The headcam mother-infant interaction assessment tool: testing the feasibility and acceptability in Soweto, South Africa, using participatory engagement.

BACKGROUND: Many children in low- and middle-income countries lack the stimulation needed to support healthy growth and development. Sensitive interactions between caregivers and infants may promote healthy movement behaviours in infants, which could improve childhood growth and development. However, reliable measures for such interactions require testing in the South African context. The aim of this study was to test the acceptability and feasibility of the headcam caregiver-infant interaction assessment tool in mothers from Soweto, South Africa. METHODS: Nineteen mother and infant (6-24 months) pairs were asked to wear headcams (first-person observation) while participating in group and individual activities. Detailed instructions on headcam use were provided before and during these activities. Mothers were then asked to use the headcams, as well as photoframe cameras (which provided context of the interactions), in at least three, 5-min mother-infant engagement sessions at home over a 1-week period. Thereafter, focus group discussions (FGDs) were conducted to explore mothers' experiences of using the tool in the home setting. The feasibility of the headcam mother-infant interaction tool was assessed according to a priori criteria which scored (i) technical reliability of the devices and (ii) usability of the recorded footage. Acceptability was assessed according to emerging themes which were coded from the FGDs using a constant comparison method by two researchers. RESULTS: The headcam mother-infant assessment tool was found to be feasible in Soweto, and sufficient data was available to code. Three main themes emerged from the FGD analysis: use of the headcam, using the headcams in the home environment and using the photoframe vs. the headcam. Mothers remarked on the ease of using the tool across daily activities, the normality of their infant's behaviour during recording and the acceptability by other members of the household. Large amounts of wasted unusable recordings were produced, and challenges related to switching the cameras on and off and to headcam placement were discussed. CONCLUSIONS: Our study shows that headcams are both an acceptable and feasible method for assessing mother-infant interactions in Soweto. However, improvements to the usability of the tool and the quality of the data collected should be made prior to future work.

Social vulnerability, parity and food insecurity in urban South African young women: the healthy life trajectories initiative (HeLTI) study.

Social vulnerability indices (SVI) can predict communities' vulnerability and resilience to public health threats such as drought, food insecurity or infectious diseases. Parity has yet to be investigated as an indicator of social vulnerability in young women. We adapted an SVI score, previously used by the US Centre for Disease Control (CDC), and calculated SVI for young urban South African women (n = 1584; median age 21.6, IQR 3.6 years). Social vulnerability was more frequently observed in women with children and increased as parity increased. Furthermore, young women classified as socially vulnerable were 2.84 times (95% CI 2.10-3.70; p < 0.001) more likely to report household food insecurity. We collected this information in 2018-2019, prior to the current global COVID-19 pandemic. With South Africa having declared a National State of Disaster in March 2020, early indicators suggest that this group of women have indeed been disproportionally affected, supporting the utility of such measures to inform disaster relief efforts.

Understanding how maternal social and biological factors are related to fetal growth in an urban South African cohort.

The aim of this study was to identify social and biological drivers of fetal growth by examining associations with household, preconception, and pregnancy factors in a cohort from Soweto, South Africa. Complete data and ultrasound scans were collected on 519 women between 2013 and 2016 at 6 time points during pregnancy (<14, 14-18, 19-23, 24-28, 29-33 weeks, and 34-38 weeks). Household-level factors, preconception health, baseline body mass index (BMI), and demographic data were collected at the first visit. During pregnancy, gestational weight gain (GWG; kg/week) was calculated. At 24-28 weeks of gestation, oral glucose tolerance test was used to determine gestational diabetes mellitus (GDM) status, and hypertension status was characterised. Longitudinal growth in head circumference, abdominal circumference, biparietal diameter, and femur length were modelled using the Superimposition by Translation and Rotation, a shape-invariant model which produces growth curves against gestational age. A priori identified exposure variables were then included in a series of sex-stratified hierarchical regression models for each fetal growth outcome. No household-level factors were associated with fetal growth. Maternal BMI at baseline was positively associated with all outcome parameters in males and females. Both GWG (in males and females) and GDM (in males) were significant positive predictors of abdominal growth. Males showed more responsiveness to abdominal growth, while females were more responsive to linear growth. Thus, fetal growth was largely predicted by maternal biological factors, and sexual dimorphism in the responsiveness of fetal biometry to biological exposures was evident.

Environmental, Social, and Structural Constraints for Health Behavior: Perceptions of Young Urban Black Women During the Preconception Period-A Healthy Life Trajectories Initiative.

OBJECTIVE: Obesity and noncommunicable disease are rapidly increasing in sub-Saharan Africa. Prevention efforts are critical, particularly for women before conception to maximize intergenerational effects. The authors sought to examine perceptions of health and everyday factors that influenced nutrition, exercise, and other health behaviors to inform a novel community preconception intervention. DESIGN: Four focus groups, each with 6-10 participants, were conducted using semistructured interview guides. SETTING: Urban Soweto, South Africa. PARTICIPANTS: Young nulliparous women aged 18-24 years were recruited using snowball sampling. PHENOMENON OF INTEREST: Health behaviors of young women and barriers and facilitators to these behaviors. ANALYSIS: After inductive thematic analysis, data were further interpreted within the theoretical framework of the Behavior Change Wheel. RESULTS: The data suggested an obesogenic environment in which structural and social factors strongly influenced young women's health choices and limited their capacity for behavior change. CONCLUSIONS AND IMPLICATIONS: Community interventions to improve young women's diet, physical activity, and health should recognize (1) the home and social contexts as a source of both role models and barriers to change, (2) the current normalization of obesity, and (3) contextual issues of safety and violence within the community. Understanding young women who overcome these barriers could be beneficial.

Understanding the Relationship between Socio-Economic Status, Physical Activity and Sedentary Behaviour, and Adiposity in Young Adult South African Women Using Structural Equation Modelling.

Socio-economic status (SES) is an important predictor of obesity, but how it is associated with differences in physical activity and sedentary behaviour is less clear. This cross-sectional study examined the association between SES (sum of household assets), physical activity and sedentary time, and how they predict adiposity. Socio-demographic, anthropometric, and physical activity data on rural (n = 509) and urban (n = 510) South African women (18-23 years) were collected. Overweight and obesity prevalence, and sedentary time, were higher; and moderate-vigorous intensity physical activity (MVPA) was lower, in the urban sample. Structural equation models (SEMs) were constructed for BMI and waist circumference. In the urban sample SES had a direct inverse effect on MVPA (ß; 95% CI, -41.69; -73.40 to -9.98), while in the rural sample SES had a direct effect on BMI (ß; 95% CI, 0.306; 0.03 to 0.59). In the pooled sample, SES had a direct inverse effect on MVPA (ß; 95% CI, -144; -170.34 to -119.04), and MVPA was directly associated with BMI (ß; 95% CI, 0.04; 0.01 to 0.08). The influence of SES, and the role of physical activity and sedentary time on adiposity differs between the urban and rural samples, and the importance of other environmental and behavioural factors must be considered in the development of obesity and the design of effective interventions.