Participation in a Community-Based Women's Health Education Program and At-Risk Child Development in Rural Kenya: Developmental Screening Questionnaire Results Analysis

Megan S. McHenry; Lauren Y. Maldonado; Ziyi Yang; Gertrude Anusu; Evelyn Kaluhi; Astrid Christoffersen-Deb; Julia J. Songok; Laura J. Ruhl

doi:10.9745/GHSP-D-20-00349

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FIGURE
Cluster-Randomized Controlled Trial Profile and Study Inclusion Criteria of Maternal Participation in a Community-Based Women's Health Education Program in Rural Kenya
Abbreviations: CUs, community health units; DSQ, developmental screening questionnaire; Chamas, Chamas for Change Program.

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TABLE 1.

Characteristics of Women Included in a Cluster-Randomized Study on the Effect of Maternal Participation in a Women's Health Education Intervention on Early Childhood Development, Tranz Nzoia County, Kenya

	Total (N=1,273) N (%)	Intervention (n=689) n (%)	Control (n=584) n (%)	P Value
Child's age, months, mean (SD)	10.9 (2.3)	11.2 (2.4)	10.5 (2.2)	<.001
Mother's age, years, mean (SD)	26.8 (6.4)	27.0 (6.6)	26.7 (6.1)	.341
Categorized mother's age, years
<18	48 (3.8)	32 (4.8)	16 (2.8)
18–24	462 (36.8)	240 (35.8)	222 (38.1)
25–32	487 (38.8)	259 (38.6)	228 (39.2)
>32	256 (20.4)	140 (20.9)	116 (19.9)	.266
Missing data (n)	20	18	2
Marital status
Single/divorced/separation/widowed	206 (16.2)	117 (17.0)	89 (15.2)
Married	1067 (83.8)	572 (83.0)	495 (84.8)	.401
Employment status
Unemployed	802 (63.0)	437 (63.4)	365 (62.5)
Temporary work	74 (5.8)	41 (6.0)	33 (5.7)
Self-employed/permanently employed	397 (31.2)	211 (30.6)	186 (31.9)	.885
Highest educational level of household head*
Pre-primary/none/other	181 (14.3)	87 (12.7)	94 (16.1)
Primary	592 (46.6)	342 (49.9)	250 (42.8)
Secondary/post-primary/ vocational	391 (30.8)	218 (31.9)	173 (29.6)
College or higher	106 (8.4)	39 (5.7)	67 (11.5)
Missing data (n)	3	3	0	<.001
Highest educational level of any member^{^a}
Pre-primary/none/other	103 (8.2)	44 (6.5)	59 (10.1)
Primary	485 (38.5)	268 (39.6)	217 (37.2)
Secondary/post-primary/vocational	468 (37.1)	272 (40.2)	196 (33.6)
College or higher	205 (16.3)	93 (13.7)	112 (19.2)	.002
Missing data (n)	12	12	0
Household food access (during last 7 days)^{^a}
Bread	834 (65.8)	439 (64.3)	395 (67.6)	.209
Missing data (n)	6	6	0
Meat/fish	924 (72.8)	488 (71.2)	436 (74.7)	.173
Missing data (n)	4	4	0
Bananas	782 (62.0)	405 (59.6)	377 (64.8)	.057
Missing data (n)	11	9	2
Household items^{^a}
Towels	761 (59.9)	398 (58.0)	363 (62.2)	.134
Missing data (n)	3	3	0
Thermos flask	899 (71.1)	492 (72.1)	407 (69.8)	.362
Missing data (n)	8	7	1
Housing: wall material^{^a}
Natural walls	994 (78.2)	561 (81.7)	433 (74.1)
Finished walls	262 (20.6)	124 (18.1)	138 (23.6)
Uncovered wall	15 (1.2)	2 (0.3)	13 (2.2)	<.001
Missing data (n)	2	2	0
Housing: floor material^{^a}
Natural floor	933 (73.6)	523 (76.4)	4110 (70.3)
Other	335 (26.4)	162 (23.7)	173 (29.7)	.015
Missing data (n)	5	4	1
% poverty likelihood^{^b} (at national poverty line^{^a}, mean (SD)	0.3 (0.2)	0.32 (0.20)	0.29 (0.21)	.007
Missing data (n)	134	94	49

Abbreviation: SD, standard deviation.
↵a Indicates variables included within the poverty probability index.
↵b The % poverty likelihood was derived based on the participants who had non-missing values on variables with ^a in the table. We excluded 6 intervention and 6 control second-born twins among live dyads assessed.

