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Background: Accurate maternal perceptions of children's weight status are crucial for early childhood obesity prevention, with evidence suggesting that maternal misperception may delay timely interventions. This study investigated the accuracy of maternal perceptions of child weight and examined associations with parenting styles and children's eating behaviors and demographic factors among preschool-aged children in Samsun, Türkiye. Methods: This cross-sectional study included 318 mother–child pairs recruited from preschools in socio-economically diverse areas of Samsun. Maternal perceptions of child weight status were assessed using a visual scale, while children's anthropometric measurements (height, weight) were recorded to calculate BMI-for-age Z-scores. Parenting styles and children's eating behaviors were evaluated using the Parental Attitude Scale (PAS) and the Children's Eating Behavior Questionnaire (CEBQ), respectively. Data analysis involved chi-square tests and multiple logistic regression to explore associations between maternal perception accuracy, parenting styles, and children's eating behaviors. Results: Among 318 mother–child pairs, 59.7% underestimated their child's weight status, with this figure being 84.9% among overweight children. Authoritative parenting was the most common style (78%); no significant association was found between parenting style and maternal perception accuracy. Accurate estimators showed significantly higher scores for food responsiveness (median: 9 (7–12), p = 0.028) and the enjoyment of food (mean: 16.3 ± 4.8, p = 0.003), whereas underestimators scored higher for satiety responsiveness (mean: 23.2 ± 5.7, p = 0.042) and slowness in eating (mean: 11.2 ± 4.2, p = 0.004). Conclusions: Maternal underestimations of child weight are prevalent, particularly for overweight children, are associated with children's specific eating behaviors. Targeted educational interventions focusing on improving maternal awareness and promoting responsive feeding practices are essential to combat childhood obesity. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To explore the support needs of parents of children with autism spectrum disorder (ASD) in China under the guidance of the nurturing care framework (NCF).A descriptive qualitative study design was used.Fourteen parents of 2–6‐year‐old children with autism were recruited for face‐to‐face individual interviews in Chongqing between July and November 2023. NVivo 12.0 software was used to manage the data, and a directed content analysis was performed to extract themes.Five nurturing care needs of parents of children with autism were extracted, including acquisition of health‐ and disorder‐related knowledge and information, maintenance of psychological and physical wellbeing, desire for individualised caregiver skills training, creation of multi‐agent social support network, and accessibility of high‐quality and coordinated services.Parents of children with autism have multidimensional unmet nurturing care needs. It is crucial to address these needs and develop targeted family support programs with consideration of the extracted need components.This study implies that health education, parental empowerment and psychological support should be prioritised in future family support programs. The findings also emphasise the importance of establishing a cross‐departmental coordination mechanism and building a multi‐agent social support network for families of children with autism.This study expands our understanding on the support needs of families of children with autism and enriches the theoretical connotation of nurturing care framework, and the results may inform the development of tailored support programs for families of children with autism in China.The results are reported in accordance with the reporting guidelines of the Consolidated Criteria for Reporting Qualitative Studies (COREQ).No patient and public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Children born small or sick are at risk of death and poor development, but many lack access to preventative follow-up services. We assessed the impact of Pediatric Development Clinics (PDC), which provide structured follow-up after discharge from hospital neonatal care units, on children's survival, nutrition and development in rural Rwanda. Methods: This quasi-experimental study compared a historic control group to children receiving PDC in Kayonza and Kirehe districts. Study populations in both districts included children born preterm or with birthweight < 2000 g and discharged alive. Kirehe additionally included children with hypoxic ischemic encephalopathy (HIE). Home-based cross-sectional surveys were conducted in Kayonza among children with expected chronological age 11–36 months in 2014 (controls) and 2018 (PDC group) and in Kirehe among children with expected chronological age 17–39 months in 2018 (controls) and 2019 (PDC group). Outcomes were measured using anthropometrics and the Ages and Stages Questionnaires. We used weighted logistic regression to control for confounding and differential non-participation. Results: PDC children (n = 464/812, 57.1%) were significantly more likely to participate in surveys (83.0% vs. 65.5%), have very low birthweight (27.6% vs. 19.0%), and be younger at the survey (26.2 vs. 31.1 months). 6.9% (n = 56) died before the survey. PDC was associated with reduced odds of death (aOR = 0.49, 95% CI: 0.26–0.92) and reduced odds of developmental delay (aOR = 0.48, 95% CI: 0.30–0.77). In Kayonza, PDC was associated with reduced stunting (aOR = 0.52, 95% CI: 0.28–0.98). PDC was not associated with reduced underweight or wasting. Conclusions: PDC was associated with improved survival and development among children born preterm, with low birthweight, or with HIE. Increased access to PDC, scale-up across Rwanda, and implementation of similar services and early intervention in other low-resource settings could support children born small or sick. [ABSTRACT FROM AUTHOR]

Background:: Growth trajectories during the first 1,000 days from conception to 2 years influence human capital, predicting intelligence, skills and health in adults. Summary:: This review describes current evidence on the impacts of adverse pregnancy outcomes such as low birth weight, preterm birth, small for gestational age, and infant nutrition on long-term neurodevelopment and summarizes interventions that have proven to be effective in improving child development and further impact human capital. To date, no globally standardized measurements of child development in low-medium-income countries exist, and comparisons among studies using different developmental scales are challenging. In the perinatal period, birth weight, gestational age at delivery and elevated placental blood flow resistance have been identified as the main risk factors for global neurological delay, poor neurosensory development and cerebral palsy. Although these adverse neurological outcomes have decreased in developed settings, it is still a problem in low-resource populations. Nutritional deficiencies are the main drivers of developmental impairment, notably iron, iodine and folate deficiencies, and environmental stressors during pregnancy such as air pollution, exposure to chemicals, substance abuse, smoking, and maternal/parental psychiatric disorders can affect the developing brain. Interventions aiming to improve maternal macro- and micronutrient status, delayed cord clamping, exclusive breastfeeding and nurturing care have demonstrated to be effective strategies to prevent perinatal complications known to affect child development. [ABSTRACT FROM AUTHOR]

