{
  "abstract": "Introduction The WHO/UNICEF Nurturing Care Framework (NCF) features five domains necessary for child development—physical/mental health, responsive caregiving, adequate nutrition, security and safety and opportunities for early learning. We explored caregiver perspectives on the NCF in two African settings.Methods Between November 2023 and July 2024, 14 focus group discussions (FGDs) were conducted with caregivers living with and without HIV; eight with mothers in Gaborone, Botswana, and six with mothers and fathers in Nairobi, Kenya. FGDs were stratified by country, sex, HIV status and partnership status. Semi-structured interviews with interactive activities elicited caregiver perspectives on the NCF to identify the most ‘important’, ‘easiest’ and ‘challenging’ domains to fulfil. Thematic analyses identified key themes and compared perspectives.Results Our qualitative study included 101 caregivers, 55 from Kenya (30 mothers, 25 fathers) and 46 mothers from Botswana. Overall, caregivers identified physical/mental health as the ‘most important’ domain to fulfil for children and caregivers, noting how closely tied they were (“ If you have pain, that pain affects your child”). The ‘most challenging’ domain was adequate nutrition in Botswana and security and safety in Kenya. The ‘easiest’ domains were responsive caregiving in Botswana and opportunities for early learning in Kenya. Kenyan caregivers noted that spiritual nourishment was also critical for well-being but missing from the NCF. Caregivers emphasised the importance of receiving social support with childcare. Caregivers living with HIV expressed similar views compared with caregivers without HIV, but mentioned that social isolation, stigma and treatment disruption impact their ability to provide adequate nurturing care.Conclusions Caregivers face unique parenting challenges depending on cultural environment. HIV disrupts caregivers’ health, which has important implications for raising children within families affected by HIV. Interventions that support caregivers’ abilities to fulfil all NCF domains and address challenges are essential to ensure children reach their developmental potential.",
  "authors": [
    {
      "affiliations": [
        "Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA",
        "Botswana Harvard Health Partnership, Gaborone, Botswana",
        "Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Michelle Ann Bulterys"
    },
    {
      "affiliations": [
        "Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Sarah Garcia"
    },
    {
      "affiliations": [
        "Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, USA",
        "Kenyatta National Hospital, Research and Programs, Nairobi, Kenya"
      ],
      "name": "Irene Njuguna"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana",
        "Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Sara Schenkel"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana"
      ],
      "name": "Kedibonye Thankane"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana"
      ],
      "name": "Irene Kitsi"
    },
    {
      "affiliations": [
        "Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, USA",
        "University of Washington Kenya, Nairobi, Kenya"
      ],
      "name": "Hellen Okinyi"
    },
    {
      "affiliations": [
        "University of Washington Kenya, Nairobi, Kenya"
      ],
      "name": "Peter Mulupi"
    },
    {
      "affiliations": [
        "University of Washington Kenya, Nairobi, Kenya"
      ],
      "name": "Irene Maeri"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana"
      ],
      "name": "Sam Kgole"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana"
      ],
      "name": "Gosego Masasa"
    },
    {
      "affiliations": [
        "Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya"
      ],
      "name": "Dalton C Wamalwa"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana",
        "Departments of Psychiatry & Psychology and Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, New York, USA"
      ],
      "name": "Adam R Cassidy"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana"
      ],
      "name": "Joseph Makhema"
    },
    {
      "affiliations": [
        "Botswana Harvard Health Partnership, Gaborone, Botswana",
        "Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Kathleen Powis"
    },
    {
      "affiliations": [
        "Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Grace John-Stewart"
    }
  ],
  "title": "“It is the foundation for the child”: a qualitative study examining caregiver perspectives on the Nurturing Care Framework in Kenya and Botswana",
  "uid": "8bb62bef-336f-529a-9540-45ef60adcfe7"
}