Evidence brief: Caregivers’ early stimulation behaviors on early child development outcomes in Northern Ghana

Abstract

Despite the government prioritizing Early Childhood Development (ECD) in Ghana, data on responsive caregiving is limited. This study examined the type and extent of Early Stimulation Activities (ESAs) practiced by mothers, and other caregivers and the associations between ESAs and children’s development by caregiver type in Northern Ghana. Data were from a cluster-randomized controlled trial with mother-child dyads that evaluated the impact of an integrated maternal mental health and early childhood intervention program. The primary outcome was measured by the Developmental Milestone Checklist (DMC-II). Covariates included maternal report of ESAs performed by herself, child’s father, and other caregivers. Linear regression analyses with cluster-adjusted standard errors were performed. Nearly 15% of mother-participants (n = 313) reported 4 + ESAs in the past 3 days. Within the last 3 days, on average, women reported 2.5 activities for themselves, 1.2 activities by the child’s father, and 2 activities by other caregivers. The associations between ESAs and children’s development varied by caregiver type. Maternal stimulation was positively associated with children’s total development and personal-social development, early stimulation by other caregivers was positively associated with children’s total development and language development, and paternal stimulation was not associated with any development domain. Other associations included receipt of postnatal care and presence of household toys. While maternal stimulation seemed particularly important, findings regarding non-primary caregivers suggest that ECD programming could also benefit from their inclusion.

Introduction

The call for investing in optimal early child development has been gaining significant ground at a global scale [1–4]. This is encouraging as about 43% of all under-5 children globally are at risk of not being on track to meet their developmental milestones [1]. In Sub-Saharan Africa, nearly two-thirds of under-5 children are at risk [1].

Both the World Health Organization (WHO) and United Nations Children Fund (UNICEF) provide guidance on responsive feeding and caregiving including age-appropriate early stimulation activities [5,6]. Timing, consistency, as well as intensity of early stimulation activities have been shown to affect different stages of early child development [7–11]. In addition, recent cluster-randomized studies have shown that parenting interventions promoting early stimulation significantly improved children’s cognitive, motor and language development [12–14]. Many studies have reported such findings [11,15–21].

It is important to recognize that children’s developmental outcomes are not only influenced by the mother-child or the father-child relationships but also by interactions occurring within the larger family context [22]. In many countries across East, West, Central and Southern Africa where the average household size maybe relatively large and/or include inter-generational living arrangements [23], it is potentially even more likely that children’s developmental outcomes are influenced by interactions with older siblings, grandparents and other adults living in the same household. According to the Ghana Demographic and Health Survey in 2022, nearly 9 out of 10 married women were employed [24]. Women’s employment, whether seasonal or permanent, could mean that children are often left in the care of other household members during the women’s absence. In some cases, co-wives may also be asked to care for children as 15% of married women reported being in a polygynous union in 2022 [24]. While there is a growing evidence base for the effectiveness of “father-inclusive” parenting interventions [25,26], only a few studies have explored the involvement of other household members in caregiving and early stimulation in the context of low- and middle-income countries [27–30].