Molecular Mechanisms for CFIm-Mediated Regulation of mRNA Alternative Polyadenylation.

Alternative mRNA processing is a critical mechanism for proteome expansion and gene regulation in higher eukaryotes. The SR family proteins play important roles in splicing regulation. Intriguingly, mammalian genomes encode many poorly characterized SR-like proteins, including subunits of the mRNA 3'-processing factor CFIm, CFIm68 and CFIm59. Here we demonstrate that CFIm functions as an enhancer-dependent activator of mRNA 3' processing. CFIm regulates global alternative polyadenylation (APA) by specifically binding and activating enhancer-containing poly(A) sites (PASs). Importantly, the CFIm activator functions are mediated by the arginine-serine repeat (RS) domains of CFIm68/59, which bind specifically to an RS-like region in the CPSF subunit Fip1, and this interaction is inhibited by CFIm68/59 hyper-phosphorylation. The remarkable functional similarities between CFIm and SR proteins suggest that interactions between RS-like domains in regulatory and core factors may provide a common activation mechanism for mRNA 3' processing, splicing, and potentially other steps in RNA metabolism.

Contribution of Food from Market Purchases and Home Production to Child Nutrient Intake: Evidence from the EFFECTS Study Baseline Data.

BACKGROUND: Child undernutrition is prevalent in Tanzania, and households rely primarily on local markets and home production as food sources. However, little is known about the contribution of food market purchases to nutrient intakes among children consuming complementary foods. OBJECTIVES: To quantify the relationships between diversity of foods purchased and produced by households and adequate child nutrient intake in Mara, Tanzania. METHODS: Cross-sectional baseline dietary and household food source data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania study were collected from mothers of 586 children aged 9-23 mo clustered in 80 villages in Mara, Tanzania. We conducted mixed effects linear regressions to quantify the association between the diversity of foods consumed at home, from market purchases and home production, and nutrient intake adequacy (based on 24-h food recalls). RESULTS: Children had inadequate diets, with fewer than half of children consuming adequate amounts of vitamin A, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B9 (folate), calcium, iron, and zinc. Breastfeeding was associated with higher overall mean adequacy (b = 0.15-0.19 across models, P < 0.001). Diversity of foods purchased was positively associated with the intake of vitamin B12 and calcium (both P < 0.001); this effect was attenuated among breastfed children. Among nonbreastfed children, production diversity was positively associated with vitamin A intake (b=0.04; P < .05) but not with intake of other nutrients. CONCLUSIONS: Both household food purchase and food production diversities were positively associated with children's nutrient intake in rural Mara, Tanzania. Nutrition programming should consider the role of food markets in addition to home food production to improve child diets. This trial was registered at clinicaltrials.gov as NCT03759821, https://clinicaltrials.gov/study/NCT03759821.

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster-randomized controlled trial.

BACKGROUND: Multicomponent interventions are needed to address the various co-occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes. METHODS: We conducted a 2×2 factorial cluster-randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard-of-care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference-in-difference approach with intention-to-treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well-being. RESULTS: Between October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (ß = .18 [95% CI: 0.01, 0.36]) and receptive language development (ß = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (ß = .21 [0.04, 0.38]) and availability of home learning materials (ß = .25 [0.07-0.43]) and reduced paternal parenting distress (ß = -.34 [-0.55, -0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (ß = .45 [0.27, 0.63]). CONCLUSIONS: Jointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.

A qualitative study of maternal and paternal parenting knowledge and practices in rural Mozambique.

BACKGROUND: Providing nurturing care for young children is essential for promoting early child development (ECD). However, there is limited knowledge about how mothers and fathers across diverse contexts in sub-Saharan Africa care for their children and from whom they receive guidance and support in their caregiving roles. We aimed to examine caregivers' nurturing care practices and sources of parenting knowledge in rural Mozambique. METHODS: This is a secondary analysis using data from a qualitative evaluation of a pilot intervention to improve nurturing care for early child health and development within existing health systems. The evaluation was conducted across three primary care health facilities and their catchment areas in Nampula province, Mozambique. For this study, we analyzed data from in-depth interviews conducted with 36 caregivers (32 mothers and 4 fathers) to investigate mothers' and fathers' daily caregiving experiences. Data were analyzed using thematic content analysis. RESULTS: Caregivers described various caregiving roles relating to general caregiving of young children (e.g., feeding, bathing, caring for child's health) and stimulation (e.g., play and communication) activities. Mothers more commonly engaged in general caregiving activities than fathers, whereas both mothers and fathers engaged in stimulation activities. Other family members, including siblings, grandparents, and aunts/uncles, were also actively engaged in general caregiving activities. With respect to sources of parenting knowledge, caregivers received parenting guidance and support primarily from their own mothers/parents and facility-based health providers. CONCLUSIONS: These findings highlight the importance of adopting a holistic approach involving caregivers and their context and reveal potential strategies to promote caregiving and ECD in rural Mozambique and similar contexts.

