Community Perceptions and Practices of Early Childhood Development in an Urban-poor Setting in Nairobi: Uncovering Contextual Drivers beneath Poverty

Abstract Worldwide, over 250 million children under five are at risk of not achieving their developmental potential due to extreme poverty, malnutrition, infections, and unstimulating environments. Caregivers’ knowledge, attitudes and practices of child care are a salient yet important factor in influencing early childhood development (ECD) outcomes. While knowledge, attitudes and practices of ECD and associated factors are indeed noticeable and contribute significantly to developmental outcomes, the chances of them being addressed are minimal as they are not being investigated. We aimed to assess the knowledge, attitudes and practices of ECD, and associated challenges in an urban-poor setting in Kenya. A qualitative survey was conducted among parents and other community members in Korogocho, Nairobi within the context of a larger study which aimed to examine the feasibility and impact of a mobile phone application for monitoring child developmental milestones. We conducted focus group discussions(FGDs) and key informant interviews(KIIs) with 64 primary caregivers, 64 community health volunteers (CHVs), and 11 representatives from county and sub-county government to gauge their knowledge, attitude and practices in ECD. We also asked them about the challenges they faced in supporting child stimulation, nutrition and health care, and what their expectations were of the proposed intervention. Interviews were audio-recorded, and the data were transcribed and analyzed using thematic analysis. The results showed that the community (parents, and CHVs) appreciated the importance of ECD. However, their perceptions and caregiving practices were generally poor and were driven by poverty and cultural and religious beliefs and practices, and family factors that act in the background of poverty. Implications of these findings for future research, policy and interventions for improving these practices are discussed.