Family day care and day care centres: Carer, family and child differences and their implications

The present study investigated child, maternal and caregiver characteristics in two day care settings, the independent contributions of these characteristics to children's adjustment to day care, and the utility of a goodness-of-fit framework as a means of assessing the impact of parent-caregiver differences on children's adjustment. Eight measures were used to assess child behavioural problems, maternal satisfaction with care, child temperament, maternal and caregiver child rearing practices, developmental timetables, day care goals, and demographic background. The study found strong support for the existence of differences between mothers choosing different types of care, between caregivers in these two settings, and between mothers and caregivers; and for the linkage between child, maternal and caregiver characteristics and child adjustment. However, the impact of goodness-of-fit between mothers and caregivers on children's adjustment to day care was not supported.     

Caregiver behaviors and resources influence child height-for-age in rural Chad

The purpose of this study was to identify caregiver characteristics that influence child nutritional status in rural Chad, when controlling for socioeconomic factors. Variables were classified according to the categories of a UNICEF model of care: caregiving behaviors, household food security, food and economic resources and resources for care and health resources. Sixty-four households with 98 children from ages 12 to 71 mo were part of this study. Caregivers were interviewed to collect information on number of pregnancies, child feeding and health practices, influence on decisions regarding child health and feeding, overall satisfaction with life, social support, workload, income, use of income, and household food expenditures and consumption. Household heads were questioned about household food production and other economic resources. Caregiver and household variables were classified as two sets of variables, and separate regression models were run for each of the two sets. Significant predictors of height-for-age were then combined in the same regression model. Caregiver influence on child-feeding decisions, level of satisfaction with life, willingness to seek advice during child illnesses, and the number of individuals available to assist with domestic tasks were the caregiver factors associated with children's height-for-age. Socioeconomic factors associated with children's height-for-age were the amount of harvested cereals, the sources of household income and the household being monogamous. When the caregiver and household socioeconomic factors were combined in the same model, they explained 54% of the variance in children's height-for-age, and their regression coefficients did not change or only slightly increased, except for caregiver's propensity to seek advice during child illnesses, which was no longer significant. These results indicate that caregiver characteristics influence children's nutritional status, even while controlling for the socioeconomic status of the household.     

Reduced Morbidity Motivated Adoption of Infant and Young Child Feeding Practices after Nutrition Education Intervention in Rural Malawi

This study assessed caregivers’ knowledge and practices and factors that influence the adoption of improved infant and young child feeding (IYCF) practices after nutrition education in Kasungu and Mzimba districts among 198 caregivers. Mixed-methods convergent-parallel design, including knowledge tests, focus group discussions, and in-depth interviews in the intervention areas, was used to collect quantitative and qualitative data. Data were analyzed using count regression and content analysis, which showed that knowledge increased among caregivers after nutrition education. The knowledge about diet diversification for young children as well as about hygienic practices when preparing food and during feeding improved in addition. Enhanced health among children motivated caregivers to apply improved IYCF practices. The study was based on the caregivers’ reports. Long-term effects of exposure to nutrition education are unknown. However, the nutrition education that focused on the child’s health benefits motivated mothers to adopt improved IYCF practices.     

Change and Continuity in Low-Income Working Mothers’ Food Practices for Young Children in Response to Life Events

Objective

To understand how changes in low-income mothers’ work, home, and childcare environments impact their food practices for young children.

Methods

The grounded theory, theory-guided, design included two in-depth qualitative interviews (6 to 8 months apart) with each of 19 low income, working/student mothers of Head Start children, living in a rural county in Upstate New York. Interviews covered mothers’ experiences of employment, school, family, household, and childcare events over one school year and whether and how events changed child food practices. Emergent themes related to mothers’ experiences of life events, with attention to influences on child food practices, were open-coded using a constant comparative approach. A life course approach and a transactional model of the stress process informed interpretation.

Results

Within the study period, most mothers reported at least one life event, with many experiencing one or more changes in employers, job schedules, residence, household members, or childcare situation. Emergent patterns of adjustment in child food practices linked with life events were shaped by mothers’ appraisals of life events, the availability of coping resources, and their adaptations to events, based on temporal, financial, and social resources. The findings support a view of child feeding informed by the transactional model of stress.

Conclusions

Instability in work, family, household, and childcare highlight changing contexts for child food practices in daily life. Research and practice should acknowledge the changing nature of the child feeding context and the need for children’s caregivers to make adjustments in response to changing resources.

