To investigate the relationship between children's nutritional status and a series of measures capturing both the current status and the lifetime history of their connection with adult caregivers in the Agincourt sub-district of rural South Africa.
Using data on a sample of 202 children from a recent ethnographic study of children's social connections and well-being, the authors (1) compare height for age and weight for age to an accepted international standard and (2) conduct bivariate analyses of the relationships between selected measures of social connection and extreme deviations below expected weight and expected height.
Fitted curves for weight for age and height for age fall between the 5th and 50th percentiles of CDC growth curves. Compromised nutrition, defined as being more than two standard deviations below expected height or weight, is associated with the death or non-co-residence of the mother, and with the absence of financial support from the father. The co-residence of maternal female kin as substitutes for the mother do not fully compensate for her absence.
The findings highlight the importance of parental living arrangements, parental financial support, birth order and the composition of sibling sets, and lifetime residential patterns in facilitating access to nutrition.
Malnutrition is a public health problem in Vietnam. Child health and the status of women have been targets for various health programs in the country. In general, reports in the literature suggest that care is positively correlated with positive nutritional status of children. In the household, the father is considered a resource for care. However, the role of paternal care in health programs has not received the attention it deserves.
To identify associations between the involvement of fathers in child care and housework and the nutritional status of children under 3 years of age.
This cross-sectional study was based on a random sample of 547 children under 3 years of age from intact families and their biological parents. The main outcome variable was child nutrition. Predictor variables represented two domains of father's involvement. Multivariable general linear modeling and multivariable logistic regression modeling were performed with the use of a combination of stepwise and hierarchical approaches in data analysis.
The overall prevalence of underweight among children was 19.1%, and the prevalence of stunting was 14.4%. Children whose fathers did not bring them to a medical facility for immunization were about 1.7 times more likely to be underweight and stunted than those whose fathers did bring them for immunization after child's age, household economic status, and mother's education were controlled for. Father's involvement in housework was not found to be related to the prevalence of malnutrition.
Paternal involvement in child immunization should be encouraged by health-care providers who manage immunization programs.
Introduction:
This systematic review will identify and summarize current research concerning the influence of fathers on the feeding behaviors of their children. Outcomes specific to child health, development of eating habits, relationships between paternal weight and child weight, and paternal dietary habits and child dietary habits were specifically targeted.
Methods:
A systematic review was conducted based on protocols outlined by PRISMA. A database search produced 851 relevant articles to be screened based on pre-determined inclusion criteria. Twenty-three studies met inclusion criteria for full review including two papers based on a single randomized control trial, 3 longitudinal studies, and 18 cross-sectional studies.
Results:
The most consistent findings across studies include the following. Father's BMI was positively correlated with child's BMI, father's dietary intake was predictive of child's dietary intake, food availability in the home influenced child intake, father's food parenting style predicted their children's eating behaviors and congruent parenting by mothers and fathers produced the best child food choices.
Conclusions:
A growing body of research indicates that fathers play a key role in influencing child eating behaviors. Further research, including randomized control trials, will help strengthen current conclusions and better inform education and interventions designed for fathers.
Early childhood education (ECE) has received rising interest from researchers in recent years. However, its effect on child development is still unclear in Sub-Saharan Africa. This study aims to shed light on the contribution of ECE in children’s development, using robust econometric estimations. We exploit data from the 2011 round of the Ghana Multiple Indicator Cluster Survey (MICS), to build a multidimensional early child development index that accounts for children’s ability to read, count, recognize numbers, interact with peers and other people, follow rules and be independent as well as their health outcomes and physical skills. Then, we estimate the effect of ECE on child development using an endogenous treatment effect model to account for children unequal access to ECE. Results indicate that attending to ECE program increases children early development indicators. We also found that mother’s education, father’s involvement and living in urban area increase child development. This finding is robust to several changes in the specifications. Policy makers and ECE program planners in Ghana should consider investing in preschool education, especially for underprivileged children, in order to build a strong foundation for Ghana’s human resource development.
Aims and objectives
To present parents’ lived experience of having a preterm infant cared for at the neonatal unit until discharge from hospital‐based neonatal home care (HNHC).
Background
Becoming a parent to a preterm infant has been reported as an experience that may influence the parent's lifeworld also after discharge. Interventions have been implemented at the NICUs, e.g. introduction of family‐centred care aiming to reduce parent‐infant separation, increased integration of the parents, in order to support them in their altered parental role.
Design
A descriptive phenomenological interview study.
