The feasibility of using videos to assess maternal sensitivity in low income urban settings in India - The researcher's perspective.

BackgroundSymptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya.MethodsThis is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean.ResultsThe primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination.ConclusionTo our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children.Trial registrationThe trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).

While some children with callous unemotional (CU) behaviours show difficulty recognizing emotional expressions, the underlying developmental pathways are not well understood. Reduced infant attention to the caregiver’s face and a lack of sensitive parenting have previously been associated with emerging CU features. The current study examined whether facial emotion recognition mediates the association between infants’ mother-directed gaze, maternal sensitivity, and later CU behaviours. Participants were 206 full-term infants and their families from a prospective longitudinal study, the Durham Child Health and Development Study (DCHDS). Measures of infants’ mother-directed gaze, and maternal sensitivity were collected at 6 months, facial emotion recognition performance at 6 years, and CU behaviours at 7 years. A path analysis showed a significant effect of emotion recognition predicting CU behaviours (β = −0.275, S.E. = 0.084, p = 0.001). While the main effects of infants' mother-directed gaze and maternal sensitivity were not significant, their interaction significantly predicted CU behaviours (β = 0.194, S.E. = 0.081, p = 0.016) with region of significance analysis showing a significant negative relationship between infant gaze and later CU behaviours only for those with low maternal sensitivity. There were no indirect effects of infants’ mother-directed gaze, maternal sensitivity or the mother-directed gaze by maternal sensitivity interaction via emotion recognition. Emotion recognition appears to act as an independent predictor of CU behaviours, rather than mediating the relationship between infants’ mother-directed gaze and maternal sensitivity with later CU behaviours. This supports the idea of multiple risk factors for CU behaviours.

Reports an error in "Maternal depressive symptoms and the growth of child executive function: Mediation by maternal sensitivity" by Seulki Ku and Xin Feng (Journal of Family Psychology, Advanced Online Publication, Mar 04, 2021, np). In the original article, there were errors in the second paragraph of the Method section whereby the text "22.1% did not in Grade 3," should have read "22.1% in Grade 3," and the text "The Ohio State University)." should have read "The Ohio State University." In addition, Figure 1 was incorrect and has been replaced. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-23726-001). This study examined the prospective associations among the trajectories of maternal depressive symptoms, maternal sensitivity, and child executive function (EF) across early and middle childhood, and tested the mediating role of maternal sensitivity in the links between change in maternal depressive symptoms and the growth of child EF. Participants included 1,364 children and mothers from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (NICHD SECCYD). We found that maternal depressive symptoms (from 6 months to Grade 5) and sensitivity (from 36 months to Grade 5) decreased, whereas child EF (planning skills; from Grade 1 to 5) increased over time. We also found several direct associations: (a) lower maternal depressive symptoms at 36 months predicted higher sensitivity at 54 months; (b) higher sensitivity at 54 months and a faster decrease in sensitivity from 36 months to Grade 5 predicted higher child EF in Grade 1; and (c) higher sensitivity at 54 months predicted greater growth of EF from Grade 1 to 5. In addition, two mediation effects were found as follows: Lower levels of maternal depressive symptoms at 36 months predicted both higher levels of child EF in Grade 1 and greater growth of EF from Grade 1 to 5 through higher levels of maternal sensitivity at 54 months. The results suggest that early maternal depressive symptoms may have long-term effects on the growth of EF, especially planning skills, during middle childhood, and that one important pathway that maternal depressive symptoms affect child EF outcomes through maternal sensitivity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Women who inject drugs (WWIDs) continue to experience challenges that accumulate their risk to HIV transmission and other co-morbidities. However, data that conceptually link diverse substance use dimensions in WWIDs are lacking particularly in developing countries. We assessed retrospective and current substance use among 306 WWIDs in low-income urban settings in Kenya using mixed methods. Descriptive analyses were performed on quantitative data while qualitative narratives revealed insights from quantitative findings. The mean age of the study participants was 17 (range 11, 30) years. Out of the 306 WWIDs 57% commenced with substance use by combining both licit and illicit drugs. Intimate sexual partners including spouses and casual sex partners introduced seventy-four percent of WWIDs to substance use. Majority of the WWIDs (39.9%) commenced with 2- way substance combination with bhang and cigarette having the highest usage. However, 4-way substance combinations containing heroin, cigarette, bhang, valium, Rohypnol had the highest frequency (12.8%) at the time of the survey. Varied routes of heroin administration were mentioned including injection, smoking and sniffing as separate routes and as 2-way or 3-way mode combinations of these. To inform policies targeting the health and rights of girls and women in low income settings, this study recommends urgent upstream policies targeting the girl adolescent life in form of a multifunctional package composed of identifying girls at risk, substance use interventions, sexual health education, improved educational attainment, and progressive social policies that target low social economic status in the adolescent phase. Harm reduction programs in Kenya should target people who use heroin through both injection and non-injection modes of administration.