Background: World Vision launched the Inclusive Playful Parenting for a Brighter Childhood (IPP4BC) project in identified vulnerable communities in Nepal and Uganda to mitigate risk for children at risk of poor development due to COVD 19. The intervention, based on the nurturing care framework, offered a customized parenting curriculum for young children, emphasizing holistic development through behavior change approaches tailored to local contexts. Objective: To evaluate the effect of the IPP4BC project, on early childhood development (ECD) and care outcomes of children under 6 years in vulnerable communities in Nepal and Uganda, particularly those affected by the COVID-19 pandemic. Methods: The intervention was delivered by trained facilitators over a 7-month period in different arms defined by the dosage: high (10 group sessions, 4 home visits) medium (5 group sessions, 2 home visits) or low (delivery of key messages through media) dose. An endline evaluation designed as quasi-experimental non-equivalent control groups post-test only study, assessed the effect of the project utilizing the Malawi Development Assessment Tool (MDAT) for child outcomes and the Multiple Indicator Cluster Survey (MICS) for caregiver outcomes. Additionally, an implementation survey was conducted to assess program fidelity and participant engagement. Findings: In Nepal, higher intervention doses were associated with significantly better child development outcomes (High dose M = 1.20, SD = 2.22, Medium dose M = 1.01, SD = 1.99; Low dose M = 0.43, SD = 2.32, p < 0.001) whereas in Uganda, only medium dose (M = -0.03, SD = 1.28) showed significant improvement (High dose M = -0.30, SD = 1.30; Low dose M = -0.28, SD = 1.51, p = 0.015). A higher proportion of caregivers in both high and medium dose reported engagement with early learning practices compared to low dose. With respect to uptake, in Nepal, a higher number of families received home visits compared to group sessions, while in Uganda, more families reported attending group sessions than receiving home visits. Conclusion: The study demonstrated that higher intervention doses were associated with better child development outcomes in Nepal and only with medium dose in Uganda, emphasizing the importance of implementation factors like dosage, quality and delivery modality in community-based interventions for improving ECD outcomes in vulnerable populations. [ABSTRACT FROM AUTHOR]

Abstract Background World Vision launched the Inclusive Playful Parenting for a Brighter Childhood (IPP4BC) project in identified vulnerable communities in Nepal and Uganda to mitigate risk for children at risk of poor development due to COVD 19. The intervention, based on the nurturing care framework, offered a customized parenting curriculum for young children, emphasizing holistic development through behavior change approaches tailored to local contexts. Objective To evaluate the effect of the IPP4BC project, on early childhood development (ECD) and care outcomes of children under 6 years in vulnerable communities in Nepal and Uganda, particularly those affected by the COVID-19 pandemic. Methods The intervention was delivered by trained facilitators over a 7-month period in different arms defined by the dosage: high (10 group sessions, 4 home visits) medium (5 group sessions, 2 home visits) or low (delivery of key messages through media) dose. An endline evaluation designed as quasi-experimental non-equivalent control groups post-test only study, assessed the effect of the project utilizing the Malawi Development Assessment Tool (MDAT) for child outcomes and the Multiple Indicator Cluster Survey (MICS) for caregiver outcomes. Additionally, an implementation survey was conducted to assess program fidelity and participant engagement. Findings In Nepal, higher intervention doses were associated with significantly better child development outcomes (High dose M = 1.20, SD = 2.22, Medium dose M = 1.01, SD = 1.99; Low dose M = 0.43, SD = 2.32, p

Multiple factors influence infant and child neurodevelopment in low resource settings. In offspring of participants in the preconception maternal nutrition trial, Women First (WF), we examined the impact of providing a preconception (Arm 1) or prenatal (Arm 2) nutrient supplement (compared to controls, Arm 3) on neurodevelopmental outcomes at 24 months; predictors of neurodevelopment scores; and associations of infant anthropometrics with neurodevelopmental scores. Follow‐up visits for anthropometry were conducted at 6‐, 12‐, 18‐ and 24‐month of age. At 24‐months, in a randomized subset, the Bayley Scales of Infant Development, 3rd edition (BSID‐III), including cognitive, motor and social‐emotional subscales, and the Family Care Indicators (FCI) questionnaire, assessing family and home environment, were completed. Multiple covariates (intervention arm, site, maternal sociodemographic characteristics, FCI subscales, birthweight and 6–24 months' change in anthropometry z‐scores, (e.g., ΔLAZ6–24) were evaluated by linear regression to predict BSID‐III outcomes and to assess associations of anthropometric changes with BSID‐III scores. The analysis consisted of 1386 infants (n = 441, 486, 459 for Arms 1, 2 and 3, respectively). None of the domain‐specific BSID‐III subscale scores differed by maternal intervention arm. Four covariates significantly predicted (p ≤ 0.01) all 3 BSID‐III subscales: secondary maternal education, ΔLAZ6–24, birthweight >2500 g, and FCI play materials. Linear growth was associated with all domains of neurodevelopment. The results underscore the multi‐dimensional aspects of child development represented by the nurturing care framework, including prenatal maternal nutrition, post‐natal growth, maternal education for responsive caregiving and opportunities for early learning. Key messages: Preconception and prenatal maternal nutrition is important to ensure adequate fetal growth and healthy birthweight.Preconception and prenatal maternal nutritional supplementation was not associated with young child neurodevelopment but has been shown to improve post‐natal growth.Post‐natal linear growth is consistently associated with offspring neurodevelopment at 24 months.Maternal education to foster responsive caregiving, and opportunities for early learning in the home also positively impact offspring neurodevelopmental outcomes.These findings underscore the importance of multi‐dimensional aspects essential for children to reach their full developmental potential. [ABSTRACT FROM AUTHOR]

