The care, stimulation and nutrition of children from 0-2 in Malawi-Perspectives from caregivers; "Who's holding the baby?"
The care, stimulation and nutrition of children from 0-2 in Malawi-Perspectives from caregivers; "Who's holding the baby?"
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DOI：
10.1371/journal.pone.0199757
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发表时间：
2018-06-27
期刊：
影响因子：
3.7
通讯作者：
Maleta, Kenneth
中科院分区：
文献类型：
--
作者：
Gladstone, Melissa;Phuka, John;Maleta, Kenneth
普及优质幼儿发展和保育是可持续发展目标4.2.1的基本组成部分。对不同环境的研究，包括对低收入和中等收入国家的研究，现在表明，促进游戏、激励、早期沟通和反应的干预措施不仅对儿童发展，而且对教育和经济增长的长期收益都能产生积极影响。国际机构最近制定了《儿童早期发展养育框架》，以促进这一点，并鼓励各国将重点从儿童生存转向儿童茁壮成长。这些方案纳入目前的护理实践，特别是在非洲设置的最佳方法的研究仍然非常有限。MethodsWe使用定性的方法，以了解护理实践（发挥，发展刺激，早期沟通和响应喂养）0-2岁的儿童。我们进行了18个焦点小组（FGD），6个PFGD（前瞻性研究焦点小组），18个深入访谈（IDIs）和20个观察与马拉维农村和城市环境中的照顾者。我们使用了一个主题指南，音频记录了FGD和IDIS，并将其转录成齐切瓦语或Yao，然后翻译成英语。我们使用归纳法对数据进行主题分析。我们将数据置于一个框架内，其中包含新出现的主要和次要主题。我们进行了翻译和编码框架的质量保证，通过交叉比较的数据和使用应答验证来检查我们的results.ResultsMalawian照顾者看到儿童的发挥作为一个结果，良好的健康和福祉，少一个互动，父母承诺促进福祉和学习。与婴儿的非语言交流和反应明显存在，护理人员与幼儿有许多一对一的互动。此外，许多照顾者对喂养建议有很好的了解，但由于资金的限制，不能总是遵循这些建议。当儿童开始移动的（学步）时，游戏是儿童之间或与兄弟姐妹或祖父母等其他照顾者之间更经常进行的活动，社区成员认为照顾0-2岁的儿童是妇女的领域。尽管如此，男子和妇女都承认产妇福祉对儿童得到良好照顾的重要性。在我们的研究中，大多数家庭目前的社会经济状况意味着创收和粮食安全是第一位的。许多母亲把大部分时间花在管理日常生活的责任上，只有有限的时间专门用于儿童的游戏、反应和与子女的沟通。讨论作为养育护理框架的一部分而推广的方案，提供有关发育刺激、游戏、早期沟通和反应性喂养的建议，应确保这些方案中的主题在文化上适合环境。此外，这些方案不应成为父母的额外负担，而应支持父母承担日常生活的许多责任。采取多部门办法，向男子和妇女提供知识，但也通过解决家庭财务、家庭工作时儿童安全空间以及家庭心理健康和关系的方案提供支持，可以使方案更有效地发挥作用。
IntroductionUniversal access to quality early childhood development and care is a fundamental part of Sustainable Development Goal 4.2.1. Research from diverse settings, including that in low and middle income countries, now demonstrates the positive impact that interventions to promote play, stimulation, early communication and responsiveness can have, not just on child development, but on long term gains in education and economic growth. International agencies have recently produced the Nurturing Care Framework for Early Child Development in order to promote this and to encourage countries to move the focus from child survival to child thrival. Research on the best methods of integration of these programmes into present care practices, particularly in African settings is still very limited.MethodsWe used qualitative methods to gain an understanding of care practices (play, developmental stimulation, early communication and responsive feeding) for children 0-2 years. We conducted 18 focus groups (FGDs), six PFGDs (Participatory Research focus groups), 18 in depth interviews (IDIs) and 20 observations with caregivers in rural and urban settings of Malawi. We used a topic guide, audio-recorded the FGDs and IDIS and transcribed them in Chichewa or Yao and then into English. We coded data using an inductive approach to thematic analysis. We placed the data within a framework with the emerging major and minor themes. We conducted quality assurance for translations and coding frameworks through cross comparison of data and used respondent validation to check our results.ResultsMalawian caregivers see children's play as a consequence of good health and wellbeing, less an interaction that a parent undertakes to promote wellbeing and learning. Non-verbal communication and responsiveness with infants is clearly present and caregivers have many one-on-one interactions with young infants. Furthermore, many caregivers have good knowledge of feeding recommendations but cannot always follow these due to constraints on money. When children become mobile (toddlers), play is an activity done more often between children or with other caregivers such as siblings or grandparents.Community members consider that caring for children from 0-2 years is a woman's domain. Despite this, both men and women acknowledge the importance of maternal wellbeing in enabling good care of children. The present socioeconomic situation of most families in our study means that income generation and food security come first. Many mothers spend most of their time managing the responsibilities of daily living and have limited time to dedicate to children's play, responsiveness and communication with their children.DiscussionProgrammes promoted as part of the Nurturing Care Framework which provide advice on developmental stimulation, play, early communication and responsive feeding should ensure that topics within these programmes are culturally appropriate for the setting. Furthermore, programmes must not be an added burden to parents but be supportive to parents managing many responsibilities of daily living. Multi-sectorial approaches where both men and women are provided with knowledge but are also supported through programmes which address family finances, safe spaces for children whilst families are working, and family mental health and relationships may enable programmes to work more effectively.