Joint parental stimulation and early childhood development in 26 sub-Saharan African countries

Engagement in stimulation activities by both parents can have synergistic effects on early childhood development (ECD). While the role of maternal stimulation is well known, the association with paternal stimulation remains underexplored and inconsistent. The current study aimed to assess the distribution of different combinations of maternal and paternal stimulation and explore their associations with ECD in the context of sub-Saharan Africa (SSA).

Using the Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 26 SSA countries, we included 69 637 children aged 3-4 years in the analysis. The standardised ECD z-score was constructed using the ECD index. We estimated three-level linear regressions to assess its association with parental engagement in stimulation activities which was classified into four categories: mother low, father low (fewer than four activities); mother high, father low; father high, mother low; mother high, father high. Stratification analyses were conducted to examine whether the association differs by socioeconomic, geographic and learning-related variables.

Only 4% of parents provided high stimulation jointly (both high), which was associated with higher ECD z-score compared with both parents providing low stimulation (both low), after adjusting for covariates (b=0.04, 95% CI=0.01, 0.08). The association between joint parental stimulation and ECD was greater for children from wealthier households compared with their poorer counterparts (interaction p=0.012).

Children showed better developmental status when both parents jointly provided high stimulation. Policies and interventions should target both mothers and fathers, and transform traditional norms about parenting to achieve the most optimal development outcomes of children.