To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. Ecological time-series study. Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais–Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P -values <0.05 represented increasing or decreasing trends. No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, −5.92%) and unhealthy foods (2019: 16.1%; APC, −4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition. [ABSTRACT FROM AUTHOR]

Research on gender‐based violence highlights the need to engage men in prevention work through social change programs that present care as a powerful antidote to violence. Implementation of such programs worldwide provides many examples of how education and support for fathers and fathers‐to‐be can promote healthy masculinities and relationships with an intimate partner and their children. This article aims to explore the findings and lessons learned from the pilot of the European Union‐funded Promotion, Awareness Raising and Engagement of men in Nurture Transformations (PARENT) project (PARENT) which sought to develop and pilot curricula adapted from the internationally tested Program P methodology. The PARENT pilot worked in four European countries to provide training activities for social, educational, and health professionals, as well as education groups for fathers and parents, with the overarching goal of preventing domestic violence through the promotion of engaged fatherhood. By reporting the results from mixed‐methods impact evaluations of pilot programs conducted with professionals and parents, this article discusses how gender‐synchronous father‐focused training can contribute to a shift toward increased positive engagement of fathers during the first 1000 days of a child's life. The article conveys the pilot's promising impact on the knowledge, attitudes, and behaviors of professionals and parents, and it examines some of the key contextual factors, limitations, and implementation approaches that plausibly contributed to the PARENT pilot outcomes, with the aim to formulate useful considerations for future scale‐up efforts or the future implementation of similar programs to engage fathers in nurturing care and violence prevention. [ABSTRACT FROM AUTHOR]

Abstract Background Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers’ nurturing care practices and sources of parenting knowledge in rural Mozambique. Methods This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers’ and fathers’ daily caregiving experiences. Data were analyzed using thematic content analysis. Results Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child’s health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers. Conclusions These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.

Background: Early childhood development (ECD) is the foundation of future life starting from conception and depends on biological and environmental factors. Seventy-four percent of these children reside in villages; many are underserved and marginalized. Enabling young children to achieve their full developmental potential is a requisite for sustainable development, but globally, 43% of children are still at risk to do so. The problem of ECD is grave for underprivileged rural population in India. Objectives: The objective of the present study was to identify the key risk factors that are prevalent in a marginalized rural community in West Bengal and to observe the impact of these impeding factors on ECD, thereby helping in priority setting in service delivery to optimize ECD promotion. Methods: In this community-based cross-sectional observational study, a random sample survey of 609 households with children 0–6 years was conducted in Purulia district, West Bengal, India, using a Multiple Indicator Cluster Survey III-based questionnaire followed by data analysis. Results: Lack of stimulatory home environment, poor learning opportunities, and inadequate responsive parental care were major hindrances. The cumulative effect of multiple other health and hygiene factors was also hindering ECD. Most factors were strongly influenced by poor maternal education. Conclusion: Education of caregivers, especially parents by dedicated health workers on early learning opportunities, showed the path of applied sciences in pediatric clinical practice. To modulate socioeconomic adversities with responsive parental care, ECD can be fostered.

Objective. To analyze the health, nurturing care, and early childhood development (ECD) of children aged 0-59 months during 2021-2023. Materials and methods. We used data from the Encuesta Nacional de Salud y Nutrición Continua 2021-2023 (Ensanut Continua 2021-2023). We calculated the prevalence and 95% confidence intervals for all indicators, and disaggregation by sociodemographic characteristics; we calculated the probability of adequate ECD using a logistic regression model. Results. Access to prenatal and health services during early childhood is low. 39.0% of children do not have access to children's books, and 50.4% are exposed to violent discipline practices. 95.2% are exposed to at least one risk factor, and the likelihood of adequate ECD decreases with each additional risk factor. Conclusion. There are early childhood related indicators to that need to be focused on so that children exposed to more risk factors achieve adequate ECD. [ABSTRACT FROM AUTHOR]

BackgroundDuring the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs’ implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS).MethodWe conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS.ResultsOut of 20 records, 27 NCI were identified across Africa (n = 3), Asia (n = 7), Europe (n = 3), North America (n = 11), Oceania (n = 1), and South America (n = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting—shifting from in-person to remote, and population—expanding interventions’ reach). Adaptation goals were to increase acceptability (n = 9, 32.1%), adoption (n = 5, 17.8%), appropriateness (n = 10, 35.7%), feasibility (n = 25, 89.3%), penetration (n = 15, 53.6%), sustainability (n = 23, 82.1%), and fidelity (n = 1, 3.7%). The rationale to adapt varied from sociopolitical (n = 6, 21.4%), organizational (n = 13, 46.4%), implementer (n = 11, 39.3%), practitioner (n = 15, 53.6%), and recipient (n = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders (n = 21, 75.0%), funders (n = 9, 32.1%), partners (n = 3, 10.7%), researchers (n = 1, 3.6%), and practitioners (n = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) (n = 1, 3.6%), organization (n = 4, 14.3%), and community system (e.g., countrywide) (n = 14, 50.0%).ConclusionThe results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.