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TABLE 2.

Rates of Child At-Risk Development, by Age and Study Group, in a Cluster-Randomized Study on the Effect of Maternal Participation in a Women's Health Education Intervention on Early Childhood Development, Tranz Nzoia County, Kenya

Child Age (Months) (N=1,273)	Intervention	Control	P Value
1 (N=5)	0/2	2/3 (66.7%)	.400
2 (N=5)	0/2	0/3	--
3 (N=8)	0/5	1/3 (33.3%)	.375
4 (N=6)	1/3 (33.3%)	1/3 (33.3%)	1.000
5 (N=9)	0/6	0/3	--
6 (N=6)	2/2 (100.0%)	3/4 (75.0%)	1.000
7 (N=55)	2/29 (6.9%)	3/26 (11.5%)	.659
8 (N=86)	0/46	4/40 (10.0%)	.043
9 (N=132)	2/59 (3.4%)	4/73 (5.5%)	.691
10 (N=169)	0/78	4/91 (4.4%)	.125
11 (N=243)	1/114 (0.9%)	1/129 (0.8%)	1.000
12 (N=236)	3/114 (2.6%)	3/122 (2.5%)	1.000
13 (N=169)	2/120 (1.7%)	2/49 (4.1%)	.580
14 (N=102)	1/73 (1.4%)	0/29 (0)	1.000
15 (N=42)	3/36 (8.3%)	0/6	1.000
TOTAL	17/689 (2.5%)	28/584 (4.8%)	0.025

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TABLE 3.

Factors Associated With Child At-Risk Development in a Cluster-Randomized Study on the Effect of Maternal Participation in a Women's Health Education Intervention on Early Childhood Development, Tranz Nzoia County, Kenya

Factor	Degrees of Freedom	Wald Chi-square Test Statistic	P Value
Study randomization (intervention vs. control)	1	4.72	.030
Categorized mother's age in years	3	0.98	.807
Marital status	1	0.11	.739
Employment status	2	4.51	.105
Highest educational level of household head	3	4.81	.186
Housing-wall material	1	5.56	.018
Housing-floor material	1	3.74	.053
Age of mixed feeding	1	1.96	.162
Attitudes towards harsh punishment	2	1.65	.437
Child's birth weight in kilograms	1	3.54	.060
Child's age in months	1	12.52	<.001

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TABLE 4.

	Odds Ratio	95% Confidence Interval
Study randomization
Intervention^{^a}	0.50^{^b}	0.27, 0.94 ^{^b}
Control (reference)	-----	-------
Categorized mother's age (in years)
<18	0.91	0.14, 5.84
18–24	1.42	0.57, 3.53
25–32	1.47	0.60, 3.62
>32 (reference)	------	-----
Marital status
Single/divorced/separated/widowed	0.86	0.36, 2.05
Married (reference)	-----	-----
Employment status
Unemployed	2.16	0.93, 5.00
Temporary work	3.30	0.97, 11.26
Self-employed/permanently employed (reference)	---	----
Highest educational level of household head
Pre-primary/none	1.55	0.39, 6.11
Primary	1.60	0.47, 5.46
Secondary	0.65	0.18, 2.41
College or higher (reference)	-----	-------
Housing- wall material
Natural/uncovered walls	0.27^{^b}	0.09, 0.80^{^b}
Finished walls (reference)	-----	-------
Housing- floor material
Natural floor	3.02	0.97, 9.26
Other (reference)	-----	-------
Age of mixed feeding
>3 months	0.63	0.33, 1.20
≤ 3 months (reference)	-----	-------
Attitudes towards harsh punishment (response to “To properly raise a child, one must use harsh punishment”)
Strongly agree/ agree	5.71	0.40, 81.53
Disagree/strongly disagree	5.42	0.36, 82.04
Neither agree or disagree (reference)	-----	-----
Child's birth weight (in kilograms)	0.64	0.40, 1.02
Child's age in months (in months)^{^c}	0.82^{^b}	0.73, 0.92^{^b}

↵a Excluded 168 subjects due to missing values for primary outcome or covariate data, with 1,105 children remaining for analysis.
↵b Statistically significant with α set at .05.
↵c At the time of developmental screening questionnaire evaluation.