P3.H144: A Rapid Assessment of Community Perceptions and Existing Structures Supporting Early Childhood Development (ECD) for Children Aged 0-5 Years in Bomachoge Borabu Sub-County, Kisii County, Kenya

Background: Early Childhood Development (ECD) is a current global priority and central tenet of the 2030 Sustainable Development Goals. The Nurturing Care Framework (NCF) was subsequently adapted as a comprehensive approach to ECD. 45% of children in Kenya are at risk for poor development. Per the 2022 Kenya Demographic Health Survey, older age, rural settings, lower socioeconomic brackets, and lower maternal literacy levels increased the risk of a child not being developmentally on track. As a result, Kenya launched the 2022 Early Childhood Development Policy. However, an ECD policy review in Kenya found that most focused on health and nutrition, thus identifying a need for further investigation and implementation of policies that more comprehensively incorporate the NCF.

Methods: The aim of our study was to explore community perceptions and existing structures supporting ECD for children aged 0 to 5 years in Bomachoge Borabu sub-county, Kisii County, Kenya. Specifically, we aimed to (1) identify knowledge of ECD amongst caregivers, healthcare workers, and community leaders; (2) identify current ECD screening and counseling practices; and (3) identify existing community structures supporting children with developmental abnormalities. We performed a mixed-method qualitative study. Activities included a free-listing survey of caregivers, focus group discussions, semi-structured key informant interviews, maternal child health clinic observation, community resource mapping, asset mapping, home visits, and an educational baraza.

Results: Five key themes emerged from our study of community knowledge and perceptions of ECD. (1) Health and nutrition were identified as key indicators of ECD. (2) Caregiving was primarily done by mothers. (3) Safety and security were not explicitly linked to ECD. (4) Play, singing, dancing, and storytelling were critical in aiding ECD. (5) Developmental abnormalities or delays were considered by many as non-medical issues, and perceived to be caused by witchcraft, the ‘evil eye,’ or a curse. There was no routine screening, counseling, and documentation for ECD. While the top community resources for ECD were community health promoters, religious figures, and ECD schools, many barriers existed including distance, long waiting times, lack of medications or supplies, and poverty. Several institutions and personnel were linked as key assets for developmental assessments and treatment, but critical challenges were found in the referral system including lack of a pediatric provider in the sub-location.

Conclusion: While knowledge of the individual components of the NCF were evident across all parties, there was less emphasis on responsive caregiving, safety and security, and opportunities for early learning. Due to widespread beliefs of alternate causes of developmental abnormalities, we recommend more active partnership between healthcare providers and traditional healers in the community to strengthen the referral process and mitigate delays in diagnosis and treatment. Further work is needed to improve routine screening and counseling regarding ECD.