Grandmother Involvement on Child Growth and Development in Rural Pakistan

Abstract

Background: Early childhood interventions have primarily focused on the mother-child relationship, but grandmothers are often critical in childcare. Prior research is mixed on how grandmother involvement influences child outcomes. There is a paucity of research on grandmother caregiving in low- and middle-income countries. We described maternally-reported grandmother caregiving activities and examined the role of grandmother involvement on child growth and development cross-sectionally and longitudinally. Methods: We utilized the Bachpan study, a birth cohort in rural Pakistan. Grandmother involvement was based on maternal report at 3 and 12 months postpartum of 20 items related to daily instrumental and non-instrumental caregiving. A summed score was created and categorized into non-involved, low, and high. Outcomes included 12- and 24-month child growth, Bayley Scales of Infant and Toddler Development at 12 months, and Ages and Stages Questionnaire-Socioemotional at 24 months. Complete data were available for 699 households. We used adjusted linear mixed models to estimate mean differences (MD). Findings: The majority of grandmothers were involved in caregiving at 3 and 12 months. Children with highly involved grandmothers at 3 months (vs. non-involved) had higher 12-month weight-for-length z-scores (MD=0·33, 95% CI: 0·07, 0·59); however, 12-month grandmother involvement was associated with lower 24-month weight-for-length z-scores (MD= -0·21, 95% CI: -0·42, -0·01). Twelve-month high grandmother involvement (vs. non-involved) was associated with improved cognitive (MD=0·48, 95% CI: 0·10, 0·87) and fine motor (MD=0·42, 95% CI: 0·09, 0·76) at 12 months and socioemotional development (MD= -15·52, 95% CI: -25·27, -5·76) at 24 months. Interpretation: Early grandmother involvement had positive associations on child weight, but this association became negative as the child grew older. Grandmother involvement was positively associated with cognitive, fine motor, and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform how to best incorporate grandmothers into caregiver interventions. Trial Registration: NCT02111915 (https://clinicaltrials.gov/ct2/show/NCT02111915); NCT02658994 (https://clinicaltrials.gov/ct2/show/NCT02658994). Trials were prospectively registered. Funding Statement: The Bachpan cohort study was supported by NICHD [R01 HD075875] and NIMH [U19MH95687]. We are grateful to the Carolina Population Center for training support [T32 HD091058] and for general support [P2C HD050924]. Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: This study was approved by institutional review boards at the Human Development Research Foundation (HDRF), the University of North Carolina at Chapel Hill, and Duke University.