Addressing social determinants of health by integrating assessment of caregiver-child attachment into community based primary health care in urban Kenya
Bryant, J.H.; Bryant, N.H.; Williams, S.; Ndambuki, R.Nduku.; Erwin, P.Campbell.
International Journal of Environmental Research and Public Health 9(10): 3588-3598
2013
ISSN/ISBN: 1661-7827 PMID: 23202764 DOI: 10.3390/ijerph9103588Document Number: 579103
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.