Clinical characteristics and outcomes after trigeminal schwannoma resection: a multi-institutional experience.

Given their rarity, the clinical course of patients undergoing trigeminal schwannoma (TS) resection remains understudied. The objective of this study is to describe clinical characteristics and outcomes in patients undergoing surgical resection for TS in a multi-institutional cohort. This is a retrospective study of patients undergoing TS resection at two institutions between 2004 and 2022. Patient, radiographic, and clinical characteristics were reviewed and analyzed with standard statistical methods. Thirty patients were included. The median patient age was 43 (IQR: 35-52) years, and 14 (47%) patients were female. Median clinical and radiographic follow-ups were 43 (IQR: 20-81) and 47 (IQR: 27-97) months respectively. The most common presenting symptoms were trigeminal hypesthesia (57%) and headaches (30%), diplopia (30%), and ataxia/cerebellar signs (30%). The median maximum tumor diameter was 3.3 (IQR: 2.5-5.4) cm. Most tumors were Samii type C (50%) and mixed cystic-solid (63%). Surgical approaches included endoscopic endonasal (33%), supratentorial (30%), combined/staged (20%), infratentorial (10%), and anterior petrosal (7%) approaches. Gross-total resection was achieved in 16 (53%) patients. Radiographic tumor recurrence was noted in four patients at a median of 79 (range 5-152) months. Twenty-six (87%) patients reported improvements in at least one symptom by last follow-up. The most common perioperative complication was new cranial nerve deficit, with 17% of patients having a transient deficit and 10% having a permanent cranial nerve deficit. Surgical resection of TS showed good progression-free survival and symptom improvement, but was associated with cranial nerve deficits.

"If my wife earns more than me, she will force me to do what she wants": Women's economic empowerment and family caregiving dynamics in Tanzania.

Women's economic empowerment is recognized as a fundamental component of gender equality and global development. Despite a significant body of evidence highlighting the positive effects of women's labor force participation in low- and middle-income countries, relatively few studies have explored how caregivers of young children perceive women's economic empowerment in relation to childcare and family responsibilities. The objective of this study was to examine how mothers and fathers viewed the links between maternal employment and family caregiving dynamics specifically in terms of couples' relationships and parenting. We conducted in-depth interviews with 23 mothers and 29 fathers of young children under aged 2 years and 9 focus group discussions with mothers and fathers across 4 communities in Mwanza, Tanzania. Data were analyzed through both deductive and inductive approaches. Results revealed distinct gender differences in maternal versus paternal perceptions regarding women's engagement in income-generating activities. Mothers held favorable views towards employment and largely perceived positive effects on parenting, child, and family outcomes. On the other hand, most fathers were unsupportive of women's employment and held restrictive gender attitudes. Men feared a loss of power and perceived various negative consequences in terms of increased marital conflict, poorer maternal parenting, and worse child outcomes. Overall, this study revealed differences in maternal versus paternal perceptions about women's economic empowerment and its links with couples' relationships and parenting that were strongly shaped by gender attitudes. Women's economic empowerment programs that engage men to transform gender norms while incorporating program components to strengthen couples' relationships and promote positive parenting have potential for achieving family-wide benefits among mothers, fathers, and young children.

Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services.

Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis.

BACKGROUND: Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS: We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS: Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

The Association Between Fathers' Depression and Children's Socioemotional Development: Evidence from a Longitudinal Household Survey in China.

