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Kinship, Nuptiality and Child Health Outcomes in a Low Income Urban Area - JAMAA na AFYA ya MTOTO (JAMO)

Sangeetha Madhavan PI, with Kristen Stoebenau, Kenneth Leonard and Michael Wagner

Despite significant progress in improving child survival, sub-Saharan Africa continues to have some of the worst outcomes for children’s physical growth and early childhood development. This is driven in large part by elevated risks for children living in low-income urban communities. Whereas research has focused on environmental factors, socioeconomic status and access to services, much less effort has gone into understanding how rapid social transformation in marriage, and the role of kin, impacts children’s well-being in these communities. This project builds on the success of an NICHD R21 project to develop and test the Kinship Support Tree (KST) to assess quantity and quality of support from kin to single mothers and their children in a slum context in Nairobi, Kenya. The mixed methods, longitudinal study develops a new measure of union formalization to examine the relationships among kinship support, union formalization and infant / child development outcomes. The union formalization measure will capture the process of recognizing unions socially and/or legally. The study will be carried out in the same site as the KST project. The site hosts a Health and Demographic Surveillance System (HDSS) which facilitates initial sample selection and provides strong infrastructure. The team will conduct rigorous cognitive testing to finalize the questions on union formalization, validate existing relationship quality scales and pretest all instruments in the first year to inform the survey development. They then will start with 1,250 children ages 0-24 months with mothers aged 18-29 and collect data on the children, mothers and selected kin two times per year over 3 years. Data on kin include geospatial indicators of residence and distance and multiple domains of kinship support. This will be supplemented with qualitative follow up once a year on a subsample of mothers, biological fathers, and current partners. Analysis will focus on the direct effects of union formalization and kinship support on child outcomes as well as on a set of intermediate outcomes known to be associated with child development. The team will use cross-lagged structural equation and growth models to examine the effects of union formalization and kinship support on children’s physical growth and early child development (ECD) over time. They will also assess the extent to which union formalization moderates the effect of kinship support on physical growth and ECD outcomes and kinship support mediates the effect of union formalization on physical growth and ECD outcomes, using moderated mediation models. The ultimate goal of the study is to identify models of family support that offer optimum protection for vulnerable mothers and young children.

See the JAMO website for details about this project.

See a selection of infographics developed for the project


Kinship, Nuptiality and Child Health Outcomes in a Low Income Urban Area, NICHD R01, $3.2 million