     

Threats to maternal and child well-being in rural communities in Ngamiland, Botswana

The authors' main objective of the study was to explore threats to maternal and child well-being in two nonriparian and two riparian communities in the east and west of the Okavango River Basin in Ngamiland District, Botswana. Primary data were collected from a simple random sample of 60 households. Data on women's access to human, financial, physical and institutional capital, productive assets and livelihood activities, household food resources, and social services (education, health, water, sanitation) were collected. Children's nutritional status was also evaluated. Our observations reveal that caregiving is gender biased toward women whose well-being is undermined by their limited access to resources. Further, women's poor access to basic household resources undermines gains made through clinic-based maternal and child welfare nutrition programs. In addition, a significant proportion of children's caregivers have access to low-tier primary health care provision in the study area, but inadequate physical infrastructural development limits their access to specialized care, particularly emergency obstetric services. Childhood malnutrition is also a concern in the study area, and it mostly affects children whose caregivers have limited access to resources. The authors conclude that improving maternal and child access to education and health services remains a challenge in the district. The authors recommend interventions that prioritize sensitive aspects of child well-being, early childhood education, and development.     

Poor maternal schooling is the main constraint to good child care practices in Accra

Life in urban areas presents special challenges for maternal child care practices. Data from a representative quantitative survey of households with children < 3 y of age in Accra, Ghana were used to test a number of hypothesized constraints to child care including various maternal (anthropometry, education, employment, marital status, age and ethnic group) and household-level factors (income, availability of food, quality of housing and asset ownership, availability of services, household size and crowding). Three care indices were created as follows: 1) a child feeding index; 2) a preventive health seeking index; and 3) a hygiene index. The first two indices were based on data from maternal recall; the hygiene index was based on spot-check observations of proxies of hygiene behaviors. Multivariate analyses (ordinary least-squares regression for the child feeding index and ordered probit for the two other indices) showed that maternal schooling was the most consistent constraint to all three categories of child care practices. None of the household-level characteristics were associated with child feeding practices, but household socioeconomic factors were associated with better preventive health seeking and hygiene behaviors. Thus, poor maternal schooling was a main constraint for child feeding, health seeking and hygiene practices in Accra, but the lack of household resources was a constraint only for health seeking and hygiene. The programmatic implications of these findings for interventions in nutrition education and behaviors in Accra are discussed.     

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Study Design,Methods and Sample Description

(1) Background: Caregiver feeding practices during the first two years of a child’s life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices lead to poorer health outcomes, such as obesity, that persist into adulthood. Although the importance of early life nutrition is well-established, there are no Australia-wide surveys of dietary intakes of children under two years of age. The 2021 Australian Feeding Infants and Toddlers Study (OzFITS) aims to fill this gap. This paper describes the methods and study sample of OzFITS 2021. (2) Methods: OzFITS 2021 is a cross-sectional study of children aged 0 to 23.9 months of age and their caregiver across Australia. Data were collected between April 2020 and April 2021. A telephone-based survey was completed with a caregiver to obtain information on child and caregiver characteristics and feeding practices. For exclusively breastfed infants, the number of breastfeeds in a 24 h period was reported. Dietary intakes for mixed fed children were estimated using a one-day food record, with 30% of caregivers completing a second food record on a non-consecutive day. (3) Results: We enrolled 1140 caregiver and child dyads. Of those eligible to complete a food record, 853 (87%) completed the food record. Compared to the Australian population, caregivers were more likely to be university-educated (>75%), married or in a de facto relationship (94%), and have a household income >$100,000/y (60%). (4) Conclusions: OzFITS 2021 is the first national study to examine food and nutrient intake in Australian children aged under 2 years. The study will provide information on breastfeeding rates and duration, use of breast milk substitutes, and timing of solid food introduction. Dietary intake data will allow the comparison of core food groups and discretionary food intake to Australian guidelines and estimate the prevalence of inadequate intake of key nutrients, like iron. Healthcare practitioners and policymakers can use the study findings as a source of evidence to inform the next iteration of infant feeding guidelines.     

Threats to Maternal and Child Well-Being in Rural Communities in Ngamiland,Botswana

The authors’ main objective of the study was to explore threats to maternal and child well-being in two nonriparian and two riparian communities in the east and west of the Okavango River Basin in Ngamiland District, Botswana. Primary data were collected from a simple random sample of 60 households. Data on women's access to human, financial, physical and institutional capital, productive assets and livelihood activities, household food resources, and social services (education, health, water, sanitation) were collected. Children's nutritional status was also evaluated. Our observations reveal that caregiving is gender biased toward women whose well-being is undermined by their limited access to resources. Further, women's poor access to basic household resources undermines gains made through clinic-based maternal and child welfare nutrition programs. In addition, a significant proportion of children's caregivers have access to low-tier primary health care provision in the study area, but inadequate physical infrastructural development limits their access to specialized care, particularly emergency obstetric services. Childhood malnutrition is also a concern in the study area, and it mostly affects children whose caregivers have limited access to resources. The authors conclude that improving maternal and child access to education and health services remains a challenge in the district. The authors recommend interventions that prioritize sensitive aspects of child well-being, early childhood education, and development.     

