Caregiver parenting practices, dietary diversity knowledge, and association with early childhood development outcomes among children aged 18-29 months in Zanzibar, Tanzania: a cross-sectional survey

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 < − 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.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey

“…This might result in a stagnant rate of reduction in the prevalence of stunting, which decreased from 52% in 1993 to 38% in 2016 [ 9 , 11 ]. In this context, insufficient child-feeding practices are the root cause of malnutrition in India [ 12 ] and elsewhere [ 13 ]. Indeed poor nutritional status, unless dealt with properly, poses dire consequences on child health [ 14 ] since it not only causes growth faulting but also elevates the life risk of children in India [ 15 ], Ethiopia [ 16 ], and Pakistan [ 17 ].…”

Nutritional status and psychosocial stimulation associated with cognitive development in preschool children: A cross-sectional study at Western Terai, Nepal

“…Psychosocial stimulation, sociocultural factors, and realistic deficiency all affect the development of skills like cognitive, motor, perceptual, and language abilities [8]. Early nutritional feeding and a healthy psychosocial stimulation environment can lead to major changes in physical and mental development that affect children's cognition, mood, and behavior [2,9].…”

“…However, there is limited information on the determinants of early child development in low-income countries, especially rural sub-Saharan Africa and South Asia, where children are at high risk of not reaching their developmental potential due to the presence of many risk factors for poor cognitive development [1,3,9]. Very few studies have examined the relationship between nutrition status, psychosocial stimulation, and cognitive development, and they suggested a study focusing on the interactive effects of nutrients and psychosocial stimulation on the cognitive development of preschool children [15].…”

Effectiveness and Preferences on Mainstreaming Early Childhood Stimulation Services in Tanzania: A Case Study of Community-based Early Childhood Development Initiative

“…Assessment of effective ECS services mainstreamed through available community structures requires proper context-based child assessment tools, which are missing in the Tanzanian context. Present studies highly focus on caregivers' awareness and capacity to conduct and implement ECS services utilising adults' opinion-based tools (Antelman et al, 2022;Jukes et al, 2021;Russell et al, 2022;World Bank, 2018b). Jukes et al (2021), for instance, assessed the social-emotional competencies of children where the parents and teachers rated children's status.…”

“…The CREDI and HOME tool relies on the adult's opinion and observation to determine children's status. Similarly, the study conducted by Russell et al (2022) in Zanzibar, Tanzania, utilised the CREDI tool to assess the association between parenting practices and child development. Further, Antelman et al (2022) assessed caregivers' knowledge using the customised questionnaire set to determine the effectiveness of integrated media, community, and facility-based ECD intervention.…”