(P17-007-23) Understanding Modifiable Caregiver Factors Contributing to Child Development Among Young Children in Rural Malawi

Objectives: To identify modifiable caregiver factors influencing child development in Malawi, and to deepen and expand empirical evidence on the complex relations between caregiver factors and child development.

Methods: We analysed baseline data from 1,021 mothers and their children < 2 years of age participating in a cluster-randomized controlled trial implemented in rural Malawi (2022-2025). We fit an evidence-based theoretical model using structural equation modelling, examining four caregiver factors: (1) diet diversity score (sum of food groups consumed in the past 24 hours), (2) empowerment (assessed using the project-level Women’s Empowerment in Agriculture Index), (3) mental health (assessed using the Self-Reported Questionnaire), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm-referenced aggregate Z-score). The model controlled for child, caregiver, and household socio-economic characteristics.

Results: Children were 9.8 months old on average and caregivers 25.2 years. Caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.081 (95% CI 0.025, 0.143)). Empowerment was directly associated with higher child development scores (0.063 (0.006, 0.123)), higher stimulation score (0.074 (0.014, 0.140)), higher dietary diversity (0.085 (0.016, 0.145)), and lower mental health scores (-0.068 (-0.137, -0.002)). Higher dietary diversity directly contributed to lower mental health scores: -0.058 (-0.111, -0.006). In addition, higher empowerment was indirectly associated with higher child development scores through improved dietary diversity: 0.007 (0.001, 0.017).

Conclusions: Caregiver diet and empowerment are two important factors directly influencing both child development and other caregiver factors. Interventions to improve child development should seek to leverage and improve these factors.

Funding Sources: Power for Nutrition