Influence of care practices on nutritional status of Ghanaian children

A community-based longitudinal study was conducted in the Manya Krobo District of the Eastern Region of Ghana with the objective of assessing how caregiving practices influence nutritional status of young children in Ghana. The study subjects were one hundred mothers with infants between the ages of 6 and 12 months. Each child was visited at home monthly for a period of six months. On each visit, information was collected on caregiver household and personal hygiene, child''s immunization status, child''s dietary diversity, caregiver responsiveness during feeding, caregiver hygienic practices related to feeding and child''s weight and length. At the end of the study, summary scores were generated for each variable and quality of care practice determined based on their distribution. Classification of child nutritional status was based on z-scores for both weight-for-age and length-for-age. The results revealed that caregivers who exhibited better quality of care practice had well-nourished children. Such caregivers were more likely to practice good household and personal hygiene than those of poorly nourished children (97.1% vs 31.8%, p<0.001). They were also more likely to complete their children''s immunization schedules (88.2% vs 62.2%, p< 0.001), provide good quality diets from highly diversified sources (79% vs 23%, p<0.001), exhibit high responsiveness during feeding (100% vs 22.7%, p<0.001) and feed under hygienic conditions (100% vs 22.7%, p<0.001). Based on the findings it was concluded that good caregiving practices are associated with improved child nutritional status.     

四川省凉山州4个重点贫困县6~24月龄婴幼儿营养及喂养现状调查

目的 了解凉山州贫困地区4个重点贫困县6~24月龄婴幼儿营养状况和家长喂养行为,为开展儿童营养与健康干预促进工作提供依据。方法 2018年4-7月采用多阶段随机抽样法,抽取4个重点县1 244名6~24月龄婴幼儿进行体格测量、血红蛋白含量检测和家长问卷调查。结果 凉山州4个重点县6~24月龄婴幼儿贫血患病率为51.9%,低体重率为9.5%,生长迟缓率为25.6%。多因素分析显示,婴幼儿性别、月龄、母亲学历、母亲职业、是否认为满3个月就可以添加辅食、是否知道谷类泥糊状食物是最适合首先添加的辅食、是否知道动物血或红肉是婴幼儿补铁的最好来源、是否知道贫血与铁缺乏有关、是否吃过母乳、6月龄后是否继续母乳喂养是影响婴幼儿营养状况的主要因素(P<0.05)。结论 凉山州贫困地区6~24月龄婴幼儿营养状况亟待改善,婴幼儿看护人喂养知识不足。应加强宣传教育,提高家长的育儿素养,掌握营养包的有效服用方法,纠正不正确的的喂养方式。     

Comparative study of early interactions in mother–child dyads and care centre staff–child within the context of Chilean crèches

Background Bowlby developed the concept of ‘caregiver’ to refer to significant adults with whom young children interact daily. Not only parents are considered significant caregivers but also the care centre staff where the child attends regularly. Within caregiver–infant interactions, sensitive response on the part of the adult is a key concept in the assessment of the quality of the relationship, as it integrates the experiences and emotions that will influence the attainment of a secure attachment and a favourable emotional, social and cognitive development in the child. Methods This study is a comparative analysis between the dyadic interactions between a child and its principal caregivers in the home and in the crèche; it is based on a group of 185 children between 8 and 24 months old, who attend a crèche regularly. The Care‐Index instrument was used to assess interaction between children and adults, analysing sensitive response in the adults and cooperativeness in the children. Results The sensitive response of adults to children was complementary; mothers and primary caregivers showed greater sensitivity in the affective aspects of the interaction, while the care centre staff showed greater sensitivity in the cognitive aspects. The fact that caregivers show significant differences in response sensitivity is consistent with existing studies, as are corresponding significant differences in the children's cooperativeness, which demonstrates that a child could benefit from interacting with adults whose different skills could strengthen diverse aspects of health child development. Conclusions The presence of children in the crèche can be a positive experience in that it favours quality exchanges with the child, developing cognitive aspects of the interaction which are cultivated to a lesser degree by mothers or primary caregivers who principally develop affective aspects.     

Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.     

Caregiver Participation in Community-Based Mental Health Services for Children Receiving Outpatient Care

Caregiver participation in child mental health treatment has been associated with better youth outcomes, but little is known about the amount and type of caregiver participation in usual care services for children. This study examined 1,255 caregivers’ reports of their participation in the outpatient services their children received through a large, public mental health system in the Southwest. The majority of the caregivers reported that they participated in their child’s services. Extent of participation was associated with several factors including children’s physical health and caregivers’ primary language, satisfaction with the services, feelings of support, and perceptions of barriers to participation. The findings offer some encouragement for the contextual fit for many evidence-based interventions that focus on caregiver involvement, and highlight which caregivers may need greater encouragement to participate in their child’s care.     