This study examined the prospective associations among the trajectories of maternal depressive symptoms, maternal sensitivity, and child executive function (EF) across early and middle childhood, and tested the mediating role of maternal sensitivity in the links between change in maternal depressive symptoms and the growth of child EF. Participants included 1,364 children and mothers from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (NICHD SECCYD). We found that maternal depressive symptoms (from 6 months to Grade 5) and sensitivity (from 36 months to Grade 5) decreased, whereas child EF (planning skills; from Grade 1 to 5) increased over time. We also found several direct associations: (a) lower maternal depressive symptoms at 36 months predicted higher sensitivity at 54 months; (b) higher sensitivity at 54 months and a faster decrease in sensitivity from 36 months to Grade 5 predicted higher child EF in Grade 1; and (c) higher sensitivity at 54 months predicted greater growth of EF from Grade 1 to 5. In addition, two mediation effects were found as follows: Lower levels of maternal depressive symptoms at 36 months predicted both higher levels of child EF in Grade 1 and greater growth of EF from Grade 1 to 5 through higher levels of maternal sensitivity at 54 months. The results suggest that early maternal depressive symptoms may have long-term effects on the growth of EF, especially planning skills, during middle childhood, and that one important pathway that maternal depressive symptoms affect child EF outcomes through maternal sensitivity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Major Study of Children's Health Faces Uncertain Future

This study tested predictions from economic and developmental theories that maternal time with an infant is important for mother-child relationships and children's development, using time-use diaries for mothers of 7- to 8-month-old infants from the National Institute of Child Health and Human Development Study of Early Child Care (N = 1,053). Employment reduced time with infants, but mothers compensated for some work time by decreasing time in other activities. With family and maternal characteristics controlled, time with infants predicted high Home Observation for Measurement of the Environment (HOME) scores and maternal sensitivity, but bore little relation to children's engagement with mothers, secure attachment, social behavior, or cognitive performance from 15 to 36 months. Mothers who spent more time at work had higher HOME scores. Maternal time with infants may reflect maternal characteristics that affect both time allocation and maternal behavior.

The interplay between child characteristics and parenting is increasingly implicated as crucial to child health outcomes. This study assessed the joint effects of children's temperamental characteristics and maternal sensitivity on children's weight status. Data from the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development were utilized. Infant temperament, assessed at child's age of 6 months by maternal report, was categorized into three types: easy, average, and difficult. Maternal sensitivity, assessed at child's age of 6 months by observing maternal behaviors during mother-child semi-structured interaction, was categorized into two groups: sensitive and insensitive. Children's height and weight were measured longitudinally from age 2 years to Grade 6, and body mass index (BMI) was calculated. BMI percentile was obtained based on the Centers for Disease Control and Prevention's BMI charts. Children, who had a BMI ≥ the 85th percentile, were defined as overweight-or-obese. Generalized estimating equations were used to analyze the data. The proportions of children overweight-or-obese increased with age, 15.58% at 2 years old to 34.34% by Grade 6. The joint effects of children's temperament and maternal sensitivity on a child's body mass status depended on the child's age. For instance, children with difficult temperament and insensitive mothers had significantly higher risks for being overweight-or-obese during the school age phase but not during early childhood. Specific combinations of child temperament and maternal sensitivity were associated with the development of obesity during childhood. Findings may hold implications for childhood obesity prevention/intervention programs targeting parents.

