Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
BMJ Glob Health. 2020 Aug;5(8). doi: 10.1136/bmjgh-2019-002181.
Early childhood interventions primarily focus on the mother-child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is a paucity of research on grandmother caregiving in low-income and middle-income countries. We examined the role of grandmother involvement on child growth and development in the first 2 years of life cross sectionally and longitudinally in rural Pakistan.
We used data from the Bachpan Cohort, a longitudinal birth cohort in rural Pakistan. Maternally reported grandmother involvement in daily instrumental and non-instrumental caregiving was collected at 3 and 12 months. A summed score was created and categorised into non-involved, low and high. Outcomes included 12-month and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development and 24-month Ages and Stages Questionnaire-Socioemotional. We used multivariable generalised linear models to estimate mean differences (MD) at 12 months (n=727) and 24 months (n=712). Inverse probability weighting was used to account for missingness and sampling.
In our sample, 68% of children lived with a grandmother, and most grandmothers were involved in caregiving. Greater 3-month grandmother involvement was positively associated with 12-month weight z-scores; however, greater involvement was associated with lower 24-month weight z-scores. High 12-month grandmother involvement was associated with improved 12-month cognitive (MD=0.38, 95% CI -0.01 to 0.76), fine motor skills (MD=0.45, 95% CI 0.08 to 0.83) and 24-month socioemotional development (MD=-17.83, 95% CI -31.47 to -4.19). No meaningful associations were found for length z-scores or language development.
In rural Pakistan, grandmothers provide caregiving that influences early child development. Our findings highlight the complex relationship between grandmother involvement and child weight, and suggest that grandmothers may positively promote early child cognitive, fine motor and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform caregiving interventions.
幼儿干预主要侧重于母婴关系，但祖母在资源匮乏环境下的儿童照护中往往起着至关重要的作用。先前的研究对于祖母的参与如何影响儿童的结果存在分歧，而且在低收入和中等收入国家，关于祖母照顾的研究也很少。我们在巴基斯坦农村地区横切面和纵向研究了祖母参与度对生命头 2 年儿童生长和发育的影响。
我们使用了来自巴基斯坦农村地区纵向出生队列 Bachpan 队列的数据。母亲报告了祖母在日常工具性和非工具性照护中的参与情况，分别在 3 个月和 12 个月时收集。创建了一个总和评分，并分为不参与、低参与和高参与。结果包括 12 个月和 24 个月的儿童生长、12 个月的贝利婴幼儿发育量表和 24 个月的年龄与阶段问卷-社会情感。我们使用多变量广义线性模型来估计 12 个月（n=727）和 24 个月（n=712）时的平均差异（MD）。逆概率加权用于解释缺失和抽样。
在我们的样本中，68%的儿童与祖母一起生活，大多数祖母都参与了照护。3 个月时祖母的参与度越高，12 个月时的体重 z 评分越高；然而，参与度越高，24 个月时的体重 z 评分越低。12 个月时高祖母参与度与 12 个月时认知（MD=0.38，95%CI-0.01 至 0.76）、精细运动技能（MD=0.45，95%CI0.08 至 0.83）和 24 个月时社会情感发展（MD=-17.83，95%CI-31.47 至-4.19）呈正相关。与长度 z 评分或语言发展没有发现有意义的关联。
在巴基斯坦农村地区，祖母提供了影响儿童早期发展的照护。我们的研究结果突出了祖母参与度与儿童体重之间的复杂关系，并表明祖母可能积极促进儿童早期认知、精细运动和社会情感发展。了解祖母的参与如何影响儿童在生命早期的结果，对于告知照护干预措施是必要的。
