Measuring the intangible resources caregivers need to provide nurturing care during the complementary feeding period: a scoping review in low- and lower-middle-income countries.

OBJECTIVE: Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries. DESIGN: We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age. RESULTS: We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures. CONCLUSIONS: Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.

Maternal resources for care are associated with child growth and early childhood development in Bangladesh and Vietnam.

BACKGROUND: Suboptimal child growth and development are significant problems in low- and middle-income countries. Maternal resources for care may help to improve growth and development. This study examined the association of maternal resources for care on child length, motor development and language development of children 12-23.9 months old. METHODS: We used baseline data from the Alive & Thrive household surveys collected in Bangladesh (n = 803) and Vietnam (n = 635). Resources for care were represented by maternal education, knowledge, height, well-nourishment, mental well-being, decision-making, employment, support in chores and perceived support. The regression analyses were adjusted for household wealth and other covariates on households, children and parents and accounted for geographical clustering. RESULTS: Maternal height (Bangladesh ß = 0.150 p < 0.001, Vietnam ß = 0.156 p < 0.001), well-nourishment (Vietnam ß = 0.882 p = 0.007) and mental well-being (Bangladesh ß = 0.0649 p = 0.008, Vietnam ß = 0.0742 p = 0.039) were associated with child length. Well-nourishment (Vietnam ß = 0.670 p = 0.042) and support in chores (Bangladesh ß = 0.0983 p = 0.021) were associated with child motor development. Mental well-being (Vietnam ß = 0.0735 p = 0.013), decision-making autonomy (Bangladesh ß = 0.0886 p = 0.029) and perceived support (Vietnam ß = 0.445 p = 0.003) were associated with child language development. CONCLUSION: Maternal height, well-nourishment, mental well-being, decision-making, support in chores and perceived social support were associated with child outcomes. Interventions that help to improve resources among mothers have potential to foster child growth and development.

Factor Structure and Equivalence of Maternal Resources for Care in Bangladesh, Vietnam, and Ethiopia.

OBJECTIVES: Resources for care among women are crucial for children's growth and development. The objectives of this cross-sectional study were to determine if: (1) the factor structure of measures of maternal resources for care was comparable across countries and consistent with the theoretical constructs and (2) the measures showed equivalence across contexts. METHODS: The study included 4400, 4029 and 2746 women from Bangladesh, Vietnam, and Ethiopia, respectively. The measures of resources for care were maternal education, knowledge, height, body mass index, mental well-being, financial autonomy, decision-making, employment, support in chores, and perceived support. RESULTS: The factor analysis demonstrated that a two-factor solution best explained the structure of resources for care in all three countries. The first factor was associated with financial autonomy and employment in all three countries and with decision-making in two countries. The second factor was associated with education and knowledge in all three countries. The measures of resources for care had measurement equivalence across countries. CONCLUSION FOR PRACTICE: Resources for care were structurally similar and measurement equivalent across countries and can be used for measurement in low- and middle-income countries. Additional work examining the structure and cross-context equivalence of resources for care in other settings is warranted.

Associations of maternal resources with care behaviours differ by resource and behaviour.

Care is important for children's growth and development, but lack or inadequacy of resources for care can constrain appropriate caregiving. The objectives of this study were to examine whether maternal resources for care are associated with care behaviours specifically infant and young child feeding, hygiene, health-seeking, and family care behaviours. The study also examined if some resources for care are more important than others. This study used baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia. Measures of resources for care were maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental support. Multiple regression analyses were conducted to examine the associations of resources for care with child-feeding practices (exclusive breastfeeding, minimum meal frequency, dietary and diversity), hygiene practices (improved drinking water source, improved sanitation, and cleanliness), health-seeking (full immunization), and family care (psychosocial stimulation and availability of adequate caregiver). The models were adjusted for covariates at child, parents, and household levels and accounted for geographic clustering. All measures of resources for care had positive associations with care behaviours; in a few instances, however, the associations between the resources for care and care behaviours were in the negative direction. Improving education, knowledge, nutritional status, mental well-being, autonomy, and social support among mothers would facilitate provision of optimal care for children.