Depression is highly prevalent among parents around the world. Although there has been substantial research on maternal depression, few studies have additionally considered paternal depression and examined the independent and potentially interactive influence between paternal and maternal depression on children's development. The objectives of this study were to investigate the unique association between paternal depression and children's later socioemotional development, and explore whether this association was moderated by maternal depression. We used data from the 2012 and 2014 waves of the China Family Panel Studies. We used multivariable linear regression models to examine the association between paternal depression, as measured using the Center for Epidemiological Studies-Depression Scale, and children's socioemotional development, as measured using the Positive Behaviors Scale. We also explored whether there was effect modification by maternal depression. The sample comprised of 1615 children (Mage = 7.38 years; 48.5% female) and their parents. Twenty-four percent of fathers and 33% of mothers were depressed. We found that paternal depression was negatively associated with children's socioemotional development (ß = - 0.18; 95% CI - 0.31, - 0.03), controlling for maternal depression and other sociodemographic covariates. Moreover, we found that the association was moderated by maternal depression, whereby the negative association was stronger when mothers were not depressed (ß = - 0.30; 95% CI - 0.52, - 0.08) versus null when mothers were depressed (ß = - 0.02; 95% CI - 0.24, 0.20). Parenting interventions should promote the mental health of fathers, in addition to mothers, as a more holistic and family-based approach for improving both the wellbeing of parents and behavioral development of children.

Associations between birth registration and early child growth and development: evidence from 31 low- and middle-income countries.

BACKGROUND: Lack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children's physical growth and developmental outcomes in LMICs. METHODS: We combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36-59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects. RESULTS: In the total sample, 34.7% of children aged 0-59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (ß = - 0.18; 95% CI: -0.23, - 0.14), WAZ (ß = - 0.10, 95% CI: -0.13, - 0.07), and ECDI z-scores (ß = - 0.10; 95% CI: -0.13, - 0.07) among children aged 36-59 months. CONCLUSION: Our findings document links between birth registration and children's early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.

Correction to: "His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan.

After publication of the original article [1], the authors wanted to make an amendment in the Acknowledgments section as Muneera Rasheed requested to be removed. This correction article shows the original and revised version of the "Acknowledgments". The original article was not updated.

"His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan.

BACKGROUND: Parents are the primary providers of nurturing care for young children's healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers' parenting roles with regards to their young children's early health and development in rural Pakistan. METHODS: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis. RESULTS: Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers' coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community. CONCLUSIONS: Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers' direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.

Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone.

BACKGROUND: Little attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors. METHODS AND FINDINGS: Using survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's α = 0.84) and EVD prevention behaviors (16 items, Cronbach's α = 0.88). Main predictors comprised war exposures (8 items, Cronbach's α = 0.85), anxiety (10 items, Cronbach's α = 0.93), depression (15 items, Cronbach's α = 0.91), and PTSD symptoms (16 items, Cronbach's α = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009). CONCLUSIONS: In post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.

Violence Against Children, Self-Harm, and Suicidal Behaviors: A Pooled and Country-Specific Analysis of Eight Low- and Middle-Income Countries.

PURPOSE: This study assessed associations between experiences of physical or sexual violence in childhood and self-harm, suicidal ideation, and suicide attempts among young people in low- and middle-income countries (LMICs) and whether these associations varied by sex and perpetrator identity. METHODS: We used nationally representative data from the Violence Against Children and Youth Surveys in eight LMICs (2017-2019). The analytic sample included 33,381 young men and women (ages 13-24 years). Multivariable logistic regressions with country-fixed effects were used to estimate the associations between childhood physical and sexual violence and the three outcomes. Stratified analyses were performed by country, participant's sex, and type of perpetrator (parent/caregiver, other adults, peers, and intimate partner). RESULTS: About 40% of the participants reported physical childhood violence, and 10% experienced childhood sexual violence. Childhood violence was associated with increased odds of self-harm (physical violence: adjusted odds ratio [aOR]: 2.2, 95% confidence interval [CI]: 2.0-2.4; sexual violence: aOR: 2.7, 95%, CI: 2.3-3.0), suicidal ideation (physical: aOR: 3.0, 95% CI: 2.7-3.3; sexual: aOR: 4.0, 95%, CI: 3.6-4.5), and suicide attempts (physical: aOR: 3.6, 95% CI: 3.2-4.1; sexual: aOR: 4.9, 95%, CI: 4.3-5.7). Consistent findings were observed in country-specific analyses. The odds of all outcomes were highest among those who experienced childhood physical violence by intimate partners and childhood sexual violence by parents or caregivers. Young women who experienced childhood sexual violence had higher odds for all outcomes than young men. DISCUSSION: Violence prevention and mental health programs for young people in LMICs should consider the types of violence experienced, the perpetrator, and the sex of the survivor.

