Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children

Background: Haiti is critically lacking early childhood development data needed for future programs and policies to improve outcomes, especially in malnourished populations. Global health literature shows the importance of developmental interventions for malnourished children and that responsive parenting improves both physical and cognitive developmental outcomes. This baseline study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy.

Methods: We used baseline cross-sectional data (N=42) from patients with moderate to severe malnutrition followed by a malnutrition clinic in St Marc, Haiti collected in 2016. Caregivers of children 0 to 2 years-old were recruited. The children were assessed for developmental status using the Ages and Stages Questionnaire translated into Haitian Creole. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood developmental delays and caregiver depression risk were calculated. Univariate and multivariable logistic regression analyses were used to test whether caregiver depression risk and low self-efficacy were associated with higher risk for childhood developmental delays.

Results: Among all participants, 45.2% (SD=7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD=7.4%) of caregivers were at high risk for depression. 47.6% (SD=7.7%) of caregivers reported low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.14-270.0) after adjusting for socio-economic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study.

Conclusion: Caregiver self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed in Haiti to design contextually appropriate interventions to promote early child development, with support for mothers to help bolster their self-efficacy.