GENDER IN LOW- AND MIDDLE-INCOME COUNTRIES: INTRODUCTION

Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review

BACKGROUND

Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items.

METHODS

We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics.

RESULTS

Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections.

CONCLUSION

Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.

Participation in organized sport and disruptive behavior in childhood: A prospective, population-based study

Child disruptive behavior refers to ongoing patterns of disorganized, uncooperative, and defiant behavior. Sport involvement promotes positive child development. However, few longitudinal studies have tested the association between organized sport participation and the behavioral components of disruptive behavior. First, we aim to examine the link between inattentive, hyperactive, aggressive, and oppositional behavior at age 4 years and trajectories of organized sport participation from ages 6 to 10 years. Then, we compare children, according to trajectory membership, on outcome differences on these same behaviors at age 12 years. Data are from the Quebec Longitudinal Study of Child Development (N = 1492). Child behavior was assessed by questionnaires completed by mothers at age 4 years and teachers at age 12 years. Preschool child inattention as perceived by mothers, significantly reduced the odds of middle childhood organized sport participation by 7% (95% CI = 1.00-1.15). Low or inconsistent participation in organized sport was subsequently associated with increased inattention (d = 0.28) by the end of sixth grade. These findings are above and beyond individual and family characteristics and baseline behavior. No other associations were statistically significant. Inattentive children who participated less in organized sport showed a greater likelihood toward increases in attention deficit by the end of sixth grade. To improve engagement from these children, coaches and trainers should use strategies that support positive experiences such as developing a one-to-one alliance with the child, favoring social cooperation through team spirit, and focusing on the performance experience rather than the outcome of winning or losing.

Development of the Family Togetherness Scale: A Mixed-Methods Validation Study in Kenya

Family functioning is an important target of clinical intervention and research given its close ties with mental health outcomes of both children and adults. However, we lack family functioning measures validated for use in many low- and middle-income country (LMIC) settings. In this mixed-methods prospective diagnostic accuracy study, we first used formative qualitative data to develop an extensive battery of screening items to measure family functioning in Kenya. We then recruited 30 Kenyan families (N = 44 adults; 30 youth aged 8-17 years) to complete the questionnaires and participate in clinical interviews conducted by local interviewers. Quantitative and qualitative analyses were then conducted to select a subset of screening items that balanced conceptual understanding of family distress with diagnostic efficiency and accuracy to yield a brief but valid scale. The final index test consisting of 30 items correctly identified distressed families in 89% of cases according to adult-report and 76% of cases according to child-report. The optimal cutoffs are associated with estimates of sensitivity/specificity of 0.88/0.90 and 0.75/0.77 for adult-report and child-report measures, respectively. The final measure-the Family Togetherness Scale (FTS)-assesses global family functioning, including items related to family organization, emotional closeness, and communication/problem-solving. In addition to general items, the scale also includes items explicitly assessing family responses to stressors common in LMIC settings. Results establish a strong rationale for larger-scale validation studies.

How do phonological awareness, rapid automatized naming, and vocabulary contribute to early numeracy and print knowledge of Filipino children?

The current study investigated the contributions of phonological awareness, rapid automatized naming (RAN), and vocabulary to early numeracy and print knowledge developmental trajectories. A total of 128 young Filipino children were tracked three times at mean ages of 4.5, 5.0, and 5.5 years. The initial level (the intercept) and the growth rate (the slope) of early numeracy and print knowledge were estimated. Results showed that phonological awareness, vocabulary, and age significantly predicted the initial level of early numeracy. RAN and vocabulary explained significant variance in the growth rate of early numeracy. Phonological awareness, RAN, and vocabulary accounted for unique variance in the initial level of print knowledge. Results highlight the differential roles of phonological awareness, RAN, and vocabulary knowledge in the development of early numeracy and print knowledge among Filipino children.

Men's and women's views on acceptability of husband-to-wife violence and use of corporal punishment with children in 21 low- and middle-income countries

BACKGROUND

Monitoring violence against women and children, and understanding risk factors and consequences of such violence, are key parts of the action plan for the Sustainable Development Goals (SDGs) set by the United Nations General Assembly in 2015.

OBJECTIVE

We examined how men's and women's views about the acceptability of husband-to-wife violence are related within households and how views about the acceptability of husband-to-wife violence are related to beliefs in the necessity of using corporal punishment to rear children and to reported use of corporal punishment with children.

PARTICIPANTS AND SETTING

We used nationally representative samples of men and women in 37,641 households in 21 low- and middle-income countries that participated in UNICEF's Multiple Indicator Cluster Survey.

METHODS

We conducted a series of logistic regression models, controlling for clustering within country, with outcomes of whether participants believe corporal punishment is necessary in childrearing, and whether a child in their household experienced corporal punishment in the last month.

RESULTS

In 46 % of households, men, women, or both men and women believed husbands are justified in hitting their wives. Children in households in which both men and women believe husbands are justified in hitting their wives had 1.83 times the odds of experiencing corporal punishment as children in households in which neither men nor women believe husbands are justified in hitting their wives (95 % CI: 1.12, 2.97).

