Mothers' caregiving resources and practices for children under 5 years in the slums of Hyderabad, India: a cross-sectional study.

BACKGROUND The extended care model of the United Nations Children's Fund (UNICEF) identifies knowledge/beliefs, nutritional status, mental health, control of resources/autonomy, workload/time constraints and social support as important caregiver resources for childcare. The aim of this paper is to examine the role of mothers' caregiving resources in child-care practices in slums. METHODS A cross-sectional study was conducted in 10 slums of Hyderabad, to appraise the caregiving practices and health status of children under 5 years. Data were collected from 506 households, selected through multistage stratified random sampling, and data relating to 451 children aged 6-59 months were analysed. Four caregiving practices were studied: psychosocial stimulation, as assessed by the Home Observation Measurement of the Environment inventory; hygienic care rated by spot-check observation; and meal frequency and dietary diversity based on maternal recall. The role of the mother's caregiving resources was examined using bivariate and multivariate logistic regression analyses. RESULTS More than 50% of the children received good psychosocial stimulation and close to 60% had good hygienic care. About 75% of the children aged 6-23 months had the recommended minimum meal frequency and 13% had the recommended dietary diversity. Mother's media exposure (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.35-3.77), participation in household budgeting (OR 2.19, CI 1.25-3.83) and husband's support (OR 2.04, CI 1.28-3.24) were predictors of psychosocial stimulation. Mother's younger age (OR 1.11, CI 1.04-1.18), poor media exposure (OR 1.95, CI 1.15-3.29), dissatisfaction with life (OR 1.84, CI 1.05-3.24), workload (OR 1.79, CI 1-3.18) and having no money for their own use (OR 1.52, CI 0.95-2.45) placed children at higher odds for receiving poor hygienic care. Leisure time (OR 2.75, CI 1.25-6.06) and participation in budgeting (OR 1.97, CI 1-3.86) were predictors of meal frequency. CONCLUSION Mother's workload, poor media exposure, dissatisfaction with life, lack of husband's support and absence of economic autonomy are constraints to good child care in slums.