title: Addressing social determinants of health by integrating assessment of caregiver-child attachment into community based primary health care in urban Kenya.
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.
authors.affiliation: 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. jbryantwcbr@gmail.com
authors.forename: John H
authors.initials: JH
authors.lastname: Bryant
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Bryant
authors.forename: Susanna
authors.initials: S
authors.lastname: Williams
authors.forename: Racheal Nduku
authors.initials: RN
authors.lastname: Ndambuki
authors.forename: Paul Campbell
authors.initials: PC
authors.lastname: Erwin
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D002947:Cities; D003153:Community Health Services; D005260:Female; D006304:Health Status; D006801:Humans; D007630:Kenya; D008297:Male; D009769:Object Attachment; D010287:Parent-Child Relations; D010290:Parents; D011320:Primary Health Care