Background: Despite increased global attention to early childhood development, children under 5 in low- and middle-income countries face heightened risks of poor developmental outcomes. In Indonesia, where innovative approaches to nurturing care are needed, video-based interventions show promise. Purpose: This study aimed to elevate maternal competence in parenting and contribute to the holistic development of children aged 0-3 years through video-based nurturing care education. Method: Non-equivalent quasi-experimental design with pre-post-test control groups was employed. This study used a consecutive sampling technique on 89 mothers with children 0-3 years old (intervention group = 40 and control group = 49). The intervention group was given health education using videos via a WhatsApp link, and the control group was given leaflets directly. Data was collected from May to August 2022, four weeks before the intervention (pre-test) and two weeks after the video and leaflets were given (post-test). The instrument was modified from the Knowledge, Attitude, and Practice (KAP) questionnaire developed by UNICEF. The effect of education was analyzed using Wilcoxon and independent t-test. Results: The group that received the intervention showed a notable and positive influence on their knowledge, attitudes, and practices (KAP levels) in contrast to the control group. This suggests the video-based intervention effectively enhanced participants' understanding, attitudes, and caregiving practices. Conclusion: The research emphasizes the positive outcomes of video-based nurturing care intervention for mothers with children aged 0-3 years. The intervention significantly improved maternal attitudes toward parenting, caregiving behaviors, and overall child development. These results emphasize the significance of employing video interventions to encourage effective nurturing care practices.

Objective: This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana. Design: We trained health facility workers and community health volunteers to deliver RCEL counselling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers' RCEL practices before and after the intervention with a household questionnaire and caregiver–child observations. Setting: The study took place in Sagnarigu, Gushegu, Wa East and Mamprugu-Moagduri districts from April 2022 to March 2023. Study sites included seventy-nine child welfare clinics (CWC) at Ghana Health Service facilities and eighty village savings and loan association (VSLA) groups. Participants: We enrolled 211 adult caregivers in the study sites who had children 0–23 months at baseline and were enrolled in a CWC or a VSLA. Results: We observed improvements in RCEL and infant and young child feeding practices, opportunities for early learning (e.g. access to books and playthings) in the home environment and reductions in parental stress. Conclusions: This study demonstrates the effectiveness of integrating RCEL content into existing nutrition and health services. The findings can be used to develop, enhance and advocate for policies integrating RCEL into existing services and platforms in Ghana. Future research may explore the relationship between positive changes in caregiver behaviour and improvements in child development outcomes as well as strategies for enhancing paternal engagement in care practices, improving child supervision and ensuring an enabling environment. [ABSTRACT FROM AUTHOR]

Last couple of decades have witnessed a substantial decline in child mortality. Now, the need of the hour is to ensure the quality survival of children beyond infancy. Adverse events in the first few years of life have a long-lasting effect on child's development, behavior and personality; and effective interventions during this time have maximum impact to prevent these consequences. Nurturing Care for Early Childhood Development (NC-ECD) is a concept adapted worldwide by health agencies to improve the level of optimum care to children in the first 1000 days as promotion of Early Childhood Development (ECD) is integral for overall social and financial progress of the country and its population. The five components of NC-ECD include good health, adequate nutrition, responsive caregiving, safety and security, and opportunities for early learning. This five-pillar approach emphasizes upon providing quality care by catering to needs like responsive caregiving, safe and secure environment and better learning opportunities apart from health and nutrition, which are already addressed by various health programs. Taking care of mental health of child as well as caregiver is another important aspect of providing optimum care to these children. To accomplish these goals, there is a need to integrate ECD with existing public health programmes with additional focus on elements of early learning opportunities, safety and security, and responsive caregiving. [ABSTRACT FROM AUTHOR]

Abstract Background Nurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old. Methods This community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China’s Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays. Results Among the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values

Early childhood development (ECD) has a significant impact on personal academic achievement, social integration and health in adulthood throughout one′s life. Promoting ECD has been proven to be one of the most cost-effective poverty alleviation strategies and a solid foundation for achieving multiple Sustainable Development Goals of United Nations. There are about 28 million children aged 0 − 4 years in rural China, which is a huge population. However, there are still gaps in health care, nutrition and early learning opportunities between the children in rural and urban areas. China is now at a critical point in the implementation of the rural revitalization strategy, and promoting ECD in rural areas is of great importance to radically interrupting the inter-generational transmission of poverty. In this paper, we described current situation of ECD, nurturing care as well as supporting environment in rural areas of China, and put forward several suggestions to promote ECD in those aspects.

Summary: Background: In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. Methods: This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Findings: Families’ limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Interpretation: Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. Funding: NIH/NICHD.

Abstract Objective: To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation. Design: We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0–23 months of age through existing community and facility-level platforms. Setting: Jalal-Abad and Batken regions in the Kyrgyz Republic. Participants: Caregivers of children aged 0–23 months at baseline. Results: We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period. Conclusions: Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.

At the heart of the Sustainable Development Goals (SDG) is the vision to “leave no one behind, and to see that all children survive, thrive and transform. However, some categories of children may remain left behind owing to their disproportionate exposure to the risk of threats and deficit of attention to the social and ecological climate that characterizes the various systems in which they are found. This study is concerned with one major question: Despite diverse local and international instruments that favor full nurturance and development of children, what social forces play as threat to full nurturance care in the context of children living in Orphan homes? Nurturing care framework and Brofenbrener’s ecological system theory were adopted as the analytical frameworks. Research design was exploratory. Data were collected through sessions of in-depth-interview with orphanage managers, caregivers, and social workers on the socio-ecology drivers of threat to children living within the orphan home space and its implications for nurturance care across the various complex systems of the child’s environment. The study found various factors across the complex systems of child development – microsystem, mesosystem, exosystem, microsysm and lastly, chronosystem- which undermine caregivers’ delivery and increases children’s vulnerability and risk of missing out on effective nurturance care. These vulnerabilities are endemic realities of social, and bio-ecologcal space in which child development occurs. This study recommends specialized interventions and policy directives relevant for each identified threat. It also calls for a stronger political will in improving the conditions of this category of the children while within the orphan home space and ultimately, actions towards deinstitutionalization of children.