CONCLUSIONS

Working toward the realization of SDG 5 and SDG 16 involving prevention of violence against women and children, respectively, should be complementary undertakings.

Sex and gender analysis in knowledge translation interventions: challenges and solutions

Sex and gender considerations are understood as essential components of knowledge translation in the design, implementation and reporting of interventions. Integrating sex and gender ensures more relevant evidence for translating into the real world. Canada offers specific funding opportunities for knowledge translation projects that integrate sex and gender. This Commentary reflects on the challenges and solutions for integrating sex and gender encountered in six funded knowledge translation projects. In 2018, six research teams funded by the Canadian Institutes of Health Research's Institute of Gender and Health met in Ottawa to discuss these challenges and solutions. Eighteen participants, including researchers, healthcare professionals, trainees and members of the Institute of Gender and Health, were divided into two groups. Two authors conducted qualitative coding and thematic analysis of the material discussed. Six themes emerged, namely Consensus building, Guidance, Design and outcomes effectiveness, Searches and recruitment, Data access and collection, and Intersection with other determinants of health. Solutions included educating stakeholders on the use of sex and gender concepts, triangulating perspectives of researchers and end-users, and participating in organisations and committees to influence policies and practices. Unresolved challenges included difficulty integrating sex and gender considerations with principles of patient-oriented research, a lack of validated measurement tools for gender, and a paucity of experts in intersectionality. We discuss our findings in the light of observations of similar initiatives elsewhere to inform the further progress of integrating sex and gender into the knowledge translation of health services research findings.

Gender disparities in child development in the east Asia-Pacific region: a cross-sectional, population-based, multicountry observational study

BACKGROUND

Gender differences in child development have been extensively studied in high-income countries, but few data are available from low-income and middle-income countries. Our objective was to assess gender disparities in child development that might arise from differential investment in child health, nutrition, and education in six countries across the east Asia-Pacific region.

METHODS

In this cross-sectional, population-based study we quantified the magnitude of gender differences in child development using the East Asia-Pacific Early Child Development Scales (EAP-ECDS) in six countries (Cambodia, China, Mongolia, Papua New Guinea, Timor-Leste, and Vanuatu). We used stratified random sampling (according to age, residence [urban vs rural], and sex) in all countries to recruit eligible children aged 3-5 years from non-ethnic minority populations with no identified or suspected special educational needs for whom EAP-ECDS scores for five or more of seven domains and urban-rural residence information were available. Gender differences in development associated with four national indicators of gender equality (sex ratio at birth, Gender Development Index, Gender Inequality Index, and Gender Parity Index for primary school enrolment) were also examined. We used generalised estimating equation regression to study moderation of differences by family socioeconomic status and wealth, and structural equation models with maximum likelihood to test mediation through health, nutrition, and education.

FINDINGS

Between June 1, 2013, and Dec 13, 2013, 7582 eligible children were included from Cambodia (n=1189), China (n=1618), Mongolia (n=1230), Papua New Guinea (n=1639), Timor-Leste (n=1176), and Vanuatu (n=730). Girls had significantly higher development scores than boys in Cambodia (difference in composite score: β=1·87 points, 95% CI 0·29 to 3·45; p=0·747), China (2·66 points, 1·20 to 4·13; p=0·0004), Vanuatu (3·10 points, 1·65 to 4·55; p<0·0001), and Mongolia (3·94 points, 2·67 to 5·21; p<0·0001), but not Papua New Guinea (-0·43 points, -1·19 to 0·33; p=0·272) or Timor-Leste (0·09 points, -0·96 to 1·14; p=0·861). Differences in favour of girls were the largest for language skills in Mongolia (5·30 points, 95% CI 4·45 to 6·15); differences in language skills were smallest in the two poorest countries, Timor-Leste (-0·07 points, -1·03 to 0·88) and Papua New Guinea (0·05 points, -1·02 to 1·12). Greater differences in composite scores for girls compared with boys-in favour of girls-were associated with higher national Gender Development Index values (R²=0·790). In Mongolia, smaller gender differences in development were associated with increased household wealth (6·07 points [95% CI 3·22 to 8·92] in the lowest wealth quartile vs 2·27 points [1·38 to 3·15] in the highest wealth quartile), whereas in Timor-Leste, girls only outperformed boys when living in households with higher socioeconomic status (2·87 points [0·27 to 5·47] in the highest wealth quartile and 3·74 points [2·17 to 5·31] in the highest quartile of parental socioeconomic status). Mediating pathways explained up to 37% (in Vanuatu) of the association between gender and development, controlling for family socioeconomic status.

INTERPRETATION

Girls aged 3-5 years generally outperformed boys on tests of development, and increasing levels of gender equality across six countries in the east Asia-Pacific region were associated with improved performance of young girls relative to boys. Greater opportunities for economic development are anticipated to result from improvements in gender equality and in the development of girls. Further study is warranted to understand family-level processes and societal norms that lead to gender differences in child development in the early years.

FUNDING

UNICEF, the Asia-Pacific Regional Network for Early Childhood, and the Open Society Foundations.

