Poster #131 - Caregiver Perceptions of Child Development in Rural Madagascar

• In Event: 3-106 - Poster Session 11
  In Poster Session: PS 11 Section - Parenting & Parent-Child Relationships

Integrative Statement

Background: Greater maternal knowledge and perceptions of parenting and early child development have predicted improved psychomotor and cognitive development in high-income countries (Hernández‐Martínez, 2011). However, no studies have examined caregiver perceptions of early child development (ECD) in a very low-income context such as Madagascar, where half of children under 5 years are stunted.

Methods: Using cross-sectional data from rural Madagascar, we compared caregiver-perceived ECD with interviewer-based ECD for children aged 16-42 months. Caregiver-perceived ECD was measured using a ladder ranking scale based on the MacArthur subjective social status scale. Interviewer-based ECD was measured using the Ages and Stages Questionnaire: Inventory (ASQ-I) and ranked percentiles were generated. We created categories of under-estimation, matched, and over-estimation by taking the difference between caregiver and interviewer ECD. Key predictors of interest included child height-for-age z-score (HAZ), weight-for-age z-score (WAZ), absolute ASQ-I, caregiver belief of influence on child intelligence (measured by asking “How much does your child’s intelligence depend on you?”), and household wealth. We generated a within-community sample where we used ASQ-I ranked percentiles within villages and a full sample using ranked percentiles across the entire sample, and conducted multinomial logistic regressions to examine associations with under- and over-estimation of ECD.

Results: Using the within-community sample, 49% of caregivers overestimated their children’s development and 8% underestimated. Caregivers who had a greater belief of influence on child intelligence had lower odds of under-estimation, after controlling for all other factors (OR=0.59, 95% CI: 0.42 – 0.83). For every standard deviation increase in HAZ and ASQ-I score, the odds of caregiver over-estimation decreased by 25% and 55%, respectively (95% CI: 0.66-0.85; 95% CI: 0.38-0.52). In contrast, for every standard deviation-increase in WAZ, the odds of caregiver over-estimation increased by 19% (95% CI: 1.05-1.35). Households in the highest wealth quintile had 1.57 times the odds of overestimating compared to households in the lowest wealth quintile (95% CI: 1.12-2.20). Using the full sample, 47% of caregivers overestimated while 7% underestimated. Caregivers with a greater belief of influence on child intelligence had lower odds of under-estimation (OR=0.57, 95% CI: 0.38-0.83). WAZ and household wealth were independently and significantly associated with an increased odds of over-estimation (OR=1.15, 95% CI: 1.01-1.32; OR=1.55, 95% CI: 1.08-2.23). In contrast to the community sample, the association between HAZ and caregiver estimation weakened to non-significance. For every standard deviation increase in absolute ASQ-I score, the odds of under-estimation was 2.75 (95% CI: 2.29-3.30) and the odds of over-estimation was 0.12 (95% CI: 0.10-0.15).

Conclusions: Caregiver perceptions of ECD in Madagascar were not consistent with an interviewer-based measure. More than half of caregivers estimated their children’s abilities differently compared to an interviewer-based measure. The use of within-community sample versus full sample produced largely similar over-estimation results; however, we found differences in under-estimation. This may be due to the small sample size of caregivers who under-estimated. With the increasing number of parenting interventions and programs in low-income contexts, it is important to consider caregiver perceptions of early child development in order to optimize behavior change.

Authors

• Esther Chung, UNC Chapel Hill
  Presenting Author

• Ann Weber, Stanford University
  Non-Presenting Author

• Emanuela Galasso, The World Bank Development Research Group
  Non-Presenting Author

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