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Father Involvement in the Care of Children born Small and Sick in Rwanda: Association with Children's Nutrition and Development.

BACKGROUND
Little is known about father's involvement in the care of children born with perinatal risk factors. This study aimed to understand father's involvement in the care of children born preterm, low birthweight (LBW) and/or with hypoxic ischemic encephalopathy (HIE) in rural Rwanda and assess child and home environment factors associated with father involvement.


METHODS
A cross-sectional study of children born preterm, LBW or with HIE who were discharged from Kirehe District Hospital neonatal unit from May 2015-April 2016 and those enrolled in a neonatal unit follow-up program from May 2016-November 2017. Interviews were conducted when the children were ages 24-47 months in the child's home. Primary caregivers reported on father involvement in parenting, home environment, child disability, child development outcomes, and children's nutritional status were directly measured. Only children whose fathers were living in the home were included in the sample. Bivariate analyses were conducted using Fisher's exact test and Wilcoxon Rank Sum test.


RESULTS
236 children aged 24-47 months were included in this study, 66.4% were born preterm or LBW with a mean age of 33.3 months. 73.5% of children were at risk of disability, 77.7% had potential delay in overall child development. 15.5% of fathers reported engaging in four or more activities with their child. Factors associated with father involvement included smaller household size (p=0.004), mother engaged in decision making (p=0.027), being on-track in developmental milestones for problem solving (p=0.042) and mother's involvement in learning activities (p=0.043); also the number of activities a father engaged in was significantly associated with the child's overall developmental status on the ASQ-3 (p=0.032).


CONCLUSION
We found that father involvement in activities to support learning was low among children born preterm/LBW and/or with HIE. Program interventions should encourage fathers to engage with their children given the benefits for children's development.