BackgroundMale involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men’s involvement in maternity care in central Tanzania.MethodsQualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men’s maternity care involvement indicators, benefits of men’s involvement in maternity health care services and barriers to men’s involvement in maternity health care services.ResultsBoth men and women participants acknowledged the importance of men’s involvement in maternity health care services, even though few men actually got involved. Identified benefits of men’s involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men’s involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services.ConclusionsMen’s involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners’ presence in the delivery room. Intervention to increase men’s involvement in maternity care should address individual and systemic barriers to men’s involvement.

Male involvement in maternal health has been linked to positive health outcomes for women and children, as they control household resources and make significant decisions, which influence maternal health. Despite of the important role they have in maternal health care, their actual involvement remains low. The objective of this study was to explore community perspectives on potential barriers to men's involvement in maternity care in central Tanzania. Qualitative research methods were used in data collection. We conducted 32 focus group discussions (16 FGDs with men and 16 FGDs with women) and 34 in-depth interviews with community leaders, village health workers and health care providers. Interview guides were used to guide the focus group discussions and in-depth interviews. The interviews and discussions were audio recorded, transcribed and translated into English and imported into QSR NVivo 9 software for thematic analysis. Three themes emerged from the data; men's maternity care involvement indicators, benefits of men's involvement in maternity health care services and barriers to men's involvement in maternity health care services. Both men and women participants acknowledged the importance of men's involvement in maternity health care services, even though few men actually got involved. Identified benefits of men's involvement in maternity health care services include: Learning any risk factors directly from the health care providers and getting prepared in addressing them; and reinforcing adherence to instruction received from the health care provider as family protectors and guardians. Barriers to men's involvement in maternity health care services are systemic; starting from the family, health care and culture-specific gender norms for maternity related behaviour as well as healthcare facilities structural constrains inhibiting implementation of couple-friendly maternity health care services. Men's involvement in maternity care is influenced by culture-specific maternity-related gender norms. This situation is compounded by the conditions of deprivation that deny women access to resources with which they could find alternative support during pregnancy. Moreover, structures meant for maternal health care services lack privacy, thus inhibiting male partners' presence in the delivery room. Intervention to increase men's involvement in maternity care should address individual and systemic barriers to men's involvement.

The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare's meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.

Research Findings: This study examined the extent to which maternal sensitivity in infancy and toddlerhood is associated with children's social and relational competence and problems in the early years of schooling as well as the extent to which this association is mediated by children's effortful control abilities. Data from 1,364 children (705 boys, 659 girls), their mothers, and teachers from the longitudinal National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used. Maternal sensitivity was assessed by coding semistructured videos of mother–child interactions; effortful control was assessed by maternal report; and children's social competence, problems, and relationships with teachers and peers were assessed by school observations and teacher report. Structural equation models examined the extent to which there was an association between maternal sensitivity and children's social and relational competence and problems as well as the extent to which this association was mediated by children's effortful control skills. Maternal sensitivity had a direct association with children's social and relational competence and problems in 1st grade. Children's inhibitory control partially mediated the association between maternal sensitivity and the quality of children's skills. Practice or Policy: The results are discussed in terms of the importance of interventions geared toward improving maternal sensitivity and children's effortful control skills to help children develop better social and relational skills to foster close and supportive relationships with teachers and peers.

This cross-sectional study explored the differences in sociodemographics, dietary intake, and household foodways (cultural, socioeconomic practices that affect food purchase, consumption, and preferences) of food secure and food insecure older women living in a low-income urban setting in South Africa. Women (n = 122) aged 60–85 years old were recruited, a sociodemographic questionnaire was completed, and food security categories were determined. The categories were dichotomised into food secure (food secure and mild food insecurity) and food insecure (moderate and severe). A one-week quantified food frequency questionnaire was administered. Height and weight were measured to calculate body mass index (BMI, kg/m2). Most participants (>90%) were overweight/obese, unmarried/widowed, and breadwinners with a low monthly household income. Food insecure participants (36.9%) more frequently borrowed money for food (57.8% vs. 39.0%, p = 0.04), ate less so that their children could have more to eat (64.4%. vs. 27.3%, p = 0.001), and had higher housing density (1.2 vs. 1.0, p = 0.03), compared to their food-secure counterparts. Overall, <30% of participants met the WHO (Geneva, Switzerland) recommended daily servings of healthy foods (fruits, vegetables, and dairy products), but >60% perceived that they consumed an adequate amount of healthy foods. The overall low-quality diet of our cohort was associated with poor nutritional perceptions and choices, coupled with financial constraints.