Methods
Six parent couples at a NICU in Sweden were included and interviewed individually after discharge from HNHC. The interviews were analyzed from the perspective of caring sciences using a descriptive phenomenological method. The study followed the Consolidated criteria for reporting qualitative research (COREQ) checklist.
Result
The journey from birth to discharge from hospital‐based neonatal home care affected the parents’ lifeworld. The parents’ experiences differed. Mothers experienced more physiological reactions that triggered feelings of existential loneliness and guilt and difficulties in combining the role of mother with partner. The fathers faced conflicts managing their partners’ demands, family challenges, and employers who claimed their time and energy, which negatively affected their transition into fatherhood.
Both mothers and fathers experienced ambivalent feelings in the relationships with the professional staff, which was more strongly expressed by the mothers.
Conclusion
It is important for health care providers to help parents clarify their individual needs and values in caring for a preterm infant to help them achieve parental and family wellbeing.
Relevance to clinical practice
These findings can guide health care providers to help parents improve care for their preterm infants in the NICU. Integrating a person‐centered approach such as supportive person‐centered dialogues focused on parents’ individual needs might be one way to support parents.
This article is protected by copyright. All rights reserved.
Links between parent-child play, book reading, and storytelling and use of objects and children's early literacy skills were assessed in the developing Caribbean nations of Belize, the Dominican Republic, Guyana, Jamaica, and Suriname using the UNICEF Multiple Indicator Cluster Survey 4 and 5. The sample consisted of 10,976 preschool-aged children and their caregivers. Maternal engagement in play, book reading, and storytelling were highest in Belize and Jamaica and lowest in the Dominican Republic and Suriname. Mothers were far more likely to engage in play, book reading, and storytelling than were fathers in all five countries. Over 90% of children played with manufactured toys, nearly two-thirds played with household objects and outside objects, and a comparatively smaller percentage played with homemade toys across countries. Preschool enrollment, wealth status, number of books in the home, and children's age were consistently associated with children's literacy skills across countries. Book reading and telling stories, but not playing with children, showed significant associations with children's early literacy skills as did homemade toys in some countries. Data are interpreted in terms of the relative importance of play, book reading, and storytelling for children's early literacy skills development in Caribbean countries.
Informed by a family systems framework, this study utilizes the actor-partner-interdependence model to examine how parents' mental health, including depressive symptoms and parenting stress, predict their own (actor effects) and their partners' (partner effects) reports of their children's behavior problems among 730 low-income families. Further, we examine whether mothers' and fathers' mental health in early childhood predicts children's teacher-reported social development in fifth grade. Both mothers' and fathers' depressive symptoms and parenting stress were associated with their own (actor effects) ratings of child behavior problems when children were 3 years (M=37.16 months, SD = 1.53); parenting stress exerted a larger effect than depressive symptoms. Further, ratings of child behavior were predicted by partners' parenting stress for fathers but not for mothers. Greater parent depression symptoms in early childhood was associated with higher fifth graders' hyperactivity, and fathers' greater depressive symptoms was associated with lower fifth graders' cooperation. Results indicate that the mental health of both parents predicts child social skills and problem behaviors, both in early childhood and later development.
This research item refers to 2 chapters of mine which appeared in the book titled The Role of the Father in Child Development (2010). (ResearchGate lists book chapters with the title of the book that included the chapter.) #1 is “Paternal involvement: Revised conceptualization and theoretical linkages with child outcomes.“ #2 is “Fatherhood and masculinity.” I have made these two chapters available on ResearchGate under those chapter titles. (Google Scholar also lists the 2010 book title as one of my publications.)
This study investigated the cross-lagged relationship between father involvement and child problem behaviour across early-to-middle childhood, and tested whether temperament modulated any cross-lagged child behaviour effects on father involvement. It used data from the first four waves of the UK's Millennium Cohort Study, when children (50.3 % male) were aged 9 months, and 3, 5 and 7 years. The sample was 8302 families where both biological parents were co-resident across the four waves. Father involvement (participation in play and physical and educational activities with the child) was measured at ages 3, 5 and 7, as was child problem behaviour (assessed with the Strengths and Difficulties Questionnaire). Key child and family covariates related to father involvement and child problem behaviour were controlled. Little evidence was found that more father involvement predicted less child problem behaviour two years later, with the exception of father involvement at child's age 5 having a significant, but small, effect on peer problems at age 7. There were two child effects. More hyperactive children at age 3 had more involved fathers at age 5, and children with more conduct problems at age 3 had more involved fathers at age 5. Child temperament did not moderate any child behaviour effects on father involvement. Thus, in young, intact UK families, child adjustment appears to predict, rather than be predicted by, father involvement in early childhood. When children showed more problematic behaviours, fathers did not become less involved. In fact, early hyperactivity and conduct problems in children seemed to elicit more involvement from fathers. At school age, father involvement appeared to affect children's social adjustment rather than vice versa.
