Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya

John H. Bryant, Nancy H. Bryant, Susanna Williams, Racheal Nduku Ndambuki and Paul Campbell Erwin
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John H. Bryant: Orphans and Vulnerable Children’s Project in Africa, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Department Public Health Sciences, University of Virginia Faculty of Medicine, 250 Pantops Mountain Road, Apt 5223 Charlottesville, VA 22911, USA
Nancy H. Bryant: Orphans and Vulnerable Children’s Project in Africa, 250 Pantops Mountain Road, Apt 5223 Charlottesville, VA 22911, USA
Susanna Williams: Guatemala Initiative, School of Medicine, University of Virginia, 737 Locust Avenue Charlottesville, VA 22902, USA
Racheal Nduku Ndambuki: Orphans and Vulnerable Children’s Project in Africa, P.O. Box 433-00242 Kitengela, Nairobi, Kenya
Paul Campbell Erwin: Department of Public Health, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA

IJERPH, 2012, vol. 9, issue 10, 1-11

Abstract: A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH.

Keywords: social determinants of health; early childhood development; caregiver-child attachment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2012
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