Effects of the COVID-19 Pandemic on Caregiver Stimulation and Maternal Mental Health in Rural Bangladesh

• In Event: Early Life Impacts of COVID-19: Prenatal and Early Childhood

Abstract

Introduction
As a consequence of the COVID-19 pandemic and subsequent mitigation strategies used in Bangladesh, the median income of families in rural areas fell to just over 25% of what it was one year previously, severe food insecurity increased from 6% to 36%, and maternal depressive symptoms increased (Hamadani et al., 2020). Poor maternal mental health and lack of child stimulation, both important risk factors for poor child development outcomes, are affected when families are facing economic hardship (Black et al., 2017; Lund et al., 2011). Determining the effects of the COVID-19 pandemic on risk factors affecting child development is critical to understanding its impact on child development, and designing interventions to promote positive developmental trajectories and improve later life outcomes. This research aims to assess the effect of the COVID-19 pandemic and related mitigation strategies on maternal depressive symptoms and caregiver stimulation in a large sample of families in rural Bangladesh, and estimate the subsequent effect on child development in rural Bangladesh.

Study Population
Participants are a population-proportional sample of caregivers of children 6-27 months in the Chatmohar Sub-District of northwestern Bangladesh. Data was collected pre-COVID (April-June 2019), and mid-COVID (July-August 2020). The in-person baseline assessments consisted of 1635 caregivers. The phone-based follow-up assessment was conducted with 520 caregivers from the original sample and a cross-sectional sample of an additional 1,176 caregivers. All participants were eligible to attend group sessions of an integrated early child development intervention delivered at community health facilities from September to March, 2019.

Methods
At both assessment time points, caregiver depressive symptoms and stimulating caregiving practices were assessed. The second assessment also included modules on changes in household health status and household economic status following the start of the COVID-19 pandemic. We use two analytic approaches to examine the impact of COVID-19 on maternal depressive symptoms and stimulating caregiving practices, 1) a longitudinal difference-in-differences analysis comparing outcomes for participants who reported and did not report economic hardship due following the start of the COVID-19 pandemic, and 2) an age- and socioeconomic status-matched cross-sectional pre-post comparison. We conduct stratified analyses by group session attendance. We then use changes in maternal depressive symptoms and stimulating caregiving to estimate potential impacts on child development.

Results
In June and August 2020, 76% of families reported a reduced income, and 8% reported no income since March. One fifth of families were not able to purchase essential food items in the last 7 days. In preliminary difference-in-differences analyses we found that for caregivers in the longitudinal sample who were more economically impacted by COVID-19, the difference in CES-D scores between baseline and endline was 1.62 points worse, on average (95% CI -0.18, 3.42, p=0.08) when compared to those less economically impacted (controlling for child age and caregiver education). We will present and discuss analysis using the entire sample, analyses for stimulating caregiving, and analyses stratified by attendance at intervention sessions. We will use the results from both analyses on maternal depressive symptoms and stimulating caregiving to estimate impacts on development outcomes.

Authors

• Helen Osborne Pitchik, University of California - Berkeley
  Presenting Author

• Fahmida Tofail, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Fahmida Akter, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Jesmin Sultana, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
  Non-Presenting Author

• Abul Shoab, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Tarique M.N. Huda, icddr,b
  Non-Presenting Author

• Jenna E. Forsyth, Stanford University
  Non-Presenting Author

• Natasha Kaushal, Johns Hopkins Bloomberg School of Public Health
  Non-Presenting Author

• Md. Ruhul Amin, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Tania Jahir, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Farzana Yeasmin, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Rizwana Khan, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Jyoti B. Das, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Khobair Hossain, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Md. Rezaul Hasan, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Md. Mahbubur Rahman, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Peter J. Winch, Johns Hopkins Bloomberg School of Public Health
  Non-Presenting Author

• Stephen P. Luby, Stanford University
  Non-Presenting Author

• Lia C.H. Fernald, University of California - Berkeley
  Non-Presenting Author