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Grandmother Involvement on Child Growth and Development in Rural Pakistan

48 Pages Posted: 14 Nov 2019

See all articles by Esther O. Chung

Esther O. Chung

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

Ashley Hagaman

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center

Katherine LeMasters

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

Nafeesa Andrabi

University of North Carolina (UNC) at Chapel Hill - Department of Sociology

Victoria Baranov

University of Melbourne

Lisa M. Bates

Columbia University - Department of Epidemiology

John A. Gallis

Duke University - Department of Biostatistics and Bioinformatics

Karen O’Donnell

Duke University - Duke Global Health Institute

Atif Rahman

University of Liverpool - Institute of Psychology, Health and Society

Siham Sikander

Human Development Research Foundation (HDRF); Health Services Academy

Elizabeth L. Turner

Duke University - Department of Biostatistics and Bioinformatics

Joanna Maselko

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

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Abstract

Background: Early childhood interventions have primarily focused on the mother-child relationship, but grandmothers are often critical in childcare. Prior research is mixed on how grandmother involvement influences child outcomes. There is a paucity of research on grandmother caregiving in low- and middle-income countries. We described maternally-reported grandmother caregiving activities and examined the role of grandmother involvement on child growth and development cross-sectionally and longitudinally.

Methods: We utilized the Bachpan study, a birth cohort in rural Pakistan. Grandmother involvement was based on maternal report at 3 and 12 months postpartum of 20 items related to daily instrumental and non-instrumental caregiving. A summed score was created and categorized into non-involved, low, and high. Outcomes included 12- and 24-month child growth, Bayley Scales of Infant and Toddler Development at 12 months, and Ages and Stages Questionnaire-Socioemotional at 24 months. Complete data were available for 699 households. We used adjusted linear mixed models to estimate mean differences (MD).

Findings: The majority of grandmothers were involved in caregiving at 3 and 12 months. Children with highly involved grandmothers at 3 months (vs. non-involved) had higher 12-month weight-for-length z-scores (MD=0·33, 95% CI: 0·07, 0·59); however, 12-month grandmother involvement was associated with lower 24-month weight-for-length z-scores (MD= -0·21, 95% CI: -0·42, -0·01). Twelve-month high grandmother involvement (vs. non-involved) was associated with improved cognitive (MD=0·48, 95% CI: 0·10, 0·87) and fine motor (MD=0·42, 95% CI: 0·09, 0·76) at 12 months and socioemotional development (MD= -15·52, 95% CI: -25·27, -5·76) at 24 months.

Interpretation: Early grandmother involvement had positive associations on child weight, but this association became negative as the child grew older. Grandmother involvement was positively associated with cognitive, fine motor, and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform how to best incorporate grandmothers into caregiver interventions.

Trial Registration: NCT02111915 (https://clinicaltrials.gov/ct2/show/NCT02111915); NCT02658994 (https://clinicaltrials.gov/ct2/show/NCT02658994). Trials were prospectively registered.

Funding Statement: The Bachpan cohort study was supported by NICHD [R01 HD075875] and NIMH [U19MH95687]. We are grateful to the Carolina Population Center for training support [T32 HD091058] and for general support [P2C HD050924].

Declaration of Interests: The authors have no conflicts of interest to disclose.

Ethics Approval Statement: This study was approved by institutional review boards at the Human Development Research Foundation (HDRF), the University of North Carolina at Chapel Hill, and Duke University.

Keywords: grandmothers; mother-in-law; child nutrition; early child development; caregiving

Suggested Citation

Chung, Esther O. and Hagaman, Ashley and LeMasters, Katherine and Andrabi, Nafeesa and Baranov, Victoria and Bates, Lisa M. and Gallis, John A. and O’Donnell, Karen and Rahman, Atif and Sikander, Siham and Turner, Elizabeth L. and Maselko, Joanna, Grandmother Involvement on Child Growth and Development in Rural Pakistan (10/22/2019 21:43:19). Available at SSRN: https://ssrn.com/abstract=3474505 or http://dx.doi.org/10.2139/ssrn.3474505

Esther O. Chung (Contact Author)

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

Chapel Hill, NC 27599
United States

Ashley Hagaman

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center ( email )

CB# 8120, University Square
123 West Franklin St.
Chapel Hill, 27599-2524
United States

Katherine LeMasters

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology ( email )

Chapel Hill, NC 27599
United States

Nafeesa Andrabi

University of North Carolina (UNC) at Chapel Hill - Department of Sociology ( email )

Chapel Hill, NC 27599
United States

Victoria Baranov

University of Melbourne

Lisa M. Bates

Columbia University - Department of Epidemiology

722 West 168th Street
New York, NY 10032
United States

John A. Gallis

Duke University - Department of Biostatistics and Bioinformatics ( email )

Durham, NC 27708
United States

Karen O’Donnell

Duke University - Duke Global Health Institute

310 Trent Drive
Box 90519
Durham, NC 27710
United States

Atif Rahman

University of Liverpool - Institute of Psychology, Health and Society ( email )

Liverpool
United Kingdom

Siham Sikander

Human Development Research Foundation (HDRF)

Rawalpindi
Pakistan

Health Services Academy

Islamabad
Pakistan

Elizabeth L. Turner

Duke University - Department of Biostatistics and Bioinformatics ( email )

Durham, NC 27708
United States

Joanna Maselko

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology ( email )

Chapel Hill, NC 27599
United States

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