Associations between women's empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data.
Associations between women's empowerment and child development, growth, and nurturing care practices in sub-Saharan Africa: A cross-sectional analysis of demographic and health survey data.
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撒哈拉以南非洲妇女赋权与儿童发展、成长和养育护理实践之间的关联：人口与健康调查数据的横断面分析。
DOI：
10.1371/journal.pmed.1003781
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发表时间：
2021-09
期刊：
影响因子：
15.8
通讯作者：
Yousafzai AK
中科院分区：
文献类型：
--
作者：
Bliznashka L;Udo IE;Sudfeld CR;Fawzi WW;Yousafzai AK
在低收入和中等收入国家，大约40%的3至4岁儿童的发育和发育处于次优状态。妇女赋权可通过建立照顾者能力和家庭支持，帮助提供对早期发展和成长的护理投入。我们研究了妇女赋权与撒哈拉以南非洲(SSA)儿童发展、成长、早期学习和营养之间的联系。我们从人口与健康调查中汇集了已婚妇女(15至49岁)及其子女(36至59个月)的数据，这些调查收集了9个SSA国家(N=21,434)的儿童发展数据(2011至2018)：贝宁、布隆迪、喀麦隆、乍得、刚果、卢旺达、塞内加尔、多哥和乌干达。我们使用因子分析构建了妇女赋权得分，并将妇女分配到特定国家的五分位数类别。儿童的结果包括认知、社会情感、识字-算术和身体发育(早期儿童发展指数)、线性增长(Z-年龄身高得分)和发育迟缓(HAZ<；−2)。早期学习结果是父母的刺激活动次数(范围0~6)和学习资源(范围0~4)。营养结果是儿童饮食多样性评分(DDS，范围从0到7)。我们使用多变量广义线性模型评估了妇女赋权与儿童发展、成长、早期学习和营养之间的关系。平均而言，我们样本中的家庭规模较大(8.5±5.7人)，主要生活在农村地区(71%)。女性平均年龄为31±6.6岁，54%未受过教育，31%已完成初等教育。儿童年龄为47±7个月，其中49%为女性。大约23%的儿童认知发展不佳，31%的儿童社会情绪发展不佳，90%的儿童识字-算术发展不佳。只有9%的儿童身体发育不佳，但35%的儿童发育迟缓。大约14%的母亲和3%的父亲提供≥4刺激活动。与最低五分位数组相比，最高赋权五分位数组妇女的孩子不太可能有次优的认知发展(相对风险(RR)0.89；95%可信区间(CI)0.80，0.99)，有更高的HAZ(平均差值(MD)0.09；95%CI 0.02，0.16)，较低的发育迟缓风险(RR 0.93；95%CI 0.87，1.00)，较高的DDS(MD 0.17；有0.0 7(95%CI 0.0 1，0.13)额外学习资源，0.16(95%CI 0.0 6，0.2 5)来自母亲的额外刺激活动，0.2 3(95%CI 0.17~0.2 9)来自父亲的额外活动。我们没有发现女性赋权与社会情感、识字算术或身体发育相关的证据。研究的局限性包括可能出现反向因果关系，以及对结果和暴露情况的次优评估。在SSA中，妇女赋权与儿童早期认知发展、儿童成长、早期学习和营养结果呈正相关。改善儿童发展和成长的努力应将赋予妇女权力作为一项潜在的战略。Lilia Bliznashka和同事研究撒哈拉以南非洲妇女赋权和相关的儿童健康结果。在低收入和中等收入国家，近40%的3至4岁儿童的发育和发育处于次优状态。儿童需要多种健康、营养、早期学习和护理投入，才能充分发挥其发展和成长潜力。妇女赋权可以通过增加共同照料、建设照顾者能力和改善家庭支持来帮助提供这些投入。尽管妇女赋权预示着更好的儿童健康、营养和成长，但人们对妇女赋权与儿童发展和早期学习成果之间的关系知之甚少。我们汇集了9个撒哈拉以南非洲国家已婚妇女(15至49岁)及其子女(36至59个月)的人口统计和健康调查数据，以调查妇女赋权与儿童发展、生长、早期学习和营养结果之间的关系。我们的结果表明，女性赋权越高，儿童的认知发展、生长发育和营养状况越好。更多被赋予权力的妇女及其伴侣也可以获得更多的学习资源，并为她们的孩子提供更多的刺激活动。我们的研究结果表明，提高妇女能力是帮助提供儿童充分发挥其发展和成长潜力所需的营养和早期学习投入的一项潜在战略。改善儿童早期发展和成长的努力应考虑妇女赋权在改善早期学习和营养成果方面的作用。未来的研究应该评估妇女赋权与儿童发展、成长、早期学习和营养结果之间的纵向和因果关系。
Approximately 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Women’s empowerment may help provide inputs of nurturing care for early development and growth by building caregiver capacity and family support. We examined the associations between women’s empowerment and child development, growth, early learning, and nutrition in sub-Saharan Africa (SSA). We pooled data on married women (15 to 49 years) and their children (36 to 59 months) from Demographic and Health Surveys that collected data on child development (2011 to 2018) in 9 SSA countries (N = 21,434): Benin, Burundi, Cameroon, Chad, Congo, Rwanda, Senegal, Togo, and Uganda. We constructed a women’s empowerment score using factor analysis and assigned women to country-specific quintile categories. The child outcomes included cognitive, socioemotional, literacy–numeracy, and physical development (Early Childhood Development Index), linear growth (height-for-age Z-score (HAZ) and stunting (HAZ <−2). Early learning outcomes were number of parental stimulation activities (range 0 to 6) and learning resources (range 0 to 4). The nutrition outcome was child dietary diversity score (DDS, range 0 to 7). We assessed the relationship between women’s empowerment and child development, growth, early learning, and nutrition using multivariate generalized linear models. On average, households in our sample were large (8.5 ± 5.7 members) and primarily living in rural areas (71%). Women were 31 ± 6.6 years on average, 54% had no education, and 31% had completed primary education. Children were 47 ± 7 months old and 49% were female. About 23% of children had suboptimal cognitive development, 31% had suboptimal socioemotional development, and 90% had suboptimal literacy–numeracy development. Only 9% of children had suboptimal physical development, but 35% were