Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health

Abstract

A potential bottleneck for increasing the adoption of child health interventions has been limited attention to designing actions that are built on the essential role that caregivers play in determining their effectiveness. In the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, we utilize the concept of maternal capabilities to examine participants' skills and attributes that affect their ability to provide appropriate care for their young child, fully engage with trial interventions, and influence the response to these interventions at the household level. We hypothesize that the impact of SHINE interventions on child stunting and anemia will be modified by these maternal capabilities. Drawing upon multiple theories, we identify and define critical maternal capabilities domains, and describe how they are measured in the trial. Description of maternal capabilities and their role as potential modifiers on impact will increase understanding of the impact of SHINE interventions, and the generalizability of our findings.

Early child development in children who are HIV‐exposed uninfected compared to children who are HIV‐unexposed: observational sub‐study of a cluster‐randomized trial in rural Zimbabwe

“… maternal capabilities scores are described in Matare et al whereby scores generated for each of the caregiver capabilities measure, higher values represent greater decision‐making autonomy, more liberal gender norm attitudes, higher levels of depressive symptoms, greater mothering self‐efficacy, perceptions of better physical health, perceptions of more social support and perceptions of high levels of time stress …”

“…To assess maternal and household characteristics, 11 research nurses made home visits during pregnancy at baseline (around two weeks after consent) and at 32 gestational weeks, to assess maternal and household characteristics. At baseline, maternal anthropometry and haemoglobin (Hemocue, Ängelholm, Sweden) were measured, and food insecurity, household wealth and maternal capabilities were assessed as described previously . Infant birth date, weight and delivery details were transcribed from health facility records.…”

“If there is no water, we cannot feed our children”: The far‐reaching consequences of water insecurity on infant feeding practices and infant health across 16 low‐ and middle‐income countries

“…We use the caregiver capabilities framework set forth by Matare et al (), which draws heavily from Engle et al (), to describe “the practices that translate food security and healthcare resources into a child's well‐being.” Since our study was not explicitly designed to capture the depth and nuances of caregiver capabilities, here we describe how we operationalized some of Matare et al's () caregiver capability constructs in our data: Education, knowledge and beliefs as hygiene knowledge , beliefs , and behaviors ; i.e. the knowledge, beliefs, and behaviors pertaining to best practices for hygiene as related to infant feeding.…”

“…It has been shown to be associated with increased emotional, mental, and physical stress for women and caregivers (Aihara, Shrestha, & Sharma, ; Brewis, Choudhary, & Wutich, ; Collins et al, ; Stevenson, Ambelu, Caruso, Tesfaye, & Freeman, ; Workman & Ureksoy, ; Wutich & Ragsdale, ). Indeed, caregiver capabilities—the skills and attributes of a caregiver that determine their ability to care for a young child in ways that produce positive nutrition, health, and development outcomes—are critical for optimal infant feeding (Matare, Mbuya, Pelto, Dickin, & Stoltzfus, ). These capabilities or resources for caregiving include caregivers' education, beliefs and knowledge, self‐efficacy, social support, autonomy to manage household resources, physical and mental health, and social support (Engle, Menon, & Haddad, ).…”

Associations between social support, psychological well‐being, decision making, empowerment, infant and young child feeding, and nutritional status in Ugandan children ages 0 to 24 months

“…The majority of essential public health interventions that are necessary to support child survival in low‐income countries, including those aimed at improving child feeding and hygiene practices, target mothers (Bhutta et al, ; Matare et al, ). Caregiver feeding practices of infants and young children present one important set of modifiable behaviours among mothers and are a common target in behaviour change communication interventions.…”