Nairobi Early Childcare in Slums (NECS) Study Protocol: a mixed-methods exploration of paid early childcare in Mukuru slum, Nairobi

Robert C Hughes; Patricia Kitsao-Wekulo; Sunil Bhopal; Elizabeth W Kimani-Murage; Zelee Hill; Betty R Kirkwood

doi:10.1136/bmjpo-2020-000822

Nairobi Early Childcare in Slums (NECS) Study Protocol: a mixed-methods exploration of paid early childcare in Mukuru slum, Nairobi

BMJ Paediatr Open. 2020 Dec 3;4(1):e000822. doi: 10.1136/bmjpo-2020-000822. eCollection 2020.

Authors

Robert C Hughes¹, Patricia Kitsao-Wekulo², Sunil Bhopal^{1

3}, Elizabeth W Kimani-Murage², Zelee Hill⁴, Betty R Kirkwood¹

Affiliations

¹ Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
² Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya.
³ Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
⁴ Epidemiology and Public Health, Institute of Global Health, University College London, London, UK.

Abstract

Introduction: The early years are critical. Early nurturing care can lay the foundation for human capital accumulation with lifelong benefits. Conversely, early adversity undermines brain development, learning and future earning.Slums are among the most challenging places to spend those early years and are difficult places to care for a child. Shifting family and work structures mean that paid, largely informal, childcare seems to be becoming the 'new normal' for many preschool children growing up in rapidly urbanising Africa. However, little is known about the quality of this childcare.

Aims: To build a rigorous understanding what childcare strategies are used and why in a typical Nairobi slum, with a particular focus on provision and quality of paid childcare. Through this, to inform evaluation of quality and design and implementation of interventions with the potential to reach some of the most vulnerable children at the most critical time in the life course.

Methods and analysis: Mixed methods will be employed. Qualitative research (in-depth interviews and focus group discussions) with parents/carers will explore need for and decision-making about childcare. A household survey (of 480 households) will estimate the use of different childcare strategies by parents/carers and associated parent/carer characteristics. Subsequently, childcare providers will be mapped and surveyed to document and assess quality of current paid childcare. Semistructured observations will augment self-reported quality with observable characteristics/practices. Finally, in-depth interviews and focus group discussions with childcare providers will explore their behaviours and motivations. Qualitative data will be analysed through thematic analysis and triangulation across methods. Quantitative and spatial data will be analysed through epidemiological methods (random effects regression modelling and spatial statistics).

Ethics and dissemination: Ethical approval has been granted in the UK and Kenya. Findings will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content.

Keywords: epidemiology.