Understanding variability in child development outcome in resource-constricted settings : the contribution of the home environment.

Abstract

The main purpose of the present study was to establish the manner in which children’s home environments (proximal processes) and family household wealth (distal contexts) individually and collectively influence child development, and how these relationships change at different child ages. Based on Bronfenbrenner’s bioecological theory, I hypothesized that proximal processes within the home environment would have a stronger impact on child outcomes than the distal factors within the children’s contexts. The effects of these factors were explored through two different studies: Sub-Study 1 among a rural school-age population (the School-age Study) and Sub-Study 2 among a rural infant population (the Infant Study). The data in the School-age Study were derived from a larger cross-sectional study examining the development of appropriate methodologies to assess executive functions, motor development and the home environment in 308 school-age children. A prospective follow-up study of approximately 300 mother-infant dyads was conducted as Sub-Study 2. The participants in the Infant Study were drawn from families enrolled in a then ongoing longitudinal study on the neurobehavioural outcomes of children exposed to HIV and malaria. Both studies were conducted at the coast of Kenya, one in the northern, and the other in the southern mainland. As tools to assess child development outcomes were not readily available for the school-age population, existing measures of language skills, motor abilities and the home environment were modified and adapted to make them culturally meaningful, and then validated for this population to establish whether or not they maintained their psychometric properties. Information on child functioning was obtained through interviews with caregivers, direct observations and assessment of children. I used Structural Equation Modelling (SEM) as the main analysis method to examine the relationships among the variables of interest in both studies. For the two groups, the varying strength of the associations between background variables and outcomes demonstrated that there are different causal pathways through which the home environment and family household wealth influence child functioning at different ages. These findings provided partial support for the bioecological theory. This study has made important contributions to the knowledge base by illustrating which aspects within the home environment have the strongest impact on child outcomes. Such information is important to child development researchers working within similar settings. We recommend, based on the findings of the current study, that these aspects be considered when planning interventions to improve future outcomes for children living in resource-constricted settings.