An international study to validate the Ten Questions screen for serious childhood disability was undertaken in communities in Bangladesh, Jamaica, and Pakistan, where community workers screened more than 22,000 children ages 2-9 years. All children who screened positive, as well as random samples of those who screened negative, were referred for clinical evaluations. Applying comparable diagnostic criteria, the sensitivity of the screen for serious cognitive, motor, and seizure disabilities is acceptable (80-100%) in all three populations, whereas the positive predictive values range from 3 to 15%. These results confirm the usefulness of the Ten Questions as a low-cost and rapid screen for these disabilities, although not for vision and hearing disabilities, in populations where few affected children have previously been identified and treated. They also show that the value of the Ten Questions for identifying disability in underserved populations is limited to that of a screen; more thorough evaluations of children screened positive are necessary to distinguish true- from false-positive results and to identify the nature of the disability if present.
In this Series paper, we review trends since the 2005 Lancet Series on Neonatal Survival to inform acceleration of progress for newborn health post-2015. On the basis of multicountry analyses and multi-stakeholder consultations, we propose national targets for 2035 of no more than 10 stillbirths per 1000 total births, and no more than 10 neonatal deaths per 1000 livebirths, compatible with the under-5 mortality targets of no more than 20 per 1000 livebirths. We also give targets for 2030. Reduction of neonatal mortality has been slower than that for maternal and child (1–59 months) mortality, slowest in the highest burden countries, especially in Africa, and reduction is even slower for stillbirth rates. Birth is the time of highest risk, when more than 40% of maternal deaths (total about 290 000) and stillbirths or neonatal deaths (5·5 million) occur every year. These deaths happen rapidly, needing a rapid response by health-care workers. The 2·9 million annual neonatal deaths worldwide are attributable to three main causes: infections (0·6 million), intrapartum conditions (0·7 million), and preterm birth complications (1·0 million). Boys have a higher biological risk of neonatal death, but girls often have a higher social risk. Small size at birth—due to preterm birth or small-for-gestational-age (SGA), or both—is the biggest risk factor for more than 80% of neonatal deaths and increases risk of post-neonatal mortality, growth failure, and adult-onset non-communicable diseases. South Asia has the highest SGA rates and sub-Saharan Africa has the highest preterm birth rates. Babies who are term SGA low birthweight (10·4 million in these regions) are at risk of stunting and adult-onset metabolic conditions. 15 million preterm births, especially of those younger than 32 weeks' gestation, are at the highest risk of neonatal death, with ongoing post-neonatal mortality risk, and important risk of long-term neurodevelopmental impairment, stunting, and non-communicable conditions. 4 million neonates annually have other life-threatening or disabling conditions including intrapartum-related brain injury, severe bacterial infections, or pathological jaundice. Half of the world's newborn babies do not get a birth certificate, and most neonatal deaths and almost all stillbirths have no death certificate. To count deaths is crucial to change them. Failure to improve birth outcomes by 2035 will result in an estimated 116 million deaths, 99 million survivors with disability or lost development potential, and millions of adults at increased risk of non-communicable diseases after low birthweight. In the post-2015 era, improvements in child survival, development, and human capital depend on ensuring a healthy start for every newborn baby—the citizens and workforce of the future.
Using a sample of resident fathers in the Early Childhood Longitudinal Study–Birth Cohort (9-month Father Study), this study examined how father involvement is associated with infant cognitive outcomes in two domains (babbling and exploring objects with a purpose). Results from a series of logistic regression models indicate that varied aspects of father involvement (cognitively stimulating activities, physical care, paternal warmth, and caregiving activities) are associated with a lower likelihood of infant cognitive delay. Two-way interaction models further indicate that father involvement is related to greater reductions in infant cognitive delay for male infants than for female infants and for infants with disabilities than for infants without. These findings point to the importance of considering fathers' roles in early infant outcomes. Early positive father–child interactions reduce cognitive delay.
