Background: Responsive caregiving, or interactions in which caregivers give appropriate responses to a child’s signals, is linked to improved psychosocial, cognitive and physical outcomes in children. However, much remains unknown about how responsive caregiving affects child development across cultural and socioeconomic contexts. The purpose of this study is to examine predictors of maternal responsive caregiving and investigate how these interactions are associated with children’s development.Methods: Data for the current analyses came from a longitudinal study designed to follow mothers from the third trimester through the first three years of the child’s life. To assess responsive caregiving, the Observation of Mother-Child Interaction (OMCI) measure was used to examine maternal and child behaviors during a 5-min picture book activity at 24 months. Outcomes included child height-for-age z-score and child socioemotional development, using the Ages and Stages Questionnaire-Socioemotional (ASQ-SE) in which lower scores demonstrated better development. Using mean comparisons, the effects of baseline sociodemographic factors and maternal depression on responsive caregiving were tested. Analyses utilized hierarchical linear regressions to examine cross-sectional associations between responsive caregiving and child development outcomes at 24 months. Additional analyses controlled for the Home Observation for Measurement of the Environment (HOME), a common measure in low-income contexts of caregiving, to assess whether OMCI was uniquely predictive of child outcomes.Results: Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Higher total OMCI scores were associated with positive child socioemotional outcomes in adjusted models (β: -0.84, 95% CI [− 1.40, − 0.29]). The finding was statistically significant, even after controlling for HOME score (β: -0.83, 95% CI [− 1.38, − 0.27]). There was no association between OMCI scores and child linear growth.Conclusions: Responsive caregiving is linked to positive child socioemotional development in rural Pakistan. Our findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development. The OMCI may be useful in identifying important pathways for change to responsive caregiving behaviors and may be of service for future interventions that optimize child development through responsive caregiving.Trial registration: NCT02111915(09/18/2015);NCT02658994(01/22/2016). Trials were prospectively registered.

Racism is now widely recognized as a fundamental cause of health inequali­ties in the United States. As such, health scholars have rightly turned their attention toward examining the role of struc­tural racism in fostering morbidity and mortality. However, to date, much of the empirical structural racism-health dispari­ties literature limits the operationalization of structural racism to a single domain or orients the construct around a White/ Black racial frame. This operationaliza­tion approach is incomprehensive and overlooks the heterogeneity of historical and lived experiences among other racial and ethnic groups.To address this gap, we present a theoreti­cally grounded framework that illumi­nates core mutually reinforcing domains of structural racism that have stratified opportunities for health in the United States. We catalog instances of structural discrimination that were particularly con­straining (or advantageous) to the health of racial and ethnic groups from the late 1400s to present. We then illustrate the utility of this framework by applying it to American Indians or Alaska Natives and discuss the framework’s broader implica­tions for empirical health research. This framework should help future scholars across disciplines as they identify and interrogate important laws, policies, and norms that have differentially constrained opportunities for health among racial and ethnic groups.Ethn Dis. 2021;31(Suppl 1):301-310; doi:10.18865/ed.31.S1.301

Introduction Early childhood interventions primarily focus on the mother–child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is a paucity of research on grandmother caregiving in low-income and middle-income countries. We examined the role of grandmother involvement on child growth and development in the first 2 years of life cross sectionally and longitudinally in rural Pakistan. Methods We used data from the Bachpan Cohort, a longitudinal birth cohort in rural Pakistan. Maternally reported grandmother involvement in daily instrumental and non-instrumental caregiving was collected at 3 and 12 months. A summed score was created and categorised into non-involved, low and high. Outcomes included 12-month and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development and 24-month Ages and Stages Questionnaire—Socioemotional. We used multivariable generalised linear models to estimate mean differences (MD) at 12 months (n=727) and 24 months (n=712). Inverse probability weighting was used to account for missingness and sampling. Results In our sample, 68% of children lived with a grandmother, and most grandmothers were involved in caregiving. Greater 3-month grandmother involvement was positively associated with 12-month weight z-scores; however, greater involvement was associated with lower 24-month weight z-scores. High 12-month grandmother involvement was associated with improved 12-month cognitive (MD=0.38, 95% CI −0.01 to 0.76), fine motor skills (MD=0.45, 95% CI 0.08 to 0.83) and 24-month socioemotional development (MD=−17.83, 95% CI −31.47 to –4.19). No meaningful associations were found for length z-scores or language development. Conclusion In rural Pakistan, grandmothers provide caregiving that influences early child development. Our findings highlight the complex relationship between grandmother involvement and child weight, and suggest that grandmothers may positively promote early child cognitive, fine motor and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform caregiving interventions.

Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale. Trial registration number The trial is registered in ISRCTN (ISRCTN16001234).