Change over time in parents' beliefs about and reported use of corporal punishment in eight countries with and without legal bans

Stopping violence against children is prioritized in goal 16 of the Sustainable Development Goals adopted by the United Nations General Assembly in 2015. All forms of child corporal punishment have been outlawed in 50 countries as of October 2016. Using data from 56,371 caregivers in eight countries that participated in UNICEF's Multiple Indicator Cluster Survey, we examined change from Time 1 (2005-6) to Time 2 (2008-13) in national rates of corporal punishment of 2- to 14-year-old children and in caregivers' beliefs regarding the necessity of using corporal punishment. One of the participating countries outlawed corporal punishment prior to Time 1 (Ukraine), one outlawed corporal punishment between Times 1 and 2 (Togo), two outlawed corporal punishment after Time 2 (Albania and Macedonia), and four have not outlawed corporal punishment as of 2016 (Central African Republic, Kazakhstan, Montenegro, and Sierra Leone). Rates of reported use of corporal punishment and belief in its necessity decreased over time in three countries; rates of reported use of severe corporal punishment decreased in four countries. Continuing use of corporal punishment and belief in the necessity of its use in some countries despite legal bans suggest that campaigns to promote awareness of legal bans and to educate parents regarding alternate forms of discipline are worthy of international attention and effort along with legal bans themselves.

GENDER IN LOW- AND MIDDLE-INCOME COUNTRIES: INTRODUCTION

How do girls and boys in low- and middle-income countries (LMIC) in the majority world vary with respect to central indicators of child growth and mortality, parental caregiving, discipline and violence, and child labor? How do key indicators of national gender equity and economic development relate to gender similarities and differences in each of these substantive areas of child development? This monograph of the SRCD is concerned with central topics of child gender, gendered parenting, gendered environments, and gendered behaviors and socializing practices in the underresearched and underserved world of LMIC. To examine protective and risk factors related to child gender in LMIC around the world, we used data from more than 2 million individuals in 400,000 families in 41 LMIC collected in the Multiple Indicator Cluster Survey, a household survey that includes nationally representative samples of participating countries. In the first chapter of this monograph, we describe the conceptual "gender similarities" and "bioecological" frameworks that helped guide the monograph. In the second chapter, we detail the general methodology adhered to in the substantive chapters. Then, in topical chapters, we describe the situations of girls and boys with successive foci on child growth and mortality, parental caregiving, family discipline and violence, and child labor. We conclude with a general discussion of findings from the substantive chapters in the context of gender and bioecological theories. Across 41 LMIC and four substantive areas of child development, few major gender differences emerged. Our data support a gender similarities view and suggest that general emphases on early child gender differences may be overstated at least for the developing world of LMIC.

A Developmental Analysis of Caregiving Modalities Across Infancy in 38 Low- and Middle-Income Countries

Caregiving is requisite to wholesome child development from the beginning of life. A cross-sectional microgenetic analysis of six caregiving practices across the child's 1st year (0-12 months) in 42,539 families from nationally representative samples in 38 low- and middle-income countries is reported. Rates of caregiving varied tremendously within and across countries. However, caregiving practices followed one of two developmental trajectories: (a) greater proportions of caregivers read, told stories, and named, counted, and drew with each additional month of infant age, and (b) proportions of caregivers who played, sang songs, and took their infants outside increased each month from birth but reached an asymptote at 4-5 months. Rates and growth functions of caregiving have implications for infant care and development.

Pathways among Caregiver Education, Household Resources, and Infant Growth in 39 Low- and Middle-Income Countries

Caregiver education is known to relate to the growth of children, but possible mediation mechanisms of this association are poorly characterized and generally lack empirical support. We test whether instructional capital (caregiver education) leads to improved infant growth through availability of physical capital (household resources) across a wide swath of low- and middle-income countries (LMIC). Using the Multiple Indicator Cluster Survey (MICS3), we explore relations among caregiver education, household resources, and infant (M age = .99 years) growth in 117,881 families living in 39 LMIC. Overall, household resources mediated 76% of the small association between caregiver education and infant growth. When disaggregated by countries characterized by low, medium, and high levels of human development (as indexed by average life expectancy, education, and gross domestic product), household resources mediated 48% to 78% of the association between caregiver education and infant growth. Caregiver education had effects on infant growth through household resources in countries characterized by low, medium, and high levels of human development; for girls and boys; and controlling for indexes of infant feeding and health.

Infant temperament: stability by age, gender, birth order, term status, and socioeconomic status

Two complementary studies focused on stability of infant temperament across the 1st year and considered infant age, gender, birth order, term status, and socioeconomic status (SES) as moderators. Study 1 consisted of 73 mothers of firstborn term girls and boys queried at 2, 5, and 13 months of age. Study 2 consisted of 335 mothers of infants of different gender, birth order, term status, and SES queried at 6 and 12 months. Consistent positive and negative affectivity factors emerged at all time points across both studies. Infant temperament proved stable and robust across gender, birth order, term status, and SES. Stability coefficients for temperament factors and scales were medium to large for shorter (< 9 months) interassessment intervals and small to medium for longer (> 10 months) intervals.