This study used longitudinal data from the National Child Development Study to explore factors associated with aspects of fathers' involvement with their children at age 7, 11 and 16 years in intact families. Father involvement was predicted by different factors at different ages but generally it was continuous and multidimensional, and strongly associated with mother involvement. Low parental socio-economic status and child behaviour problems were negatively related to father involvement at age 7. With older children, father involvement was inversely related to family size and poor school performance. Financial difficulties in the family were not related to father involvement at either age. Domestic tension was negatively related to certain aspects of fathers' involvement with younger children. Father's education was generally related to father's involvement but maternal employment was only related to low father-interest in child's education at age 7 and 11 years.
Father characteristics and psychosocial functioning were examined as predictors of father involvement both with an Early Head Start (EHS) program and with their infant. Variables examined as potential predictors were selected based on the program's emphasis on building relationships as their primary intervention strategy. The 72 low-income fathers included in this study were predominantly Caucasian and married or living with their child's mother. Fathers' characteristics predicted their involvement in expected ways. Fathers were rated as more involved, both with their infants and with the EHS program, when they were better educated, less depressed, more likely to use social support especially spiritual support, and more active in their religion. Fathers who had better relationships with home visitors were those who had these same characteristics and also were less anxious about close relationships. In addition, fathers who were later rated as more engaged with their infants reported doing more activities with their infants at 10 months. These results suggest that the fathers who most need support to become more involved with their children are likely to be those who are the most difficult to get involved in an EHS program. ©2002 Michigan Association for Infant Mental Health.
The presence of a father has been positively associated with outcomes in several aspects of a child's life. This descriptive study investigated coping methods used by fathers of chronically ill children, fathers' perceived severity of the child's illness, and demographic differences related to coping mechanisms.
A sample of 54 fathers of chronically ill children completed measurements of demographics, coping processes, and severity levels of their child's chronic condition. Data were analyzed with SPSS 14.0 using parametric and nonparametric tests to examine relationships and coping behaviors used by fathers in northwest Florida.
A majority of fathers used an emotion-focused coping process with a religious dimension. No association was found between perceived level of severity of their child's illness and eight subscales used to measure coping methods; however, statistical significance was found between the age and marital status of fathers with seven of the subscales. Married and older fathers more often used "positive" coping mechanisms than did younger, unmarried fathers.
The findings emphasize the need for practitioners, clinicians, and educators to assess, support, and provide appropriate resources to fathers in order to promote positive effective coping and increase the level of involvement in the child's life.
An international study to validate the Ten Questions screen for serious childhood disability was undertaken in communities in Bangladesh, Jamaica, and Pakistan, where community workers screened more than 22,000 children ages 2-9 years. All children who screened positive, as well as random samples of those who screened negative, were referred for clinical evaluations. Applying comparable diagnostic criteria, the sensitivity of the screen for serious cognitive, motor, and seizure disabilities is acceptable (80-100%) in all three populations, whereas the positive predictive values range from 3 to 15%. These results confirm the usefulness of the Ten Questions as a low-cost and rapid screen for these disabilities, although not for vision and hearing disabilities, in populations where few affected children have previously been identified and treated. They also show that the value of the Ten Questions for identifying disability in underserved populations is limited to that of a screen; more thorough evaluations of children screened positive are necessary to distinguish true- from false-positive results and to identify the nature of the disability if present.
This paper uses five strategies to evaluate the reliability and other measurement qualities of the Ten Questions screen for childhood disability. The screen was administered for 22,125 children, aged 2-9 years, in Bangladesh, Jamaica and Pakistan. The test-retest approach involving small sub-samples was useful for assessing reliability of overall screening results, but not of individual items with low prevalence. Alternative strategies focus on the internal consistency and structure of the screen as well as item analyses. They provide evidence of similar and comparable qualities of measurement in the three culturally divergent populations, indicating that the screen is likely to produce comparable data across cultures. One of the questions, however, correlates with the other questions differently in Jamaica, where it appears to "over-identify" children as seriously disabled. The methods and findings reported here have general applications for the design and evaluation of questionnaires for epidemiologic research, particularly when the goal is to gather comparable data in geographically and culturally diverse settings.
Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data--the prevalence of early childhood stunting and the number of people living in absolute poverty--to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.
The effects of father involvement: A summary of the research evidence
- Allen S.
Allen, S., & Daly, K. (2002). The effects of father involvement: A summary
of the research evidence. Newsletter of the Father Involvement
Initiative-Ontario Network, 1, 1-11.
Rwanda gender and social inclusion analysis report
- Usaid