Father involvement is a protective factor for maternal mental health in Western Kenya.

Depression is a major global health concern especially among mothers of young children in low- and middle-income countries (LMICs). While various risk and protective factors have been well-established, the role of fathers in potentially mitigating maternal depression remains understudied. This study aimed to investigate the association between father involvement and maternal depressive symptoms in rural Western Kenya. We used cross-sectional baseline data collected in February-March 2023 from a cluster-randomized controlled trial evaluating the effectiveness of a community-based parenting program for improving early childhood development. Primary caregivers with children 0-18 months of age were enrolled into the trial across 51 villages in Nyamira and Vihiga counties. We analyzed data from 413 mothers who were in a relationship with a male partner (i.e., father of the young child). Maternal depressive symptoms were measured using the CESD-10. Father involvement was reported using a multidimensional measure of men's engagement in childcare activities, household chores, early learning activities, and affection towards their child. We used multilevel regression models to estimate the adjusted associations between father involvement (overall score and by specific domains) and maternal depressive symptoms. We also conducted exploratory subgroup analyses to assess whether this association differed by child age. Overall, greater father involvement was associated with fewer maternal depressive symptoms. Specifically, fathers' engagement in household chores and childcare activities had the strongest protective associations. Exploratory subgroup analyses revealed larger associations for mothers with younger children under 6 months. Our findings suggest that father involvement is a protective factor for maternal mental health. Engaging fathers in early childhood interventions and encouraging men's involvement in caregiving activities may potentially benefit maternal well-being.

"Good fathers": Community perceptions of idealized fatherhood and reported fathering behaviors in Mwanza, Tanzania.

Globally, perceptions of idealized fatherhood have been expanding beyond men's breadwinning roles to also value men's engagement in nurturing care. While fathers' caregiving behaviors are increasing, most childcare activities are still largely performed by mothers. In this study, we unpacked community members' beliefs about the meaning of "good fathers" and explored the degree to which these values aligned with the main caregiving behaviors reported about fathers with young children under age 2 years in Mwanza, Tanzania. Qualitative data were collected as part of a broader formative research study for which we conducted in-depth interviews with 29 fathers, 23 mothers, 4 village leaders and 4 community health workers as well as 3 focus group discussions with fathers, 2 with mothers, and 6 with both fathers and mothers combined. For this secondary data analysis, we used a grounded theory approach combined with thematic content analysis to investigate the nature of fatherhood. We discovered four key ideals associated with "good fathers": fathers as providers, nurturers, supportive partners, and authoritarians. The primary ideal of fathers as breadwinners was strongly aligned with the main reported practice of fathers trying hard to financially providing for their families. However, paternal behaviors reflecting ideals of fathers as nurturers and supportive partners were less practiced. Although ideals towards good fathers as authoritarian were least explicitly valued, many fathers were reported as engaging in controlling behaviors and using violence. The links between fatherhood ideals and behaviors was influenced by various factors, including poverty, men's limited time availability at home, and restrictive gender norms. Overall, our results reveal some alignment but also inconsistencies between the ideal version of fatherhood and commonly reported paternal practices. These discrepancies highlight the need for further investigation into the underlying factors that both enable and constrain the links between fatherhood ideals and behaviors. Our study results have important implications for the design of interventions that seek to enhance fatherhood to improve the development and wellbeing of children and families.

Women's empowerment and child anthropometric failures across 28 sub-Saharan African countries: A cross-level interaction by Gender Inequality Index.

