"We struggle with the earth everyday": parents' perspectives on the capabilities for healthy child growth in haor region of Bangladesh.

BACKGROUND: Childhood stunting is an important public health problem in the haor region of Bangladesh. Haor areas are located in the north-eastern part of the country and are vulnerable to seasonal flooding. The key objective of this study is to identify the capabilities of the parents and their children that shape multidimensional child growth outcomes in the haor region in the first thousand days of life. METHODS: A qualitative study was conducted in two sub-districts of the haor region, including in Derai in the Sunamganj district and Baniachang in the Habiganj district. We facilitated eight focus group discussions with the parents of children under age two. To allow us to explore individual stories, we conducted in-depth interviews with four fathers and four mothers. A capability framework to child growth was used in shaping the interview guides and analysing the data. RESULTS: The findings were categorised at four levels: a) capabilities for the child, b) capabilities for the mother, c) capabilities for the father, and d) capabilities at the household level. At the child's level, the parents discussed the capability to stay away from disease and to eat well, the capability to stay happy and playful, and the capability to be born with God's blessings and the hereditary traits needed to grow in size. The mothers frequently mentioned the capability to stay healthy and nourished, to stay away from violence, and to practice autonomy in allocating time for child care. The fathers stressed the earning opportunities that are affected by long-term flooding and the loss of agricultural productivity. At the household level, they discussed the capability to live in a safe shelter, to be mobile, to overcome their struggles with the earth, and to have a source of safe drinking water. CONCLUSIONS: The capability framework for child growth helped identify relevant capabilities in the haor region. These findings can guide discussions with communities and policy makers about developing programmes and interventions aimed at enhancing the identified capabilities for child growth in this vulnerable region.

Towards a Multi-Dimensional Index of Child Growth to Combat the Double Burden of Malnutrition.

BACKGROUND: There is growing awareness in the field of public health that combatting the double burden of malnutrition requires approaches that address its multi-dimensional origin, rather than focusing primarily on the biomedical domain. Current frameworks of malnutrition like the UNICEF conceptual framework, and the Lancet Series 2013 framework have been instrumental in understanding the determinants of malnutrition and developing appropriate interventions. However, these frameworks fail to explicitly address issues of agency, that is, about being able to pursue one's goal. The capability approach as originally developed by Amartya Sen includes agency in the causal chain. Summary and key Messages: In the past 5 years, the International Union of Nutritional Sciences Task Force "Towards a multi-dimensional index for child growth and development" has developed a capability framework for child growth, and conducted empirical research applying this framework. The working group discussed what would be needed to further develop the approach and explained the added value to international organisations and policy makers. We suggest developing an index of advantage that will be a proxy for a child's agency. We hypothesise that such an index will explain much of the variance in studying inequalities in child nutrition and thus call for action to improve this focal point.

Towards a capability approach to child growth: A theoretical framework.

Child malnutrition is an important cause of under-5 mortality and morbidity around the globe. Despite the partial success of (inter)national efforts to reduce child mortality, under-5 mortality rates continue to be high. The multidimensional approaches of the Sustainable Development Goals may suggest new directions for rethinking strategies for reducing child mortality and malnutrition. We propose a theoretical framework for developing a "capability" approach to child growth. The current child growth monitoring practices are based on 2 assumptions: (a) that anthropometric and motor development measures are the appropriate indicators; and (b) that child growth can be assessed using a single universal standard that is applicable around the world. These practices may be further advanced by applying a capability approach to child growth, whereby growth is redefined as the achievement of certain capabilities (of society, parents, and children). This framework is similar to the multidimensional approach to societal development presented in the seminal work of Amartya Sen. To identify the dimensions of healthy child growth, we draw upon theories from the social sciences and evolutionary biology. Conceptually, we consider growth as a plural space and propose assessing growth by means of a child growth matrix in which the context is embedded in the assessment. This approach will better address the diversities and the inequalities in child growth. Such a multidimensional measure will have implications for interventions and policy, including prevention and counselling, and could have an impact on child malnutrition and mortality.

Disaster Risk Reduction in Iranian Primary and Secondary School Textbooks: A Content Analysis.

OBJECTIVE: School textbooks have a significant role in transferring knowledge to the students and changing their behavior. This work aims to analyze school textbooks to find the representation of natural hazards in Iran, which is vital for supporting children in disaster situations. METHODS: In this study, a qualitative content analysis was used. Data were analyzed qualitatively by using MAXQDA 2018 software. For the 2019-2020 school year, 300 Iranian school textbooks in Persian language were collected. RESULTS: Findings of this work show that students receive information about disaster risk reduction (DRR) education through the primary and secondary grade levels in all 12 grades. The educational content covers various types of natural hazards, including geophysical, hydrological, climatological, meteorological, and biological disasters. In addition, the textbooks contain discussions about local hazards, causes and effects of disasters, and the disaster management cycle. CONCLUSIONS: The coverage of DRR and the relevant contents in school textbooks reveals that the discourse of natural hazards is important for Iranian authorities, especially in the education system. This study helps decision-makers and practitioners design more effective interventions to prepare children for disasters.