stunted. Approximately 14% of mothers and 3% of fathers provided ≥4 stimulation activities. Relative to the lowest quintile category, children of women in the highest empowerment quintile category were less likely to have suboptimal cognitive development (relative risk (RR) 0.89; 95% confidence interval (CI) 0.80, 0.99), had higher HAZ (mean difference (MD) 0.09; 95% CI 0.02, 0.16), lower risk of stunting (RR 0.93; 95% CI 0.87, 1.00), higher DDS (MD 0.17; 95% CI 0.06, 0.29), had 0.07 (95% CI 0.01, 0.13) additional learning resources, and received 0.16 (95% CI 0.06, 0.25) additional stimulation activities from their mothers and 0.23 (95% CI 0.17 to 0.29) additional activities from their fathers. We found no evidence that women’s empowerment was associated with socioemotional, literacy–numeracy, or physical development. Study limitations include the possibility of reverse causality and suboptimal assessments of the outcomes and exposure. Women’s empowerment was positively associated with early child cognitive development, child growth, early learning, and nutrition outcomes in SSA. Efforts to improve child development and growth should consider women’s empowerment as a potential strategy. Lilia Bliznashka and co-workers study empowerment of women and associated child health outcomes in sub-Saharan Africa. Nearly 40% of children 3 to 4 years of age in low- and middle-income countries have suboptimal development and growth. Children require multiple health, nutrition, early learning, and care inputs to reach their full developmental and growth potential. Women’s empowerment may help provide these inputs by increasing shared caregiving, building caregiver capacity, and improving family support. Even though women’s empowerment is predictive of better child health, nutrition, and growth, less is known about the relationship between women’s empowerment and child development and early learning outcomes. We pooled Demographic and Health Surveys data from married women (15 to 49 years) and their children (36 to 59 months) in 9 sub-Saharan African countries to investigate the association between women’s empowerment and child development, growth, early learning, and nutrition outcomes. Our results showed that higher women’s empowerment was predictive of better child cognitive development, growth, and nutrition. More empowered women and their partners also had access to more learning resources and provided more stimulation activities to their child. Our findings indicate that improving women’s empowerment is one potential strategy to help provide the nutrition and early learning inputs children require to reach their full developmental and growth potential. Efforts to improve early child development and growth should consider the role of women’s empowerment in improving early learning and nutrition outcomes. Future research should assess the longitudinal and causal relationships between women’s empowerment and child development, growth, early learning, and nutrition outcomes.
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DOI：
10.1016/s0140-6736(16)31389-7
发表时间：
2017-01-07
期刊：
Lancet (London, England)
影响因子：
--
作者：
Black MM;Walker SP;Fernald LCH;Andersen CT;DiGirolamo AM;Lu C;McCoy DC;Fink G;Shawar YR;Shiffman J;Devercelli AE;Wodon QT;Vargas-Barón E;Grantham-McGregor S;Lancet Early Childhood Development Series Steering Committee
通讯作者：
Lancet Early Childhood Development Series Steering Committee
影响因子：
168.9
作者：
Adair, Linda S.;Fall, Caroline H. D.;Osmond, Clive;Stein, Aryeh D.;Martorell, Reynaldo;Ramirez-Zea, Manuel;Sachdev, Harshpal Singh;Dahly, Darren L.;Bas, Isabelita;Norris, Shane A.;Micklesfield, Lisa;Hallal, Pedro;Victora, Cesar G.
通讯作者：
Victora, Cesar G.
影响因子：
3.8
作者：
Asaolu, Ibitola O.;Alaofe, Halimatou;Ernst, Kacey C.
通讯作者：
Ernst, Kacey C.
影响因子：
34.3
作者：
Ewerling, Fernanda;Lynch, John W.;Barros, Aluisio J. D.
通讯作者：
Barros, Aluisio J. D.
影响因子：
8.1
作者：
Doku, David T.;Bhutta, Zulfiqar A.;Neupane, Subas
通讯作者：
Neupane, Subas