|Care and Nutrition - Concepts and Measurement (IFPRI, 1997, 56 p.)|
UNICEF's (1990) original conceptual model of child survival, growth, and development, which identifies the role of care, is
|Care and Nutrition - Concepts and Measurement (IFPRI, 1997, 56 p.)|
UNICEF's (1990) original conceptual model of child survival, growth, and development, which identifies the role of care, is presented in Figure 1. In this model, care, household food security, and a healthy environment are the three underlying factors that determine the nutrient intake and health of children, and, in turn, their survival, growth, and development. "Care" refers to practices performed by caregivers that affect nutrient intake, health, and the cognitive and psychosocial development of the child.2
2 Care differs from caring capacity because "capacity" refers to a potential to provide care, but it may not indicate whether the care is provided. If, the caregiver has many constraints to care, she may not be able to put her capacity into practice. A second commonly used term that seems to overlap with care is "infant and young child feeding practices." However, feeding practices, which are usually assessed by interviewing the mother, may reflect overall patterns of behavior rather than specific actions. What people actually do, on the other hand, may or may not be consistent with these general patterns of behavior. For example, a woman may state that she introduced complementary feeding to a child at four months of age and forget the small bites offered to a curious child at three months because they did not seem to be significant events and were not encoded in her memory as foods offered. If she thinks that her overall decision was to introduce complementary food at four months, the small bites earlier may be inconsistent with her overall pattern and therefore not remembered. Thus the reported infant feeding practice represents a simplification of practices consistent with belief, but not necessarily an accurate reflection of day-to-day practices. Both practices and behavior are important to evaluate, but the difference between them should be recognized.
This model of care can be expanded in two directions. First, it should emphasize that effective care practices require time and other resources, and second, it should underscore that the child's behavior or characteristics play a role in determining care.
The Extended UNICEF Model of Care
In order to perform care practices, the caregiver needs sufficient education, time, and support. The provision of these resources by family or society can be considered care for the caregiver. In Figure 2, the UNICEF model is adapted to incorporate care to the caregiver. Six major categories of resources that caregivers need can be identified from the literature: (1) education, knowledge, and beliefs; (2) health and good nutritional status; (3) mental health, lack of stress, and self-confidence; (4) autonomy, control of resources, and control of intrahousehold allocation; (5) reasonable workloads and adequate time available; and (6) social support from family members and the community. These six are the human, economic, and organizational resources identified in the UNICEF model, defined at family and community levels (Jonsson 1995).
Education, knowledge, and beliefs represent the capacity of the caregivers to provide appropriate care. The physical and mental health (including self-confidence and lack of stress and depression) of the caregiver represent individual factors that facilitate the translation of capacity to behavior. Finally, autonomy, workload, and social support are facilitating conditions in the family and community. Some of these resource categories have been investigated extensively, whereas others have been investigated primarily in developed countries or await further investigation.
The Transactional Model of Care
The extended UNICEF model of child care is a useful framework for assessing the capacity and ability of the caregiver and family to provide care. However, a model of child care should assess not only the caregiver's behavior, but also the behavior of the child and the characteristics of the child's environment. All three of these factors play a significant role in the eventual nutritional status of the child (Black et al. 1994).
For the past 25 years, psychologists have documented the significant role that children play in determining the care that they receive (see, for example, Bell 1971). Differences between children, such as endowed healthiness, perceived vulnerability, perceived weight, and even physical attractiveness, affect the practices of their caregivers3 The transactional model of care argues that the results or effects of a child's endowments are a function of a long series of mutual interactions or transactions between the developing child and the care-giver, and that these interactions are constantly changing with the changing developmental status of the child (Sameroff 1989). At the heart of the process is the relationship between the child and the caregiver (or care-givers). This affective, or emotional, relationship is a unique and life-long bond between two humans, called an attachment (Ainsworth et al. 1978). Problems in this emotional relationship can contribute to child malnutrition or ill health or may result in attachment problems. For example, Valenzuela (1990) found that in Chile, children who were undernourished were far less likely to be securely attached to a caregiver, though this association could not be interpreted as causality.
3 See Engle and Riccuiti 1995 for a summary of this argument.
Figure I - The UNICEF conceptual model
Source: UNICEF 1990.
Figure 2 - The extended model of care
The healthy development o