AUTHOR=Nampijja Margaret , Langat Nelson , Oloo Linda , Okelo Kenneth , Muendo Ruth , Kiyeng Martin , Amboka Patrick , Abboah-Offei Mary , Ray Anna , Kitsao-Wekulo Patricia , Kimani-Murage Elizabeth W. , Elsey Helen 

TITLE=Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1163491

DOI=10.3389/fpubh.2023.1163491

ISSN=2296-2565

ABSTRACT=<sec id="sec1"><title>Background</title><p>Rapid urbanization and increased women’s involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa.</p></sec><sec id="sec2"><title>Methods</title><p>We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers’ knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment.</p></sec><sec id="sec3"><title>Findings</title><p>A total of 129 childcare centers were identified and categorized as home-based (<italic>n</italic> = 45), center-based (<italic>n</italic> = 14), school-based (<italic>n</italic> = 61), and church-based (<italic>n</italic> = 9). The number of home-based centers was particularly high in Viwandani (<italic>n</italic> = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers’ education level, type of center, support received, caregiver–child ratio, number of children in the center, and center providers’ KAP score (<italic>p</italic> &lt; 0.05). However, in the multivariable regression, only higher levels of center provider KAP (<inline-formula><mml:math id="M1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>β</mml:mi></mml:math></inline-formula> = 0.51; 95% CI: 0.18, 0.84; <italic>p</italic> = 0.003) and center type (<inline-formula><mml:math id="M2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>β</mml:mi></mml:math></inline-formula> = 8.68; 95% CI: 2.32, 15.04; <italic>p</italic> = 0.008) were significantly associated with center quality score.</p></sec><sec id="sec4"><title>Implication</title><p>Our results show that center providers’ knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision.</p></sec>