Int. J. Environ. Res. Public Health 2012, 9(10), 3588-3598; doi:10.3390/ijerph9103588
Article

Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya

John H. Bryant 1 email, Nancy H. Bryant 2 email, Susanna Williams 3 email, Racheal Nduku Ndambuki 4 email and Paul Campbell Erwin 5,* email
1 Orphans and Vulnerable Children’s Project in Africa, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Department Public Health Sciences, University of Virginia Faculty of Medicine, 250 Pantops Mountain Road, Apt 5223 Charlottesville, VA 22911, USA 2 Orphans and Vulnerable Children’s Project in Africa, 250 Pantops Mountain Road, Apt 5223 Charlottesville, VA 22911, USA 3 Guatemala Initiative, School of Medicine, University of Virginia, 737 Locust Avenue Charlottesville, VA 22902, USA 4 Orphans and Vulnerable Children’s Project in Africa, P.O. Box 433-00242 Kitengela, Nairobi, Kenya 5 Department of Public Health, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA
* Author to whom correspondence should be addressed.
Received: 16 August 2012; in revised form: 18 September 2012 / Accepted: 26 September 2012 / Published: 12 October 2012
(This article belongs to the Special Issue Social and Economical Determinants of Health)
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Abstract: A principle strategic insight of the Final Report for WHO’s Commission on Social Determinants of Health (SDOH) is that the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development. A key determinant of early childhood development is the establishment of a secure attachment between a caregiver and child. We report initial field-tests of the integration of caregiver-child attachment assessment by community health workers (CHWs) as a routine component of Primary Health Care (PHC), focusing on households with children under 5 years of age in three slum communities near Nairobi, Kenya. Of the 2,560 children assessed from July–December 2010, 2,391 (90.2%) were assessed as having a secure attachment with a parent or other caregiver, while 259 (9.8%) were assessed as being at risk for having an insecure attachment. Parent workshops were provided as a primary intervention, with re-enforcement of teachings by CHWs on subsequent home visits. Reassessment of attachment by CHWs showed positive changes. Assessment of caregiver-child attachment in the setting of routine home visits by CHWs in a community-based PHC context is feasible and may yield valuable insights into household-level risks, a critical step for understanding and addressing the SDOH.
Keywords: social determinants of health; early childhood development; caregiver-child attachment

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Cite This Article

MDPI and ACS Style

Bryant, J.H.; Bryant, N.H.; Williams, S.; Ndambuki, R.N.; Erwin, P.C. Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya. Int. J. Environ. Res. Public Health 2012, 9, 3588-3598.

AMA Style

Bryant JH, Bryant NH, Williams S, Ndambuki RN, Erwin PC. Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya. International Journal of Environmental Research and Public Health. 2012; 9(10):3588-3598.

Chicago/Turabian Style

Bryant, John H.; Bryant, Nancy H.; Williams, Susanna; Ndambuki, Racheal Nduku; Erwin, Paul Campbell. 2012. "Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya." Int. J. Environ. Res. Public Health 9, no. 10: 3588-3598.

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