Sustainable day-care for 1-4 year olds in disadvantaged urban communities in Dhaka, Bangladesh

孟加拉国达卡贫困城市社区 1-4 岁儿童的可持续日托

• 批准号: MR/P017037/1
• 负责人: Helen Elsey
• 金额: $ 19.18万
• 依托单位: University of Leeds
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP017037%2F1
• 关键词: Sustainable; day; care; year; olds

Our partners, CIPRB, have shown, through a natural experiment, that community day-care for 1-4 year old children in rural areas is effective in reducing risk of all-cause mortality by 44%, drowning by 82% and injuries by 88%, compared to children not in day-care [9]. We wish to adapt this model so it can be appropriately, feasibly and sustainably delivered to benefit urban disadvantaged communities. Low-income countries (LICs) are experiencing rapid and uncontrolled urbanisation. This can clearly be seen in Dhaka, Bangladesh with an annual urban population growth of 3.6% [6], and an estimated 4 million inhabitants living in slums. Urbanisation is changing gender dynamics: 22% of women in Dhaka now work outside the home (11% non-slum) [9]. With limited extended family support in slums, women must either leave children with elder siblings - often sisters who then drop-out of school - or neighbours. This limited supervision contributes to high rates of injuries, poor hygiene and limited nutrition, resulting in 50% of slum children suffering stunting (33% non-slum). Child day-care presents a holistic solution, allowing women to work whilst knowing their children are safe, cared-for and have opportunities for early childhood development (ECD). Our partners, CIPRB, have extensive experience of delivering day-care in rural Bangladesh [9]. Building on CIPRB's rural model we plan to develop and refine a sustainable day-care model based on principles of ECD and improving nutrition and hygiene for 1-4 year olds. Financial sustainability is key for longevity and scale-up. We plan to place day-care centres adjacent to slums so services at a suitable fee can be provided to parents in non-slum neighbourhoods. This approach is designed to promote integration between the two communities, potentially facilitating social mobility for slum children. Objectives and methods, to:1) Understand the extent and nature of demand for day-care we will survey 200 households with children under 5 from slum and non-slum communities, and conduct qualitative interviews to understand perceptions of childcare among women, carers, men and community leaders. 2) Co-produce a proto-type integrated, self-sustaining, child day-care model we will establish a technical working group of childcare experts, community representatives, local government officials, donors and (I)NGOs. The group will draw on CIPRB's, (I)NGO models and findings of a systematic review being conducted by UWA (not included in this proposal) to develop a prototype model and all materials required. The group will also develop a draft theory of change to guide the evaluation.3) Test and refine an integrated self-sustaining model, we will implement the day-care model for six months. During this time, we will facilitate a group of day-care users and staff to reflect on how the model is working and make changes for improvement. Our qualitative researchers will observe the process, and interview users to understand how to further improve the model. We will assess model costs and the extent that fees from non-slum day-care users can support sustainable delivery.4) Inform the design of a pilot study for a larger evaluation to assess the cost-effectiveness of the day-care model, we will assess the feasibility and then refine methods for recruitment, assessment and follow-up among day-care users and a potential comparator group. This will involve repeating the survey among the same sample of 200 households. We will also assess children when they start at day-care and six months later. We will use our overall analysis to refine our theory of change. Throughout the study we will engage closely with local government and donors to understand and influence plans to scale up day-care across Dhaka, targeting the urban poor. We will identify the most appropriate outcome measures from our theory of change and discussions with policy makers. We expect these will include ECD, stunting and injuries.

