Perceptions of Caregivers and Healthcare Workers on a Digital Child Development Intervention in Nairobi

• In Event: A Deeper Dive: Examining implementation of early childhood interventions across three countries

Abstract

Background
Despite recent advances in addressing undernutrition, low- and middle- income countries in Africa have experienced an increase in the number of children with suboptimal height-for-age z-scores (Dwomoh et al., 2022). Children suffering from undernutrition have been shown to have low cognitive skills, poor educational attainment, diminished human capital, and increased risk of behavioral problems (Victoria et al., 2021). Caregivers in low-resource settings often have limited knowledge on tracking important health, nutrition, and child development indicators. We are developing a digital intervention that sends parenting messages, and tracks various indicators for health, nutrition, and child development.

Objectives
To understand the perceptions of caregivers and healthcare workers on caregiver and child health, nutrition, and development; and the facilitators and barriers to implementing the digital parenting and nutrition intervention.

Methods
The study was based in urban informal settlements in Eastleigh, Nairobi, characterized by a high-density population with a large number of refugees and low-income households. We applied a qualitative approach which involved collection of data through key informant interviews (n=12) and two focus group discussions with caregivers of children below two years (n=17). The key informants included health, nutrition and child development officials from the ministry of health, and representatives from community-based organizations. Data were audio-recorded, transcribed and analyzed thematically using NVIVO software.

Results
Preliminary findings showed that caregivers perceived health, nutrition and responsive caregiving to be important for child growth and development. However, there was limited knowledge on nutrition for lactating mothers and complementary feeding. Exclusive breastfeeding was not followed by some of the caregivers, mostly because of participation in economic activities. While adherence to vaccination schedules was believed to be high due to reminders from the health workers and knowledge that it was beneficial, it was reported that some groups such as caregivers who abuse substances, and refugees experiencing language barrier were unlikely to adhere.
Healthcare workers reported challenges in service provision among caregivers including refugees’ underuse of health services for fear of being arrested, low uptake of immunization among refugees due to ignorance, and poor feeding practices e.g., overconsumption of fast foods. Responsive feeding was also perceived to be a challenge with force feeding being reported as common.
Perceived facilitators for successful implementation of the digital intervention included adequate training of the health workers and caregivers, use of local language and audio option to address low literacy levels, intervention being free of charge, sharing meaningful content, limiting the number of messages to one or two per week to avoid engagement fatigue, male involvement especially at recruitment, and confidentiality to enhance refugees’ participation. Some of the perceived barriers were internet costs, phone sharing, low level of smart phone ownership, phone loss, caregivers’ lack of time and non-motivated caregivers.

Conclusion
Findings from this study could benefit researchers, policy makers and other stakeholders intending to implement interventions in similar contexts in their efforts to alleviate undernutrition and enhance the growth and development of young children.

Authors

• Joyce Marangu, Aga Khan University - Kenya
  Presenting Author

• Amina Abubakar, Aga Khan University - Kenya

• Barack Aoko

• Kevin Juma Wekesa, Aga Khan University - Kenya

• Mark Tomlinson, University of Stellenbosch