Background: Child undernutrition remains a major global health issue, particularly in sub-Saharan Africa (SSA). Given the important role mothers play in early childhood health and development, we examined how individual-level women's empowerment and country-level Gender Inequality Index (GII) are jointly related with child undernutrition in SSA. Methods: We pooled recent Demographic and Health Surveys from 28 SSA countries. For 137,699 children <5 years old, undernutrition was defined using anthropometric failures (stunting, underweight, wasting). Women's empowerment was assessed using three domains of Survey-based Women's EmPowERment (SWPER) index: attitude to violence, social independence, and decision-making; and country-level gender inequality was measured using GII from United Nations Development Programme. Three-level logistic regression was conducted to examine the joint associations of SWPER and GII as well as their interactions with child anthropometric failures, after adjusting for sociodemographic covariates. Results: Overall, 32.85% of children were stunted, 17.63% were underweight, and 6.68% had wasting. Children of mothers with low-level of empowerment for all domains of SWPER had higher odds of stunting (attitude to violence: OR=1.15; 95% CI, 1.11-1.19; social independence: OR=1.21; 95% CI, 1.17-1.25; decision-making: OR=1.16; 95% CI, 1.12-1.20), and consistent results were found for underweight and wasting. Independent of women's empowerment, country-level GII increased the probability of underweight (ranging ORs=1.46; 95% CI, 1.15-1.85 to 1.50; 95% CI, 1.18-1.90) and wasting (ranging ORs=1.56; 95% CI, 1.24-1.97 to 1.61; 95% CI, 1.27-2.03). Significant interaction was found between women's empowerment and country-level GII for stunting and underweight (p<0.05). Conclusions: In SSA countries with greater gender inequality, improving women's social independence and decision-making power in particular can reduce their children's risk of anthropometric failures. Policies and interventions targeted at strengthening women's empowerment should consider the degree of gender inequality in each country.

Fathers' mental health and coping strategies: a qualitative study in Mwanza, Tanzania.

OBJECTIVES: To investigate the nature of paternal mental health problems, their causes and the coping strategies used by fathers of young children under the age of 2 years. DESIGN AND SETTING: We conducted in-depth interviews with fathers, mothers, community leaders and community health workers as well as focus group discussions with fathers-only, mothers-only and mixed groups of fathers and mothers. Respondents provided their perspectives on the psychosocial challenges affecting fathers and how fathers responded to their mental health problems. Data were triangulated across stakeholders and analysed using thematic content analysis. SETTING: The study was conducted in four communities in Mwanza, Tanzania. PARTICIPANTS: The total sample included 56 fathers, 56 mothers and 8 community stakeholders that were equally distributed across the four communities. RESULTS: Respondents highlighted a spectrum of mental health concerns affecting fathers, including elevated parenting stress, depressive symptoms, and anxiety. Causes of paternal mental health problems included poverty, child-related concerns, marital problems and family illness. When asked about paternal coping strategies, both fathers and mothers shared that fathers mostly turned to negative coping strategies to manage their distress, such as paternal alcohol use and poor conflict resolution strategies. However, respondents also shared how some fathers used positive coping strategies, such as seeking out social support from their family and friends, engaging in exercise and leisure activities and relying on their faith. CONCLUSIONS: Overall, this study highlights the importance of supporting positive mental health among fathers. Our findings can inform the design of psychosocial programme components that can be integrated within parenting interventions to promote the well-being of specifically fathers and ultimately improve the family caregiving environment.

A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development.

This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.

Maternal Decision-Making Power and Care-Seeking Behaviors for Acutely Ill Children: A Multilevel Analysis of 33 Sub-Saharan African Countries.

Timely and appropriate healthcare seeking is crucial to reduce child mortality. However, rates of care seeking for acute childhood diseases remain low in sub-Saharan Africa (SSA). This study investigated the association between maternal decision-making power and care-seeking behaviors for children with diarrhea and acute respiratory infection (ARI) in SSA. Demographic and Health Surveys from 33 SSA countries were used in a sample of mother-child pairs (mothers aged 15-49 years; children aged 0-59 months) with a recent child episode of diarrhea (N = 41,729) and ARI (N = 71,966). Maternal decision-making power was defined as making decisions on all four familial topics alone or jointly with the husband/partner. Care-seeking behaviors were measured as seeking care from health providers, other types of providers, and any providers (including both). Multivariable three-level logistic regressions were conducted. Approximately 60% of the sample sought care from any provider (46-48% from health providers versus 13-14% from others). Approximately 28% of mothers had high decision-making power. After adjusting for sociodemographic characteristics, high maternal decision-making power was associated with higher likelihood of seeking care from a health provider for both diarrhea (adjusted odds ratio [aOR] = 1.06, 95% CI = 1.01-1.12) and ARI (aOR = 1.07, 95% CI = 1.03-1.11) and lower likelihood of seeking care from others (aOR = 0.89, 95% CI = 0.82-0.97 for diarrhea; aOR = 0.88, 95% CI = 0.82-0.94 for ARI). Maternal decision-making power was positively associated with their care-seeking behaviors from health providers for acutely ill children in SSA. Women's empowerment interventions that particularly increase women's agency in decision-making may holistically improve health and well-being of the next generation.