我们的合作伙伴CIPRB通过一项自然实验表明，与没有日托的儿童相比，农村地区1-4岁儿童的社区日托有效地将全因死亡率降低44%，溺水风险降低82%，受伤风险降低88%。我们希望调整这种模式，使其能够适当、可行和可持续地造福城市弱势群体。低收入国家正在经历快速和不受控制的城市化。这一点在孟加拉国的达卡可以清楚地看到，它的城市人口年增长率为3.6%，估计有400万居民生活在贫民窟。城市化正在改变性别动态：达卡22%的女性现在外出工作（11%非贫民窟）。在贫民窟，由于家庭的支持有限，妇女要么把孩子留给哥哥姐姐（通常是姐姐，后来往往辍学），要么留给邻居。这种有限的监督导致受伤率高、卫生条件差和营养不足，导致50%的贫民窟儿童发育迟缓（非贫民窟儿童为33%）。儿童日托提供了一种全面的解决方案，使妇女在工作的同时知道她们的孩子是安全的、受到照顾的，并有机会获得儿童早期发展。我们的合作伙伴CIPRB在孟加拉国农村地区提供日托服务方面拥有丰富的经验。在CIPRB农村模式的基础上，我们计划根据幼儿发展和改善1-4岁儿童的营养和卫生的原则，开发和完善可持续的日托模式。财务可持续性是长期和扩大规模的关键。我们计划在贫民窟附近设立日托中心，以便以适当的费用向非贫民窟社区的父母提供服务。这种做法的目的是促进两个社区之间的融合，有可能促进贫民窟儿童的社会流动性。目标和方法：1)了解日托需求的程度和性质我们将调查来自贫民窟和非贫民窟社区的200个有5岁以下儿童的家庭，并进行定性访谈，以了解妇女、护理人员、男性和社区领导人对儿童保育的看法。2)共同生产一个一体化、自给自足的儿童日托模式的原型。我们将建立一个由托儿专家、社区代表、地方政府官员、捐助者和(I)非政府组织组成的技术工作组。该小组将借鉴CIPRB的(I)非政府组织模型和西澳大学正在进行的系统审查的结果（不包括在本提案中），以开发原型模型和所需的所有材料。该小组还将制定一份变革理论草案，以指导评估。3)测试和完善一个综合的自我维持模式，我们将实施六个月的日托模式。在这段时间里，我们会让日托中心的使用者和员工反思这个模式是如何运作的，并做出改进。我们的定性研究人员将观察这个过程，并采访用户，了解如何进一步改进模型。我们将评估模式成本，以及非贫民窟日托使用者收取的费用能在多大程度上支持可持续交付。4)告知设计一项试点研究，以进行更大规模的评估，以评估日托模式的成本效益，我们将评估可行性，然后完善日托用户和潜在比较组的招募、评估和随访方法。这将涉及在200个家庭的相同样本中重复调查。我们也会在孩子开始上日托和六个月后对他们进行评估。我们将使用我们的整体分析来完善我们的变化理论。在整个研究过程中，我们将与地方政府和捐助者密切合作，了解并影响在达卡各地扩大日托服务的计划，以城市贫困人口为目标。我们将从我们的变革理论和与政策制定者的讨论中确定最合适的结果措施。我们预计这些问题将包括儿童早期发育、发育迟缓和受伤。

项目成果

Additional file 1 of Understanding demand for, and feasibility of, centre-based child-care for poor urban households: a mixed methods study in Dhaka, Bangladesh

附加文件 1：了解贫困城市家庭对中心托儿服务的需求和可行性：孟加拉国达卡的混合方法研究

• DOI: 10.6084/m9.figshare.13363959
• 发表时间: 2020
• 作者: Elsey H

Protocol to develop sustainable day care for children aged 1-4 years in disadvantaged urban communities in Dhaka, Bangladesh.

• DOI: 10.1136/bmjopen-2018-024101
• 发表时间: 2018-08-01
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Das M;Elsey H;Shawon RA;Hicks J;Ferdoush J;Huque R;Fieroze F;Nasreen S;Wallace H;Mashreky SR
• 通讯作者: Mashreky SR

Understanding demand for, and feasibility of, centre-based child-care for poor urban households: a mixed methods study in Dhaka, Bangladesh.

• DOI: 10.1186/s12889-020-09891-z
• 发表时间: 2020-12-10
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Elsey H;Fieroze F;Shawon RA;Nasreen S;Hicks JP;Das M;Huque R;Hirano I;Wallace HJ;Saidur M
• 通讯作者: Saidur M

Additional file 2 of Understanding demand for, and feasibility of, centre-based child-care for poor urban households: a mixed methods study in Dhaka, Bangladesh

附加文件 2：了解贫困城市家庭对中心托儿服务的需求和可行性：孟加拉国达卡的混合方法研究

• DOI: 10.6084/m9.figshare.13364642
• 发表时间: 2020
• 作者: Elsey H

Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries

• DOI: 10.1136/bmjgh-2019-001501
• 发表时间: 2019-05-01
• 期刊: BMJ GLOBAL HEALTH
• 影响因子: 8.1
• 作者: Elsey, Helen;Agyepong, Irene;Mirzoev, Tolib
• 通讯作者: Mirzoev, Tolib