Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya

Abstract

A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH.

The care network of the families involved in violence against children and adolescents: the Primary Health Care perspective

“…); nevertheless, there are great challenges to qualifying this care, especially in service access and coverage (Bryant et al . , Thomas et al . ).…”

“…), improves and promotes their equitable access to the health system (Bryant et al . ), and ensures longitudinal care focused on people and communities, not on their individual diseases (Lahariya et al . , Bryant et al .…”

“…, McPherson & McGibbon , Bryant et al . ), PHC transforms into an essential agent in the debate on and in coping with FVACA, as well as in general care for this population and their families (Spinney , Turner et al . in press ).…”

“…In addition, as PHC offers people-centred care, and not care centred on the course of the disease, it coordinates or integrates all other care levels (World Health Organization 2008, Kringos et al 2010. Keeping in mind that the focus of PHC should be people's health, in the constellation of other determinants, such as the physical and social environment in which they live and work (Starfield et al 2005, McPherson & McGibbon 2010, Bryant et al 2012, PHC transforms into an essential agent in the debate on and in coping with FVACA, as well as in general care for this population and their families (Spinney 2013, Turner et al in press).…”

‘Haven of safety’ and ‘secure base’: a qualitative inquiry into factors affecting child attachment security in Nairobi, Kenya

“…Bryant et al (2012) reported 91% security in three urban slums outside of Nairobi—Mlolongo, Sophia, and Bondeni as measured through the Circle of Security Test adapted for African context, and Van IJzendoorn & Sagi-Schwartz (2008) reported 57-69% security in Gusii villages outside of Nairobi using Ainsworth Strange Situation Test. Both studies focused on children under 5 years.…”