Integrated multi-input interventions to promote child growth and development in low-resource settings: building a supportive and enabling caregiver environment

Abstract

In low- and middle-income countries (LMICs), 21% of children years of age are stunted and 43% are not developmentally on track. To reach their full growth and developmental potential, children require multiple health, nutrition, and care inputs and services. Multi-input multi-generational interventions - interventions combining health, nutrition, and care inputs for children with inputs to support and enable caregivers - are recognized as essential for optimal child growth and development in early life. Although a rich literature has demonstrated that multi-input interventions can improve child growth and/or development, evidence on caregiver outcomes is limited.

This dissertation addresses this research gap. In three papers, we explore whether multi-input interventions, which integrate messages and opportunities across health, nutrition, stimulation, and responsive care, can support and enable caregivers in LMICs. We examine three caregiver outcomes: mental health, responsiveness, and empowerment. Paper 1 uses data from a cluster-randomized controlled trial conducted in rural Tanzania and shows that a health, nutrition, stimulation, and responsive care intervention improved maternal mental health. Paper 2 shows that a nutrition, stimulation, and responsive care intervention implemented in rural Pakistan improved maternal responsiveness, and that these improvements translated into improvements in child growth and development. Lastly, paper 3 assesses the relationship between caregiver empowerment and nurturing care practices associated with child development and growth. Using data from nine Demographic and Health Surveys conducted in sub-Saharan Africa, this paper shows that more empowered caregivers can provide a more nurturing care environment. Together these three papers show that multi-input interventions combining health, nutrition, responsive care, and stimulation components are a promising strategy to support and enable caregivers in LMICs. The findings presented here expand the literature on how multi-input interventions improve caregiver outcomes. The discussion of limitations, implications, and future directions is intended to be informative for researchers and practitioners implementing multi-input interventions to promote child and caregiver wellbeing in LMICs.