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Grandmother Involvement in Rural Pakistan: An Observational Study on Child Growth and Development

47 Pages Posted: 27 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 primarily focus on the mother-child relationship, but grandmothers are often critical in childcare in low-resource settings. We examined the role of grandmother involvement on child growth and development cross-sectionally and longitudinally in rural Pakistan.

Methods: Maternally reported grandmother involvement was collected at 3 and 12 months postpartum about daily instrumental and non-instrumental caregiving and categorized into non-involved, low, and high. Outcomes included 12- and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development, and 24-month Ages and Stages Questionnaire-Socioemotional. We used adjusted linear mixed models to estimate mean differences (MD) on 699 households with complete data.

Findings: The majority of grandmothers were involved in caregiving at 3 and 12 months. High 3-month grandmother involvement (vs. non-involved) was associated with 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). High 12-month grandmother involvement was associated with improved 12—month cognitive (MD=0·48, 95% CI: 0·10, 0·87) and fine motor (MD=0·42, 95% CI: 0·09, 0·76) skills and 24-month socioemotional development (MD= -15·52, 95% CI: -25·27, -5·76).

Interpretation: Early grandmother involvement had positive associations with child weight, but became negative as children aged. 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 caregiving interventions.

Funding: National Institute of Child Health and Human Development, National Institute of Mental Health, Carolina Population Center.

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

Ethical Approval: 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; caregiving; child nutrition; early child development

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 in Rural Pakistan: An Observational Study on Child Growth and Development (November 15, 2019). Available at SSRN: https://ssrn.com/abstract=3487743 or http://dx.doi.org/10.2139/ssrn.3487743

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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