Coping strategies, care manager support and mental health outcome among Japanese family caregivers

Coping and social support are regarded as major modifiers of the caregiving stress and negative mental health effects experienced by caregivers. Under Japan's Long-term Care Insurance (LTCI) system, care managers have played a major role in providing psychosocial support for family caregivers while coordinating formal and informal care resources for elderly people. However, since the launch of the LTCI system in 2000, no evaluation has examined the role care managers play in buffering the negative effects of the caregiver burden among family caregivers in Japan. This study examined the direct and buffering effects of stress-coping strategies and care manager support on caregiver burden and depression among Japanese family caregivers (n = 371) caring for community-dwelling persons aged 65 or over who were having difficulties with the activities of daily living. A self-administrated questionnaire survey was conducted between February and March 2005 in a rural suburb in south-western Japan. Hierarchical regression analyses revealed the following. (i) Coping strategies and 'social talk' by care managers had direct effects on caregiver burden and depression. (ii) 'Avoidant' coping and 'social talk' by care managers had buffering effects on the care needs-depression relationship. (iii) 'Information giving' by care managers had no significant direct effect, but it had a negative effect on the care needs-depression relationship. Overall, results concerning 'approaching' coping were in line with those of previous studies, while findings concerning 'avoidant' coping were not consistent with findings in Western countries. The type of care manager support appeared to have a variable influence on caregiver burden and depression.     

Caregivers of frail elderly and medically fragile children: perceptions of ability to continue to provide home health care

The purposes of this study were to compare the characteristics and support systems of caregivers of frail elderly and medically fragile children and to determine what factors discriminated between caregivers who could (and could not) continue to provide home health care. Caregivers of children were significantly more likely (chi 2 = 52.30)2), p = < .0000) to report that they were managing OK than caregivers of frail elderly. They also reported receiving more support and assistance from formal and informal sources, although in general, less than 30% of the caregivers received any help. Five variables (Mental impairment of the elder, poor physical and mental health of the caregiver, high monthly caregiving-related expenses, and use of paid in-home assistance) explained 35% of the variance between caregivers of frail elderly who were managing OK and those who were unable to continue to manage. Six variables (physical and mental impairment of the child, physical health of the caregiver, feeling like there were no alternative providers, time demand and lack of assistance from others) explained 26.57% of the variance between caregivers of children who were managing OK and those who were unable to continue to manage. The findings suggest that a strong objective stressor, combined with a lack of personal and social resources are associated with caregivers' perceptions that they cannot continue to manage home health care.     

The direct and indirect financial costs of informal cancer care: A scoping review

Informal caregivers are the primary source of support for cancer patients, providing assistance with household tasks, medical care and emotional support. These responsibilities often result in high levels of emotional, physical, social and financial burden for the caregiver. The aim of this study was to perform a scoping review exploring what is known regarding the financial costs experienced by caregivers and identify gaps in the literature. Seven databases were searched for articles published between May 2008 and May 2018 related to direct and indirect costs of informal cancer care. Included articles reported on the costs incurred by cancer caregivers as a dollar value, relied on caregiver‐reported costs and were peer reviewed. A total of 19 studies met the inclusion criteria. These studies reported out of pocket costs? opportunity costs of informal care time and caregiver time loss from paid employment. Care time was the largest source of cancer caregiver costs, averaging $4,809 per month when valued using the proxy good method or $2,877 per month when the opportunity cost approach was used. Caregiver costs were highest when the care recipient was in the palliative phase of the disease. There was an absence of literature reporting costs for cancer caregivers in low and middle income countries and none of the included studies considered costs related to the caregivers' medical expenditures. There were many challenges when comparing the costs across studies due to variations in the type of expenses reported and the methods used to value expenses. Quantifying the financial costs associated with being an informal caregiver can facilitate the communication of the financial burden caregivers experience, potentially spurring the development of policies and programs to reduce their financial burden and better support cancer caregivers.     

Strengthening human resources for health systems resilience to care for mothers and children

Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson’s chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to systematically document all inputs and monetary costs borne by the MOH to implement the model.     

Child Feeding Practices in Families of Working and Nonworking Mothers of Indonesian Middle Class Urban Families: What Are the Problems?

This study aims to explore the feeding practices in families of working and nonworking mothers with children (aged 12–36 months) of different nutritional status and types of domestic caregiver in Indonesian urban middle class families. It was designed as a qualitative multiple case study. Mothers and caregivers from 26 families were interviewed in depth, and caregivers were categorized as family and domestic-paid caregivers. The result suggested that offering formula milk to young children was a common practice, and there was a high recognition and familiarity toward a range of formula milk brands. Mothers reported challenges in encouraging their children to eat, and in some cases they appeared to lack knowledge on overcoming their child's feeding problem. The findings suggested the need to address the child feeding problems experienced by mothers in order to overcome the double burden of child nutrition in Indonesia.