Integrated early childhood development services improve mothers’ experiences with prevention of mother to child transmission (PMTCT) programs in Malawi: a qualitative study

Dovel, Kathryn; Kalande, Pericles; Udedi, Evelyn; Temelkovska, Tijana; Hubbard, Julie; Mbalanga, Chipariro; Bruns, Laurie; Mulungu, Siyenunu; Gupta, Sundeep; Richter, Linda; Coates, Thomas J.

doi:10.1186/s12913-021-06342-2

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…These beneficiaries mostly came from low socioeconomic backgrounds. Nine studies specifically targeted vulnerable groups: children born prematurely or with low birth weight (( 40 ) [Dominican Republic]), children with visual impairments (( 27 ) [Malawi]), children with other physical and/or cognitive disabilities (( 40 ) [Dominican Republic]; ( 41 ) [El Salvador], ( 42 ) [Peru]; ( 31 ) [India]), children of HIV+ mothers (( 43 ) [Malawi]; ( 28 ) [Kenya]), children of incarcerated mothers (( 44 ) [Paraguay]), and children of HIV+ mothers experiencing antenatal depressive symptoms (( 39 ) [South Africa]).…”

Section: Resultsmentioning

confidence: 99%

“…They also highlighted some issues. For example, some caregivers stated that they would have liked a better explanation of the service's purpose (( 48 ) [Mozambique]) and to have more explicit and repetitive messages on why specific activities are important for children's development (( 43 ) [Malawi]). Two of the reports (( 24 ) [Indonesia]; ( 30 ) [Turkey]) described the training of delivery agents in the CCD package and one of them reported data on delivery agents' program acceptance.…”

Section: Resultsmentioning

confidence: 99%

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Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

Ahun

Aboud

Wamboldt

et al. 2023

Front. Public Health

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

Ahun

Aboud

Wamboldt

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…And some would prefer the presence of external social workers as part of the initiative rather than the utilisation of healthcare providers due to the overcrowding and busy schedule of healthcare providers. Dovel et al (2021) reported that parents demanded increased frequency and time of ECS sessions for effective learning on the aspects of parent-to-child engagement in play-based stimulation activities.…”

Section: Discussionmentioning

confidence: 99%

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

Lukanga,

Nyanda

2023

EJEDU

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Early childhood stimulation (ECS) services are globally championed due to their proven ability to help children at risk of developmental delay attain their developmental potential. This study explored the effect of different ways of mainstreaming ECS services on child development. A mixed research approach was employed, involving quantitative and qualitative collection methods. Quantitative data was collected using the adopted ZamCAT tool administered to 334 children sampled from the benefited households. Qualitative data was collected through focus group discussions with the parents (n=4) and in-depth interviews with the key informants (n=14), respectively. The collected quantitative data were coded and analysed using Statistical Package for Social Sciences (25), and the collected qualitative data were analysed through content analysis. The binary logistic regression model was employed where the results showed a significant effect on child development from home visiting (p = 0.01) and Early childhood development centres (p = 0.016) compared to clinic outreaches. Children's nutritional status was also an influencing factor for a child to attain optimal developmental status. Furthermore, both community members and ECS services providers highly preferred ECD centres and home visiting services as opposed to a preference for clinic outreaches. The study concludes that when children are subjected to ECS services, attaining optimal development potential regardless of the household background characteristics is the forecasted result. Therefore, the study underscores the capacitation of communities on ECS practices utilising the available enabling environment and increased budget allocation for developing specific ECD policies and deploying experts.

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“…A detailed description of the PMTCT–ECD intervention can be found elsewhere 17. In brief, we conducted an integrated PMTCT–ECD intervention for mothers infected with HIV and their young children (aged 1.5–24 months) in six health facilities in central Malawi.…”

Section: Methodsmentioning

confidence: 99%

“…A detailed description of the PMTCT–ECD intervention can be found elsewhere. 17 In brief, we conducted an integrated PMTCT–ECD intervention for mothers infected with HIV and their young children (aged 1.5–24 months) in six health facilities in central Malawi. Facilities varied in size, type (district hospital, mission hospital, health centre) and district (Lilongwe, Kasungu, Nkhotakota).…”

Section: Methodsmentioning

confidence: 99%

Men care too: a qualitative study examining women’s perceptions of fathers’ engagement in early childhood development (ECD) during an ECD program for HIV-positive mothers in Malawi

Temelkovska

Kalande²,

Udedi³

et al. 2022

BMJ Open

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ObjectivesIntegrated early childhood development (ECD) and prevention of mother-to-child transmission (PMTCT) interventions rarely target fathers, a missed opportunity given existing research demonstrating that father involvement improves maternal and child outcomes. We aimed to explore mother’s perceptions of fathers’ buy-in to an integrated PMTCT-ECD programme, any impact the programme had on couple dynamics, and perceived barriers to fathers’ involvement in ECD activities.DesignQualitative study using individual in-depth interviews with mothers participating in a PMTCT–ECD programme. Interviews assessed mothers’ perceptions of father buy-in and engagement in the programme and ECD activities. Data were coded using inductive and deductive strategies and analysed using constant comparison methods in Atlas.ti V.1.6.SettingFour health facilities in Malawi where PMTCT services were provided.ParticipantsStudy participants were mothers infected with HIV who were enrolled in the PMTCT–ECD programme for >6 months.InterventionsThe PMTCT–ECD intervention provided ECD education and counselling sessions during routine PMTCT visits for mothers infected with HIV and their infants (infant age 1.5–24 months). The intervention did not target fathers, but mothers were encouraged to share information with them.ResultsInterviews were conducted with 29 mothers. Almost all mothers discussed the PMTCT–ECD intervention with male partners. Most mothers reported that fathers viewed ECD as valuable and practised ECD activities at home. Several reported improved partner relationships and increased communication due to the intervention. However, most mothers believed fathers would not attend the PMTCT–ECD intervention due to concerns regarding HIV-related stigma at PMTCT clinics, time required to attend and perceptions that the intervention was intended for women.ConclusionsFathers were interested in an integrated PMTCT–ECD programme and actively practised ECD activities at home, but felt uncomfortable visiting PMTCT clinics. Interventions should consider direct community outreach or implementing ECD programmes at facility entry points where men frequent, such as outpatient departments.

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Integrated early childhood development services improve mothers’ experiences with prevention of mother to child transmission (PMTCT) programs in Malawi: a qualitative study

Cited by 7 publications

References 29 publications

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

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

Men care too: a qualitative study examining women’s perceptions of fathers’ engagement in early childhood development (ECD) during an ECD program for HIV-positive mothers in Malawi

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