Flexible Multi-Level Models for Health Effects of Air Quality Actions: Results from the Children's Health StudyAbstract Number:2892 Kiros Berhane*, Jim Gauderman, Chih-Chieh Chang, Robert Urmann, and Frank Gilliland Kiros Berhane* University of Southern California, United States, E-mail Address: [email protected] Search for more papers by this author , Jim Gauderman University of Southern California, United States, E-mail Address: [email protected] Search for more papers by this author , Chih-Chieh Chang University of Southern California, United States, E-mail Address: [email protected] Search for more papers by this author , Robert Urmann University of Southern California, United States, E-mail Address: [email protected] Search for more papers by this author , and Frank Gilliland University of Southern California, United States, E-mail Address: [email protected] Search for more papers by this author AbstractDetermination of the positive health impacts of declining air pollution levels is important in assessing the effectiveness (or lack thereof) of environmental regulatory policy. In data from children, the challenges in doing this properly include dealing with effects of puberty (e.g., non-linear growth trajectories over the entire childhood period), long term temporal trends due to unmeasured time-varying confounders, complexity in the potentially multi-pollutant dose response relationships and potentially synergistic effects acting at multiple levels of data aggregation (e.g., between communities, between individuals and across time). By using data on multiple cohorts of children spanning a long time period (1993-2012) from the Southern California Children’s Health Study as a motivation, we outline a flexible multi-level modeling framework that allows for the assessment of the healthimpacts of the recent declines in air pollution levels in Southern California. The focus will be on assessment of bronchitic symptoms (in children with or without asthma) and lung function development in children. The Generalized Linear Mixed Models setup will be used as a general modeling paradigm for all outcomes from the exponential family of distributions. For lung function outcomes, splines will be used to characterize growth trajectories for ‘homogenous’ sub-groups of children, with random effects used to capture subject-to-subject heterogeneity in growth trajectories. For bronchitic symptoms, the logistic setup will be used with a rich random effects structure to allow for heterogeneity of pollution effects across communities. In all cases, the effects of declining of pollution levels will be assessed using models of increasing complexity to deal with (a) non-constant effects across time,(b) non-linear dose-response relationships, (c) heterogeneity in pollution effects across multiple sites (e.g., communities, cities, regions, etc.), and/or (d) multi-pollutant health effects.

Introduction: The early years of life are important for a child's health and development. Positive parenting and quality interactions were needed to develop all children’s abilities according to their age by meeting their social, emotional, and educational needs for stimulation. A mother plays an important role in encouraging a child's growth and development. This research aims to determine the influence of social psychological factors that influence maternal behavior on healthy child development using the Information Motivation Behavior Skills (IMB) model. Materials and methods: A cross-sectional study was conducted on 400 pairs of mothers and children under five years old. Respondents were measured using questionnaires and observation sheets. The maternal behavior level was measured using the Daily Development Stimulation for Children (DDSC) questionnaire. Path analysis was applied to analyze the relationship between IMB and maternal behavior in improving the development of children. Results: Healthy maternal behavior in improving the development of children was directly and positively related to maternal behavioral skills (b= 1.00, p&lt;0.001). Then, it is indirectly and positively related to information (b= 0.28, p&lt;0.001), self-efficacy (b= 0.18, p&lt;0.001), and motivation (b= 0.51, p&lt;0.001). The goodness of fit path analysis indicated values of p= 0.57, RSME&lt; 0.001, TFI= 1.00, TLI= 1.00, and SRMR= 0.003. Conclusion: A mother's healthy behavior that improves child development is directly and positively related to the behavioral skills that a mother has. Furthermore, it is indirectly and positively related to the information and motivation that a mother has.