Introduction: Children who are HIV‐exposed and uninfected (CHEU) are a growing population at potential risk of poor neurocognitive development. We tested a nurturing care intervention on children's neurocognitive development and maternal depressive symptoms (primary) with mediation through caregiving activities (secondary). Methods: This study was conducted among six intervention and nine comparison antenatal‐care/prevention of vertical transmission (ANC/PVT) HIV clinics in eSwatini. We enrolled pregnant women and measured infant development at 9 and 18 months. mothers2mothers (m2m) designed and implemented the clinic‐home‐community‐based intervention. We measured infants' neurodevelopment, maternal depressive symptoms and caregiving activities with the Mullen Scales of Early Learning (MSEL), Edinburgh Postnatal Depression Scale, HOME Inventory and Family Care Indicators. We fitted linear mixed effects regression models with clinic random effects to compare intervention versus comparison arms, and generalised structural equation models to evaluate mediation, adjusting for confounders. Results: Mother‐infant pairs (n = 429) participated between January 2016 through May 2018. Socio‐demographic characteristics were balanced between arms except for higher rates of peri‐urban versus rural residence and single versus married mothers in the comparison group. The 18 month retention was 82% (180/220) intervention, 79% (166/209) comparison arm, with 25 infant deaths. Intervention MSEL scores were significantly, and modestly, higher in receptive language (55.7 [95% CI 54.6, 56.9] vs. 53.7 [95% CI 52.6, 54.8]), expressive language (42.5 [95% CI 41.6, 39.8] vs. 40.8 [95% CI 39.8, 41.7]) and composite MSEL (85.4 [95% CI 83.7, 84.5] vs. 82.7 [95% CI 81.0, 84.5]), with no difference in maternal depressive symptoms or in observations of mother‐child interactions. Intervention book‐sharing scores were higher (0.63 vs. 0.41) and mediated the effect on MSEL scores (indirect effect, p‐values ≤ 0.024). The direct effects on visual reception and expressive language scores were significantly higher in the intervention compared to the comparison arm (coefficients 1.93 [95% CI 0.26, 3.60] and 1.66 [95% CI 0.51, 2.79, respectively]). Conclusions: Nurturing care interventions can be integrated into ANC/PVT clinic‐home‐community programmes. The intervention, mediated through interactive caregiving activities, increased language development scores among CHEU. Partnering with a local team, m2m, to design and implement a culturally relevant intervention illustrates the ability to impact parent‐child play and learning activities that are associated with children's neurodevelopment. [ABSTRACT FROM AUTHOR]

Background. Many studies show the impact of adolescent mothers on child development. To prevent the impact of adolescent pregnancy, nurturing care is needed to support optimal children's development. Objective. This study aims to identify comprehensive nurturing care among adolescent mothers. Methods. This study used secondary data in the integration of the 2018 National Socioeconomic Survey and Basic Health Survey. To measure nurturing care, 5 components were used: health, adequate nutrition, security and safety, responsive caregiving, and opportunities for early learning with latent class analysis. Results. The results of the analysis showed that 62% of adolescent mothers provided uncompleted nurturing care. About 21% of adolescent mothers need assistance in improving nurturing care related to adequate nutrition and learning opportunities, and 17% need assistance to improve health, nutrition, responsive caregiving, and opportunities for early learning. Conclusion. Adolescent mothers are in need of comprehensive nurturing care for their children. Practice is needed in order to enhance nurturing care initiatives, particularly for teenage mothers. [ABSTRACT FROM AUTHOR]

BackgroundRapid urbanization and increased women’s involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa.MethodsWe conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers’ knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment.FindingsA total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers’ education level, type of center, support received, caregiver–child ratio, number of children in the center, and center providers’ KAP score (p

Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context‐specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross‐sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p <.00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p =.00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p =.03). Having child in the age group of 14–20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21–30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p =.01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development. [ABSTRACT FROM AUTHOR]

Early childhood (ECC) is the main period of cognitive development, physical and mental health in children. The well-being of future generations depends on early childhood development and care. Poverty, malnutrition, violence, gender inequality, environmental pollution and caregiver mental health problems threaten the development of young children and prevent them from being physically and mentally healthy, being happy, having positive relationships and being productive adults. Nurturing Care (NC) is a policy framework proposed by the World Health Organization (WHO), UNICEF and other stakeholders, aimed at achieving national and global goals to help children survive and thrive, in order to transform health and human potential. Its components are health, adequate nutrition, responsive care, early learning opportunities and safety. NC aims to provide family-centered, holistic services to each child, especially in the first three years of life, starting from pregnancy. The aim of this review is to increase the awareness of NC in Turkey and to share studies from other countries. [ABSTRACT FROM AUTHOR]

Background: Nurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old. Methods: This community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China's Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays. Results: Among the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values < 0.05). The linear trend tests found that the more parental risks, the higher possibility of developmental delay (P values < 0.05). Conclusions: Parental risks are prevalent among children under three years in rural East China, which may increase the risk of developmental delays in children. Meanwhile, parental risk screening can be used to recognize poor nurturing care in primary health care settings. Targeted interventions are warranted to improve nurturing care for optimal early childhood development. [ABSTRACT FROM AUTHOR]

IntroductionAlmost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs.MethodsThe SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat.Results1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4–75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15–83%, p = 0.002) compared to children in the control groups.DiscussionThe lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low‐resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low‐ and middle‐income countries. Forty‐four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community‐based peer‐groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions. [ABSTRACT FROM AUTHOR]

