Parenting for Growth and Development: A New Intervention Approach in Haiti

Background/purpose: Worldwide, a disturbingly high number of children live in poverty and are at risk for poor growth and developmental outcomes. Recent estimates show 250 million children less than five years of age are not reaching their developmental potential, and 151 million have stunted growth (Black, Walker, Fernald, et al., 2017). The mechanisms through which poverty disrupts healthy growth and development are biological (i.e., nutrition, infection), psychosocial (i.e., responsive parenting, stimulating environment) and environmental (i.e., hygiene and sanitation). Hence, the World Health Organization has recommended integrated interventions that simultaneously target nutrition, parenting and WASH. This pilot study addressed that need through its feasibility and acceptability assessment of one such intervention. This formative study reports qualitative findings regarding a nutrition and child development intervention to promote healthy growth and development among young children in a low-resourced urban community in Haiti.

Methods: A small pilot study was conducted in Cap-Haïtien, Haiti between January and March 2017. Prior to the implementation of the pilot study four focus groups (n= 31) and in-depth interviews (n= 14) were conducted with community health workers and parents of children aged 6-24 months. Using a grounded theory approach, interviews were analyzed to explore parenting behaviors and receptivity to different intervention types. Findings were used to adapt a group-based parenting intervention. Families of young children ages 6-24 months were then recruited and randomly assigned to the intervention (n=15) or control (n=15) groups for two months. Children in the intervention group received a weekly ration of eggs, and their parents received the parenting for growth and development intervention which included messages related to child feeding, hygiene and sanitation, responsive parenting, and child development. Following completion of the intervention, interviews were conducted with parents in the intervention group to assess intervention acceptability, feasibility and receptivity among parents.

Results: Pre-implementation focus group and in-depth interview analysis revealed that information about child development, and parenting for growth and development is not incorporated into usual well-baby care in Cap-Haïtien. Both parents and community health workers wanted more information about ways to promote healthy development in their young children. Parents reported they preferred a group based intervention so that they could receive support and learn from other parents. This information was used to adapt a 12-week group-based parenting intervention. Parents who participated in the intervention reported that they learned many new behaviors related to child feeding, sleeping, playing, and calming methods. Overall, they responded favorably to the intervention. Additionally, the intervention was able to be feasibly delivered within a community health clinic.

Conclusion and implications: Promising findings suggest that this parenting intervention, plus the ration of eggs, is an important strategy to promote healthy growth and development among a vulnerable population at high risk for stunting. These findings were utilized to inform a larger clinical trial assessing the effectiveness of an integrated nutrition and child development intervention in Cap-Haïtien.