Grandmother Involvement in Rural Pakistan: An Observational Study on Child Growth and Development
47 Pages Posted: 27 Nov 2019More...
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
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