1. The majority of fathers in low- and middle-income countries have little to moderate engagement with their children in cognitively stimulating activities.
2. Less paternal engagement was associated with poorer child development across 3 of 4 domains; no association specifically with physical development was found.
Study Rundown: Multiple factors, including malnutrition, lack of cognitive stimulation, environmental hazards, and disease, may hinder early child development in low- and middle-income countries (LMICs). To date, studies investigating the role of cognitive stimulation on child development have primarily focused on the role of the mother. Few have analyzed the importance of paternal stimulation, let alone in the context of LMICs. To investigate a possible association between paternal engagement and developmental outcome, researchers analyzed data from rounds 4 and 5 of the Multiple Indicator Cluster Survey (MICS) program, a United Nations Children’s Fund survey administered around the world. In the study population of children ages 3 to 5 years, the Early Childhood Development Index (ECDI) was used to assess child development, and calculated height-for-age z-scores (HAZs) provided a metric for physical growth. In an adjusted model, although the data suggested that level of paternal stimulation was not associated with physical growth, a benefit from greater stimulation was observed in the literacy-numeracy, learning, and socioemotional domains of the ECDI. One limitation of this study was its metric of parental stimulation, only incorporating parental stimulation over a 3-day period, as behavior may not be uniform across 3-day intervals. Nevertheless, this study highlights the importance of stimulating home environments for child development and suggests that the positive influence of parental stimulation may help to offset risk factors for poor development.
Study Author, Joshua Jeong, MPH talks to 2 Minute Medicine: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
“Our results have strong implications for child health care providers. Child health care providers absolutely play an important role in encouraging and engaging fathers in children’s early development — which may be even more influential in low- and middle-income countries, where parents have been shown to have lower knowledge of early childhood development and children are more likely to have fewer opportunities for learning than those in high-income countries. During care visit, providers can emphasize the importance of both mothers’ and fathers’ stimulation and encourage a variety of specific activities that fathers can engage with their children.”
In-Depth [survey]: Nationally representative MICS data (rounds 4 and 5) across 38 LMICs were analyzed. This included caregiver responses on 87 286 children ages 3 to 5 years. HAZs and ECDI z-scores (internal consistency: α = 0.55) were used to assess growth and development. Parental stimulation was determined from a 3-day recall of engagement in 6 activities (e.g. reading together and singing songs; internal consistency: α = 0.77). Results were categorized by level of engagement: high (5-6 activities), moderate (1-4 activities), or none (0 activities), and linear regression models were designed. Although paternal stimulation rates varied considerably by country, taken together, only 6.4% of fathers exhibited high engagement (vs. 20.3% of mothers), and 47.8% (vs. 24.5% of mothers) had no engagement. After adjusting for potential confounders such as parental education, wealth, and maternal stimulation, an association was found between paternal stimulation and composite ECDI z-score. Compared to children receiving high levels of paternal engagement, ECDI scores of those receiving moderate and no engagement were lower (moderate: adjusted β (aβ) = -0.09, p < 0.001; none: aβ = -0.14, p < 0.001). Although significant under the unadjusted model, associations between paternal stimulation and HAZ lost significance with the inclusion of additional covariates. In further analyses, the strength of association between paternal stimulation and ECDI score was greater with low maternal stimulation (high maternal and no paternal stimulation aβ = -0.11 vs. no maternal and no paternal stimulation aβ = -0.33) and lack of early childhood education. Consistent with HAZ results, no association with the ECDI physical subdomain was observed.
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