Date of Award

Spring 2019

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Edward A. Frongillo

Abstract

Poor child growth and suboptimal early childhood development are global health problems. Provision of appropriate care may help to achieve optimum child growth and development. Maternal resources for care such as education, knowledge, health, autonomy, reasonable workload, and social support may be needed to provide appropriate care behaviors, and improve children’s nutritional status, and early childhood development. The overall goal of this research was to understand the role of resources for care in improving care behaviors, child nutritional status, and early childhood development. The baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia were used. We examined the structures and equivalence of resources for care measures. Multiple regression analysis was used to examine the association between maternal resources for care and care behaviors. Path analysis was used to determine the paths through which maternal resources for care are associated with height-for-age z scores and motor and language development.

The factor analysis demonstrated that a three-factor solution best explained the structure of resources for care in Bangladesh and a two-factor solution best explained the structure in Vietnam and Ethiopia. The structure of resources for care was similar in some instances but differences also existed across settings. For the measures that were scales, the order of the percentage of the affirmative responses was similar across settings, but a few differences were also found. Resources for care were associated with the care behaviors of exclusive breastfeeding, minimum meal frequency, dietary diversity, improved drinking water source, improved sanitation, cleanliness, child immunization, psychosocial stimulation, and adequate care. The associations differed by the types of resources for care, care behaviors, and study settings. Resources for care were associated with children’s height-for-age z scores, motor development, and language development through direct and indirect paths. Care behaviors mediated the associations of resources for care with child outcomes. Children’s physical growth also partially explained the associations between resources for care and child development. Findings suggest that strengthening resources for care among mothers will be beneficial in improving care behaviors, children’s nutritional status, and early childhood development.

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