School-Based Education Programs for Preparing Children for Natural Hazards: A Systematic Review.

Schools have a significant role in disaster education to children. This study investigates the research works about school-based education programs in order to discover challenges and best practices. We conducted a systematic review of English language papers published in peer-review journals.The search identified 2577 publications and 61 articles meeting selection criteria and included in the review. Reviewed studies indicated that disaster education in schools is effective but yet insufficient in many countries. Lack of equipment, financial resources, policy gaps, and teachers' knowledge are common problems in programs. Main outcomes of this systematic review are showing methods used for health emergency preparedness of children of different ages and gender differences in school-based disaster preparedness, as well as the difference in their lifesaving skills in disasters.This study shows that some disaster education programs reported in the papers reviewed were not high-quality enough, which may lead to insufficient preparedness of children in disasters and consequently may put their health at risk, considering the increasing number of natural hazards.

Qualitative content analysis as a research method to investigate hazards information in school textbooks.

This study explains how qualitative content analysis was applied to investigate natural hazards in textbooks for children with intellectual disabilities in Iran. Qualitative content analysis of textbooks is one of the ways for understanding the priorities of Iranian education system with regard to natural hazards. Data samples included whole textbooks for children with intellectual disabilities in all grades during school year 2020-2021 in Iran. Data were collected by transferring textbooks to MAXQDA 2018 software and coding themes with the software. A narrative format was used for analyzing qualitative data. Examples were presented along with tables and quotations in the study. Peer checking and expert check were employed to ensure trustworthiness of the study. The above research design showed the strengths and weaknesses of information provided in Iranian textbooks on natural hazards and disasters management. Iran is a disaster-prone country and various natural hazards happen in Iran every year including earthquake, flood, drought, and extreme weather. Children are a vulnerable population in disasters. One of the most important issues for children's health is disaster preparedness. Intersection of age with other social determinants such as disability, gender, and ethnicity can increase vulnerability. This method was recommended to researchers investigating representation of natural hazards in textbooks of children in different countries, grades, and textbooks. Furthermore, it is possible to use this method for a comparative analysis of information in two or more countries, or different school years in a country.•Explicit and implicit information on natural hazards in textbooks could be investigated with qualitative content analysis.•This method could facilitate cross-country comparisons by providing a framework to investigate the content of textbooks for children without disabilities and/or with disabilities.•It is a valuable method for evaluation of disaster programs for children in local, national, and global levels.

"When I Breastfeed, It Feels as if my Soul Leaves the Body": Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania.

The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers' capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women's control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers' real opportunities for achieving healthy child growth.

Preparing children for climate-related disasters.

Climate-related disasters affect different dimensions of children's health and well-being both directly and indirectly. Reducing children's vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health. As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster's risks. Main factors in shaping children's behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that. So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness.

Students' preparedness for disasters in schools: a systematic review protocol.

INTRODUCTION: Children are one of the most vulnerable groups in disasters. Improving students' knowledge and skills to prepare for disasters can play a major role in children's health. School as a place to teach children can make a significant contribution to provide the necessary skills. This study aims to identify the effects, strengths and weaknesses of interventions in schools to prepare children for disasters. METHODS AND ANALYSIS: We use Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to develop a protocol for this systematic review. The included studies will report on the results of interventions targeting 'schoolchildren' defined as individuals between 4 and under 18 years old studying in schools. Different electronic databases will be used for a comprehensive literature search, including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and EMBASE to identify the records that match the mentioned inclusion criteria published till December 2020. The main search terms are 'disaster', 'preparedness', 'children' and 'school'. Four types of data will be extracted from the qualified studies including study characteristics (study design, year of publication and geographical region where the study was conducted), participant characteristics (sample size, age and gender), intervention characteristics (aim of intervention, intervention facilitators and barriers) and intervention outcomes. The quality appraisal of the selected papers will be conducted using Cochrane Collaboration's Risk of Bias for quantitative studies and Critical Appraisal Skills Programme checklist for qualitative studies. We use a narrative synthesis for this systematic review. The narrative synthesis refers to an approach to systematic reviews which focuses mostly on applying words and texts to summarise and explain findings. ETHICS AND DISSEMINATION: This paper is a part of a Ph.D. thesis of Hamed Seddighi at University of Social welfare and Rehabilitation Sciences with ethics code IR.USWR.REC.1399.008 approved by the Ethics Committee of the above-mentioned university. PROSPERO REGISTRATION NUMBER: CRD42020146536.