Academic journal article Journal of Health Population and Nutrition

Use of Family Care Indicators and Their Relationship with Child Development in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Use of Family Care Indicators and Their Relationship with Child Development in Bangladesh

Article excerpt

INTRODUCTION

An estimated 219 million children in developing countries are failing to fulfil their developmental potential in the first five years of life due to poverty, poor health, and malnutrition (1). Poor stimulation in the home is one of the main mechanisms through which poverty detrimentally affects child development (2-3). However, specific risk factors in the home environment that affect cognitive and socio-emotional development of children are not well-documented in developing countries, and there are no globally-agreed indicators that could be easily assessed.

The dimensions of the home environment usually assessed are the quality of stimulation and learning opportunities, and the most commonly-used and validated instrument across countries is the Home Observations for Measurement of the Environment (HOME) (4-5). It provides a reasonably broad coverage of the social and physical conditions considered to influence both cognitive and socio-emotional development and is associated with child development in both developed (6-7) and developing countries (8-15). In a review of studies using the HOME from Africa, Asia, and Latin America, Bradley and Corwyn concluded that, although there are large differences in parenting across cultural groups, there remains significant variation in patterns within cultures that is associated with child competence (2).

Although the HOME is a good measure of the home environment, the scale is not suitable for use in large-scale population surveys. The HOME takes 45-60 minutes to administer and requires skilled, well-trained interviewers and considerable adaptation when used in developing countries. Moreover, the HOME involves observations, which are more difficult to standardize. Therefore, there is an urgent need for indicators that are simple, easy to administer, and applicable across different cultures for use in large population surveys. Such an instrument could contribute to assessing the size of the problem of poor home stimulation and monitoring interventions.

United Nations Children's Fund (UNICEF) developed the family care indicators (FCIs) questionnaire to measure the home environment of young children in developing countries in large population surveys, emphasizing items likely to be related to cognitive and language development. Items were adapted from several sources, including the HOME. Dimensions of the HOME measured here were derived from the Learning Materials, Parental Involvement, and Variety of Experiences subscales of the Infant Toddler version of the inventory (16).

Large household surveys that measure other aspects of children's well-being provide an opportunity for collecting information on the family environment. We proposed the addition of the FCI questionnaire to the Multiple Indicator Cluster Survey, which the UNICEF conducts in a number of developing countries every 3-5 years. Therefore, the questionnaire needed to meet the following criteria: be easily administered by trained but not specialized surveyors, contain a relatively few questions, be clear enough to be used for advocacy purposes, and be valid within and across cultures.

Determining the validity of the FCIs across cultures requires studies in a number of cultural settings and is beyond the scope of this study. The specific aims of the present study were to: (a) assess the test-retest reliability and stability over time of the FCI subscales; (b) examine their relationship with concurrent measures of children's development at 18 months, the HOME, and socioeconomic background; and (c) identify a subset of items for use in household surveys in developing countries.

MATERIALS AND METHODS

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) conducted a large longitudinal study to examine the effects of giving food and micronutrient supplementation to pregnant women on birth outcomes. The study was conducted in Matlab, a rural area in the east-central plain of Bangladesh. …

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