Abstract Background Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar’s Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD) following the Nurturing Care Framework within an integrated maternal and child healthcare package. Using program baseline data, we explored home environment, caregivers’ parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar. Methods We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI), with higher scores representing higher levels of child development. We analyzed CREDI scores, along with MICS questions on parenting knowledge, practices, and characteristics of the home environment. We developed multivariate regression models to assess associations between caregiver-child interactions, knowledge of dietary diversity, and ECD. Results Ten percent of children had overall CREDI z-scores 2 standard deviations [SD] or more below the global reference population mean, with 28% of children at risk of developmental delay with z-scores 1 SD or more below the mean. Cognitive and language domains were of highest concern (10.2 and 12.7% with z-score

Abstract Background Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding. Methods This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge. Results Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge. Conclusions Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.

IntroductionIn the last decade, there has been increased global policy and program momentum to promote early childhood development. The Care for Child Development (CCD) package, developed by UNICEF and the WHO, is a key tool responding to the global demand. The CCD package comprises two age-specific evidence-based recommendations for caregivers to 1) play and communicate and 2) responsively interact with their children (0–5 years) and was designed to be integrated within existing services to strengthen nurturing care for child development. The aim of this report was to provide an up-to-date global review of the implementation and evaluation of the CCD package.MethodsIn addition to a systematic review of 55 reports, we interviewed 23 key informants (including UNICEF and WHO personnel) to better understand the implementation of CCD.ResultsThe CCD package has been or is being implemented in 54 low- and middle-income countries and territories, and it has been integrated into government services across the health, social, and education sectors in 26 countries. Across these contexts, CCD has been adapted in three primary ways: 1) translations of CCD materials (mostly counseling cards) into local language(s), 2) adaptations of CCD materials for the local context, vulnerable children, or a humanitarian/emergency setting (e.g., including local play activities, using activities that are better suited to children with visual impairments), and 3) substantive modifications to the content of CCD materials (e.g., expansion of play and communication activities, addition of new themes, creation of a structured curriculum). While there is promising evidence and examples of good implementation practice, there has been mixed experience about implementation of CCD with respect to adaptation, training, supervision, integration into existing services, and monitoring implementation fidelity and quality. For example, many users of CCD found difficulties with training the workforce, garnering buy-in from governments, and ensuring benefits for families, among others.DiscussionAdditional knowledge on how to improve the effectiveness, implementation fidelity and quality, and acceptance of CCD is needed. Based on the findings of the review we make recommendations for future efforts to implement CCD at-scale.

Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the experiences of early childhood development (ECD) centre staff in providing care and learning support to children living in a high-risk, low socioeconomic community. We interviewed 14 staff from an ECD centre. Interviews were audio-recorded, transcribed verbatim and analysed thematically. We derived four over-arching themes which demonstrated contextual-, parent-, child- and staff-related factors that influenced ECD staff's daily work experiences. Challenges relating to poverty, violence, trauma, and substance exposure cut across each theme. Providing a safe and nurturing learning place for children was essential to staff and allowed them an opportunity to deal with some challenges. Characteristics of staff such as passion, resourcefulness, and commitment, went a long way in providing motivation to overcome challenges. Finding ways to support ECD staff working in low socioeconomic environments are important avenues for further research to prevent staff burnout, and to promote optimal child development. [ABSTRACT FROM AUTHOR]

Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence‐based programs, policies, and services that are co‐designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations. [ABSTRACT FROM AUTHOR]

IntroductionThe Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.MethodsA search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.Results127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.ConclusionFindings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains.

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

Nurturing care interventions postulated on strengthening caregiver-child relationships have proven to be effective for improving early childhood development outcomes in low- and middle-income countries. Hence, a scale-up of the interventions has been recommended with an emphasis on the health sector given the contact with families in the critical first 3 years of life. However, an effective scale-up of an integrated intervention through healthcare requires a theory of change approach elucidating pathways of sustainable change. From this viewpoint, I reflect on my experience of scaling the intervention in a private pediatric care setting. I realized that buy-in from the health sector required realization of benefits to include health outcomes framed as the potential to improve the quality of life and the process of recovery; sustainable behavior change required a culture that promoted nurturing care highlighting the role of leadership; subsequently improving the experience of frontline staff and at an individual level, this could be achieved through the provision of supportive supervision-rooted in a framework of compassion. The lessons learned are shared to be considered for future integration efforts.

Background: Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar's Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD) following the Nurturing Care Framework within an integrated maternal and child healthcare package. Using program baseline data, we explored home environment, caregivers' parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar. Methods: We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI), with higher scores representing higher levels of child development. We analyzed CREDI scores, along with MICS questions on parenting knowledge, practices, and characteristics of the home environment. We developed multivariate regression models to assess associations between caregiver-child interactions, knowledge of dietary diversity, and ECD. Results: Ten percent of children had overall CREDI z-scores 2 standard deviations [SD] or more below the global reference population mean, with 28% of children at risk of developmental delay with z-scores 1 SD or more below the mean. Cognitive and language domains were of highest concern (10.2 and 12.7% with z-score < − 2 SD). In 3-day recall, 75% of children engaged in ≥4 early stimulating activities with all caregivers averaging 3 total hours of play. CREDI scores were positively associated with greater frequency of caregivers' engagement (β = 0.036, p = 0.002, 95%CI = [0.014, 0.058]), and dietary diversity knowledge (β = 0.564, p < 0.001, 95%CI = [0.281, 0.846]). Conclusions: Our findings demonstrate a positive association between both the frequency of caregiver child interactions and knowledge of adequate dietary diversity, and ECD outcomes. This aligns with global evidence that promoting early stimulation, play and learning opportunities, and dietary diversity can improve developmental outcomes. Further study is needed to establish causal relationships and assess the impact of ECD programming in Zanzibar. [ABSTRACT FROM AUTHOR]

