Predictors of quality of child care centers in low income settings: Findings from two informal settlements in Nairobi, Kenya

• In Event: Early learning and literacy

Proposal

Background: Rapid urbanization and increased involvement of women in paid work has contributed to the upsurge of informal child care centers especially in low income settings where quality is a major issue. However, there is limited empirical data on the status of child care centers in the informal settings in sub-Saharan Africa and the factors that influence their quality. We aimed to examine the quality of child care centers in two slums in Nairobi and to identify factors associated with quality.
Methods: We conducted a cross-sectional survey of 66 centers and their care providers in two Nairobi slums; Korogocho and Viwandani. These communities represent the urban poor settings where children of working mothers are usually taken to local and cheap child care centers. Centers were eligible for the survey if they were located within the two settlements, were providing paid child care services for children under five years (below pre-primary), were operational and the managers/owners were willing to participate. We focused on under-fives because they do not go to pre-school and whose parents need to use child care services when they go out to work. We collected data on the quality of child care centers, center provider knowledge attitudes and practices (KAP), center provider socio-demographic characteristics, and child care center characteristics - type, location, size, and duration since establishment. The quality of centers was assessed using a tool developed based on the Family Child Care Environment Rating Scale (FCCERS). The center providers’ KAP in child care was assessed using a tool developed for the study focusing on key areas of nurturing care, and business management. Data were summarized using means and SDs or frequencies and percentages. The association between quality of care score (outcome) with predictors were examined using ordinary least squares regression (OLS). Simple linear regression and multiple linear regression with robust standard errors were used to determine the crude and adjusted association respectively between quality of care score and the predictors. In the main model, the dependent variable was the quality of care score (%) while the independent variables included: center provider KAP score (%), center provider socio-demographic characteristics, and child care center characteristics - type, location, size, and duration since establishment. The β-coefficient and the corresponding 95% confidence interval and p-value were reported.
Findings: More than three quarters (77%) of the child care centers were in Viwandani and almost all (95%) the center caregivers were female. The mean age of the center caregivers was 40 (standard deviation (SD) = 10) years, ranging from 23 to 74 years. Approximately two-thirds (68%) of the centers were home-based. The mean of quality of care score was 59% (11%). The type of child care center (faith-based vs home based: p=0.002) and center provider KAP score (p=0.001) were statistically significantly positively associated with the quality of care score.
After controlling for the other factors in the model, the mean quality of child care center score of faith-based centers was 9.2% higher than that of home-based centers (β=9.21; 95% CI: 3.47, 14.94). In other words, faith-based centers provide better quality child care services compared to home-based centers.
Adjusting for other predictors in the model, for every 1% increase in the caregiver KAP score, the quality of care score increased by 0.53% (β=0.53; 95% CI: 0.23, 0.84). This implies that there was a positive association between KAP score and quality of care score, that is, the higher the KAP score, the higher the quality of child care center score.
Conclusion: Our results show that even when facilities are poor and provider education levels are low, their knowledge and skills in providing child care can improve the quality of their child care centers. There is need to enhance the knowledge and skills of center providers in order to improve the quality of the child care centers and ultimately enhance the health and well-being of the children they care for.
Limitation: Though every effort was made to survey all the child care centers in the two settlements, the actual number reached was relatively small. This may have had a negative influence on the power of the study. There is a need for larger studies to better understand the predictors of quality of child care environments.

Authors

• Nelson Kipkoech Langat, African Population And Health Research Center

• Margaret Nampijja, African Population and Health Reserach Center, Nairobi

• Patricia K Kitsao-Wekulo, African Population and Health Research Center