%0 Journal Article
%T Addressing Social Determinants of Health by Integrating Assessment of Caregiver-Child Attachment into Community Based Primary Health Care in Urban Kenya
%A John H. Bryant
%A Nancy H. Bryant
%A Susanna Williams
%A Racheal Nduku Ndambuki
%A Paul Campbell Erwin
%J International Journal of Environmental Research and Public Health
%D 2012
%I MDPI AG
%R 10.3390/ijerph9103588
%X 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¨CDecember 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.
%K social determinants of health
%K early childhood development
%K caregiver-child attachment
%U http://www.mdpi.com/1660-4601/9/10/3588