The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is a population‐based approach to monitor the nurturing care environment for early childhood development (ECD) using routine information system data. It is unknown whether IMAPI can be applied to document metropolitan urban territorial differences in nurturing care environments. We used Brasilia, Brazil's capital with a large metropolitan population of 2,881,854 inhabitants divided into 31 districts, as a case study to examine whether disaggregation of nurturing care data can inform a more equitable prioritization for ECD in metropolitan areas. IMAPI scores were estimated at the municipal level (IMAPI‐M, 31 indicators) and at the district level (IMAPI‐D, 29 indicators). We developed a quantitative prioritization process for indicators in each IMAPI analysis, and those selected were jointly mapped in the socioecological model for the role of indicators in relation to the enabling environment for nurturing care. Out of 28 common nurturing care indicators across IMAPI analysis, only four were prioritized in both analyses: one from the Adequate nutrition, two from the Opportunities for early learning, and one from the Responsive caregiving domains. These four indicators were mapped as enabling policies, supportive services, and caregivers' capabilities (socioecological model) and Effort, Coverage, and Quality (indicator's role). In conclusion, the different levels of nurturing care data disaggregation in the IMAPI can better inform decision‐making than each one individually, especially in metropolitan areas where municipalities and districts within metropolitan areas have relative decision‐making autonomy. Key messages: The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is an innovative population‐based approach created to systematically measure nurturing care for early childhood development (ECD) using routine information systems data at the municipal level.Brasilia was used as a case study to evaluate whether different levels of nurturing care data disaggregation (municipal vs. district level) can inform more equitable prioritization for ECD investments in metropolitan areas.We developed a quantitative prioritization process of indicators to analyse IMAPI at the municipal and district levels, and the selected indicators were jointly mapped into the socioecological model, specifying the roles of the indicator in the enabling environment for nurturing care.The two different levels of data disaggregation of the IMAPI can better inform nurturing care‐related decisions than each individual level in metropolitan areas where municipalities and districts within metropolitan areas have relative decision‐making autonomy. [ABSTRACT FROM AUTHOR]

Selecting indicators to monitor nurturing care (NC) environments that support decision‐making and guide the implementation of integrated early childhood development (ECD) programmes has become a priority globally. Several population‐based approaches have been attempted to create a set of indicators or a composite index methodology to measure the NC environment using existing secondary data. However, they have not been systematized. Our scoping review aimed to analyse the population‐based approaches for monitoring the domains of the NC (e.g. good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning). ECD experts, peer‐reviewed, and grey literature were systematically searched with no year or language restrictions. Data extraction used a standard predefined protocol. Thirty‐two population‐based approaches were identified. Most approaches were composed of a set of indicators (53.1%, n = 17) versus composite indexes (46.9%, n = 15) and had the country as their unit of analysis (68.8%, n = 22). Twenty‐seven approaches were applied in middle‐income countries (84.4%) and thirteen in low‐income countries (40.6%). Four approaches were guided by the NC framework (12.5%), and 56.3% (n = 18) did not include any indicator representing responsive caregiving. NC indicators (n = 867) were sorted into 100 groups of indicators. Twenty of the 32 approaches had some kind of methodological validation (62.5%). We identified six methodological challenges to build a population‐based approach. Standardized methods for selecting and validating indicators, and coordinated efforts to share findings/data with stakeholders should be prioritized. Given the great variability in methods and indicators used to measure NC environments, valid approaches should be flexible to work well across different contexts. [ABSTRACT FROM AUTHOR]

Providing an enabling nurturing care environment for early childhood development (ECD) that cuts across the five domains of the Nurturing Care Framework (i.e., good health, adequate nutrition, opportunities for early learning, security and safety and responsive caregiving) has become a global priority. Brazil is home to approximately 18.5 million children under 5 years of age, of which 13% are at risk of poor development due to socio‐economic inequalities. We explored whether the Early Childhood Friendly Municipal Index (IMAPI) can detect inequities in nurturing care ECD environments across the 5570 Brazilian municipalities. We examined the validity of the IMAPI scores and conducted descriptive analyses for assessing sociodemographic inequities by nurturing care domains and between and within regions. The strong correlations between school achievement (positive) and socially vulnerable children (negative) confirmed the IMAPI as a multidimensional nurturing care indicator. Low IMAPI scores were more frequent in the North (72.7%) and Northeast (63.3%) regions and in small (47.7%) and medium (43.3%) size municipalities. Conversely, high IMAPI scores were more frequent in the more prosperous South (52.9%) and Southeast (41.2%) regions and in metropolitan areas (41.2%). The security and safety domain had the lowest mean differences (MDs) among Brazilian regions (MD = 5) and population size (MD = 3). Between‐region analyses confirmed inequities between the North/Northeast and South/Southeast. The biggest within‐region inequity gaps were found in the Northeast (from −22 to 15) and the North (−21 to 19). The IMAPI distinguished the nurturing care ECD environments across Brazilian municipalities and can inform equitable and intersectoral multilevel decision making. [ABSTRACT FROM AUTHOR]

