Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi

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Abstract

Background

Social protection interventions, including cash grants and care provision have been shown to effectively reduce some negative impacts of the HIV epidemic on adolescents and families. Less is known about the role of social protection on younger HIV affected populations. This study explored the impact of cash grants on children’s cognitive development. Additionally, we examined whether combined cash and care (operationalised as good parenting) was associated with improved cognitive outcomes.

Methods

The sample included 854 children, aged 5 – 15, participating in community-based organisation (CBO) programmes for children affected by HIV in South Africa and Malawi. Data on child cognitive functioning were gathered by a combination of caregiver report and observer administered tests. Primary caregivers also reported on the economic situation of the family, cash receipt into the home, child and household HIV status. Parenting was measured on a 10 item scale with good parenting defined as a score of 8 or above.

Results

About half of families received cash (55%, n = 473), only 6% ( n = 51) reported good parenting above the cut-off point but no cash, 18% ( n = 151) received combined cash support and reported good parenting, and 21% ( n = 179) had neither. Findings show that cash receipt was associated with enhanced child cognitive outcomes in a number of domains including verbal working memory, general cognitive functioning, and learning. Furthermore, cash plus good parenting provided an additive effect. Child HIV status had a moderating effect on the association between cash or/plus good parenting and cognitive outcomes. The association between cash and good parenting and child cognitive outcomes remained significant among both HIV positive and negative children, but overall the HIV negative group benefited more.

Conclusions

This study shows the importance of cash transfers and good parenting on cognitive development of young children living in HIV affected environments. Our data clearly indicate that combined provision (cash plus good parenting) have added value.

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Most cited references 36

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Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents.

Murray A Straus, Sherry L Hamby, David Finkelhor … (1998)

To create a parent-to-child version of the Conflict Tactics Scales, the CTSPC. Description of the conceptual and methodological approaches used and psychometric data for a nationally representative sample of 1,000 U.S. children. (1) Improved Psychological Aggression and Physical Assault scales. (2) New Nonviolent Discipline scale, supplementary scale for Neglect, and supplemental questions on discipline methods and sexual abuse. (3) Reliability ranges from low to moderate. (4) Evidence of discriminant and construct validity. The CTSPC is better suited to measuring child maltreatment than the original CTS. It is brief (6 to 8 minutes for the core scales) and therefore practical for epidemiological research on child maltreatment and for clinical screening. Methodological issues inherent in parent self-report measures of child maltreatment are discussed.

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Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling

Dana McCoy, Evan D. Peet, Majid Ezzati … (2016)

Background The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. Methods and Findings The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of children ages 3 and 4 y), followed by South Asia (27.7 million; 37.7%) and the East Asia and Pacific region (15.1 million; 25.9%). Positive associations were found between low development scores and stunting, poverty, male sex, rural residence, and lack of cognitive stimulation. Additional research using more detailed developmental assessments across a larger number of LMICs is needed to address the limitations of the present study. Conclusions The number of children globally failing to reach their developmental potential remains large. Additional research is needed to identify the specific causes of poor developmental outcomes in diverse settings, as well as potential context-specific interventions that might promote children’s early cognitive and socioemotional well-being.

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Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis.

Marie-Louise Newell, Hoosen Mohamed Coovadia, Marjo Cortina-Borja … (2004)

HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors. Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically. 378 (11%) of 3468 children died. By age 1 year, an estimated 35.2% infected and 4.9% uninfected children will have died; by 2 years of age, 52.5% and 7.6% will have died, respectively. Mortality varied by geographical region, and was associated with maternal death (adjusted odds ratio 2.27, 95% CI 1.62-3.19), CD4+ cell counts <200 per microL (1.91, 1.39-2.62), and infant HIV infection (8.16, 6.43-10.33). Mortality was not associated with either ever breastfeeding and never breastfeeding in either infected or uninfected children. In infected children, mortality was significantly lower for those with late infection than those with early infection (0.52, 0.39-0.70). This effect was also seen in analyses of survival from the age at infection (0.74, 0.55-0.99). These findings highlight the necessity for timely antiretroviral care, for support for HIV-infected women and children in developing countries, and for assessment of prophylactic programmes to prevent MTCT, including child mortality and infection averted.

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Author and article information

Contributors

Lorraine Sherr: l.sherr@ucl.ac.uk

Ana Macedo: ana.macedo@ucl.ac.uk

Mark Tomlinson: markt@sun.ac.za

Sarah Skeen: skeen@sun.ac.za

Lucie Dale Cluver: lucie.cluver@spi.ox.ac.uk

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 12 May 2017

Publication date PMC-release: 12 May 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 123

Affiliations

[1 ]ISNI 0000000121901201, GRID grid.83440.3b, Research Department of Global Health, , University College London, ; Rowland Hill Street, London, NW3 2PF UK

[2 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Department of Psychology, , Stellenbosch University, ; Stellenbosch, South Africa

[3 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Department of Psychiatry and Mental Health, , University of Cape Town, ; Cape Town, South Africa

[4 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Department of Social Policy & Social Intervention, Centre for Evidence-Based Intervention, , University of Oxford, ; Oxford, UK

Article

Publisher ID: 883

DOI: 10.1186/s12887-017-0883-z

PMC ID: 5427556

PubMed ID: 28499423

SO-VID: 1d59f698-9ae4-427d-8f2b-e1b3b9df9183

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 August 2016

Date accepted : 8 May 2017

Funding

Funded by: Norad Sweden

Funded by: HelpAge

Funded by: FundRef http://dx.doi.org/10.13039/100006641, UNICEF;

Funded by: RIATT

Funded by: FundRef http://dx.doi.org/10.13039/501100000781, European Research Council;

Award ID: 313421

Award Recipient : Lucie Dale Cluver

Funded by: Philip Leverhulme Trust

Award ID: PLP-2014-095

Award Recipient : Lucie Dale Cluver

Custom metadata

ScienceOpen disciplines: Pediatrics

Keywords: south africa,malawi,hiv/aids,cash grant,parenting,child development

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: south africa, malawi, hiv/aids, cash grant, parenting, child development

Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi

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Abstract

Background

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 36

Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: development and psychometric data for a national sample of American parents.

Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling

Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis.

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