Differential effects of out-of-home day care in improving child nutrition and augmenting maternal income among those with and without childcare support: a prospective before-after comparison study in Pokhara, Nepal.
OBJECTIVE
We examined (1) whether attending out-of-home day care centres (DCCs) has differential effects on improvement of child nutrition and facilitation of maternal employment depending on availability of non-institutionalised childcare support and (2) whether attendance increases infectious diseases.


METHODS
In a prospective before-after comparison study at public DCCs in Pokhara, Nepal, we compared weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) among children attending DCCs between at admission, after 6 months, and after 1 year and determined differential changes in these measures between those with and without appropriate childcare support. We used repeated measures analysis of variance with interaction terms between support availability and DCC attendance. We compared maternal income and incidence of diarrhoea and fever in children between the periods of waiting and attending.


RESULTS
After 6 months, neither WAZ nor HAZ significantly changed. After 1 year, WAZ significantly improved, but HAZ did not change among all participants. Those without appropriate childcare support showed greater improvement in both WAZ and HAZ than those with support. While children were attending, income increased only among those mothers who were already working without any childcare support at baseline. Neither diarrhoea nor fever increased.


CONCLUSIONS
DCCs can be more beneficial for child nutrition and working mothers in households lacking childcare support than in those with support.
Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
Shinji
S
Nakahara
Krishna C
KC
Poudel
Milan
M
Lopchan
Om Raj
OR
Poudel
Kalpana
K
Poudel-Tandukar
Masao
M
Ichikawa
D000704:Analysis of Variance; D001827:Body Height; D001835:Body Weight; D002654:Child Care / Q000191:economics / Q000458:organization & administration; D002656:Child Day Care Centers; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D004651:Employment / Q000191:economics; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D007239:Infections / Q000453:epidemiology; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D009390:Nepal / Q000453:epidemiology; D011446:Prospective Studies; D012959:Socioeconomic Factors