The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low‐cost and large‐scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from existing routine information systems to develop the Brazilian Early Childhood Friendly Index (IMAPI). Three methodological steps developed through a participatory decision‐making process were followed. First, a literature review identified potential indicators to translate the NCF domains. Four technical panels composed of stakeholders from federal, state and municipal levels were consulted to identify data sources, their availability at the municipal level and the strengths and weakness of each potential indicator. Second, national and international ECD experts participated in two surveys to score, following a SMART approach, the expected performance of each nurturing care indicator. This information was used to develop analytical weights for each indicator. Third, informed by strengths and weaknesses pointed out in the previous steps, the IMAPI team reached consensus on 31 nurturing care indicators across the five NCF domains (Good health [n = 14], Adequate nutrition [4], Responsive caregiving [1], Opportunities for early learning [7] and Security and safety [4]). IMAPI represents the first attempt to select nurturing care indicators at the municipal level using data from existing routine information systems. [ABSTRACT FROM AUTHOR]

Background The United Nations Children's Fund (UNICEF) Community Infant and Young Child Feeding Counselling Package (C-IYCF CP) is used globally for infant and young child feeding (IYCF) counseling. With the C-IYCF CP last updated 8 y ago, mapping existing nurturing care content, identifying gaps, and documenting current country-level changes offers a unique opportunity to guide recommendations to strengthen the nurturing care content of this package. Objectives The primary study aims were to: 1) identify and map existing nurturing care content within UNICEF's C-IYCF CP, 2) identify gaps related to nurturing care or feeding elements within the C-IYCF CP, 3) identify country-level nurturing care adaptations to the C-IYCF CP, and 4) identify best practices and lessons learned from country adaptations that can be recommended for inclusion in the C-IYCF CP. Methods The assessment included 4 phases: 1) conduct an iterative process to identify and map nurturing care elements within the C-IYCF CP using a codebook explicitly developed for this assessment; 2) identify gaps in the C-IYCF CP; 3) apply the codebook to IYCF packages from 11 countries, revise, then finalize the codebook; and 4) identify and interview key informants from 4 countries whose IYCF packages had the most comprehensive nurturing care content plus 1 country where health care professionals make routine mother–child home visits. Results The C-IYCF CP contained limited nurturing care content, especially around safety/security and early learning. All 5 countries interviewed had systematically identified and included priority nurturing care content in each package, yet content level varied. Two countries were also incorporating information technology into the training and delivery of the C-IYCF CP. Conclusions Existing country-level best practices can address nurturing care elements missing from UNICEF's C-IYCF CP. Sharing these practices can allow countries to make context-driven, evidence-informed decisions on the nurturing care content to prioritize. [ABSTRACT FROM AUTHOR]

Background: Early initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding. Methods: This pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge. Results: Pre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge. Conclusions: Expansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness. [ABSTRACT FROM AUTHOR]

Abstract Background Global investments in neonatal survival have resulted in a growing number of children with morbidities surviving and requiring ongoing care. Little is known about the caregivers of these children in low- and middle-income countries, including maternal mental health which can further negatively impact child health and development outcomes. We aimed to assess the prevalence and factors associated with poor maternal mental health in mothers of children born preterm, low birthweight (LBW), and with hypoxic ischemic encephalopathy (HIE) at 24–47 months of age in rural Rwanda. Methods Cross-sectional study of children 24–47 months born preterm, LBW, or with HIE, and their mothers discharged from the Neonatal Care Unit (NCU) at Kirehe Hospital between May 2015–April 2016 or discharged and enrolled in a NCU follow-up program from May 2016–November 2017. Households were interviewed between October 2018 and June 2019. Mothers reported on their mental health and their child’s development; children’s anthropometrics were measured directly. Backwards stepwise procedures were used to assess factors associated with poor maternal mental health using logistic regression. Results Of 287 total children, 189 (65.9%) were born preterm/LBW and 34.1% had HIE and 213 (74.2%) screened positive for potential caregiver-reported disability. Half (n = 148, 51.6%) of mothers reported poor mental health. In the final model, poor maternal mental health was significantly associated with use of violent discipline (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.17,4.45) and having a child with caregiver-reported disability (OR 2.96, 95% CI 1.55, 5.67). Greater household food security (OR 0.80, 95% CI 0.70–0.92) and being married (OR = 0.12, 95% CI 0.04–0.36) or living together as if married (OR = 0.13, 95% CI 0.05, 0.37) reduced the odds of poor mental health. Conclusions Half of mothers of children born preterm, LBW and with HIE had poor mental health indicating a need for interventions to identify and address maternal mental health in this population. Mother’s poor mental health was also associated with negative parenting practices. Specific interventions targeting mothers of children with disabilities, single mothers, and food insecure households could be additionally beneficial given their strong association with poor maternal mental health.

Background: South Africa has migrated the responsibility for early childhood development (ECD) centres from the Department of Social Services to the Department of Basic Education. This functional shift has ushered in consultations and discussions on how best to implement ECD, including opportunities the change may bring. Aim: By anchoring the understanding of ECD services in nurturing care, this study aimed to elucidate the provision of appropriate, inclusive services in early childhood development, including early childhood intervention, for children with disabilities in South Africa against the backdrop of the migration of services from one government ministry to another. Methods: This is an analytical article based on South African literature on ECD services, including interventions, with particular attention to children with disabilities, basing our understanding of these services in nurturing care. Results: We elucidate how the ideals of the Nurturing Care Framework can be achieved in the context of children with disabilities in South Africa using five themes: the need to localise services, developing tools and strategies for screening and early intervention, enhancing the efficacy of caregivers, supporting and training staff and collaborations. Conclusion: It is necessary to empower caregivers and professionals to address early childhood intervention and ECD needs of children with disabilities. Early childhood development centres are an important context for nurturing care, providing opportunities to promote and sustain health amongst a large number of children. Considering the function shift of ECD services in South Africa, these centres are well positioned to further nurturing care to children with disabilities through the provision of supportive environments that promote health and well-being.