Caring practices and support for early childhood development among pastoralists in Kenya: gaps and opportunities

• In Event: Highlighted Session: Critical Perspectives on Policy and Discourse

Proposal

Background
Optimal early childhood development (ECD) lays the foundation for a child's future, impacting their physical health, ability to learn, and economic prospects. The early years represent a critical period for development and insufficient nurturing care during this time may be linked to poor cognitive, language, health, and psychosocial outcomes, undermining prospects for healthy, productive adulthood. Unfortunately, nearly two-thirds of children in sub-Saharan Africa don’t reach their full developmental potential, resulting in lifelong disparities in health, academic achievement, and earning potential. Nomadic pastoralists in Kenya, representing around 13% of the rural population, suffer significant barriers to early childhood development (ECD) and healthcare due to migratory lifestyles, geographic isolation, and underrepresentation in national ECD policies. Despite some caregiving practices like facilitating play behaviors by mothers, awareness and structured support for psychomotor development among children aged 0-36 months are limited, highlighting the need for tailored interventions guided by the Nurturing Care framework to enhance developmental outcomes in these vulnerable settings. This study explored how existing caregiving practices and support for early child development among nomadic pastoralists in Kenya could inform inclusive, culturally grounded, and supportive ECD systems that promote equity and social cohesion.

Methods
This paper utilized data from the Caring Practices and Support for Early Childhood Development (CAPS-ECD) project conducted in Kajiado County, Kenya. Conducted in 2020, CAPS-ECD was a cross-sectional study exploring caring practices and support for early childhood development among nomadic pastoralists. The study included 659 caregiver-child pairs. Data collection took place from September to October 2020 during COVID-19, following Kenyan health protocols. Caregiver interviews conducted in Maa (back-translated into English) gathered information on the five nurturing care components - responsive caregiving, opportunities for early learning, nutrition, health, and safety/security - as well as nutritional indicators (underweight, stunting, wasting via WHO igrowup macro), and child health. Child development was assessed using the culturally adapted Ages and Stages Questionnaire version 3 (ASQ-3), with higher aggregated domain scores indicating more advanced development. Multivariable linear regression model was used to determine the association between nurturing care practices and early child development outcomes (ASQ-3 scores).

Results
Children in the study had a median age of 15 months, with gender evenly distributed (49% female). Caregivers had a median age of 27 years, most were married or living together (91%), nearly half (49%) had no formal education, and 41% of households were in the lowest wealth tertile.
Responsive caregiving: Caregivers used both positive and negative strategies to manage child behavior. Praising good behavior was common and increased with age. Methods like explaining wrong behavior, offering alternatives or taking away privileges were reported. Negative strategies such as, shouting, physical punishment, repeated hitting, and the belief in the necessity of physical punishment were also reported especially among older children.
Opportunities for early learning: Few families owned books, magazines, or pictures. Mobile phone ownership was high (92%) with 39% of children accessing phones for viewing videos or photos. Play items were mostly household or homemade objects, with shop-bought toys less common. Caregiver stimulation through talking, smiling, singing was frequent and increased with child age. Engagement in play and outdoor activities also increased with age but structured activities like reading or naming/counting were less frequent.
Nutrition: Stunting affected about one-fifth of children while wasting (14%) and underweight (14%) were less prevalent. Boys were more affected than girls across all nutritional indicators.
Health: Around half of children were fully vaccinated. Recent illness was common (38%), with less than one-third of ill children receiving treatment.
Safety and security: About a quarter of the children were left alone or in the care of another young child (<10 years). Maternal presence decreased as children aged. Most caregivers (93%) believed their children felt safe and secure.
Associations: Children from wealthier households had significantly higher overall ASQ-3 developmental scores compared to those from low-wealth homes and particularly in communication, problem-solving, and personal-social domains. Fully vaccinated children had significantly higher fine motor scores compared to unvaccinated children. No significant associations of vaccination with other domains were observed. Access to mobile phones was significantly associated with higher ASQ-3 scores across all domains. Caregiver engagement in ECD practices like storytelling, singing, and counting was associated with higher developmental scores across all domains. In contrast, stunted and underweight children had lower scores in communication, motor, and problem-solving areas. Negative or mixed caregiver disciplinary strategies were associated with poorer developmental outcomes.

Conclusion
Our findings highlight the need for equitable, multi-sectoral investments in ECD tailored to pastoralist communities. While barriers to nurturing care such as limited access to books, poor nutrition, and healthcare challenges are evident, there are opportunities that can be leveraged in the community to promote early child development. Mobile phones offer a promising avenue to share early learning content like stories and pictures with nomadic families, whose mobility limits traditional interventions. By combining mobile-based content with existing strengths such as storytelling and singing, policymakers can create community-driven, culturally relevant approaches. Mobile phones also potentially offer a point of regular contact to support caregivers with access to community nutrition and health programs, such as information about the location of vaccination services, to ensure that Maasai families are well supported to deliver nurturing care.

Authors

• Nelson Kipkoech Langat, African Population and Health Research Center (APHRC)

• Silas Odhiambo Onyango, African Population and Health Research Center (APHRC)

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

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

• LINDA AWUOR OLOO, African Population and Health Research Center (APHRC)