Cltild:care. health and development, I9S5. 11,81-90.

Using primary-school children to improve child-rearingpractices in rural Jamaica

JENNIFER KNIGHTand SALLY GRANTHAM-McGREGOR TtopicalMetabolism Research Unit. University of the West Itidies, Moita. St Andrew. Jamaica

Accepted for publication 14 November 1984

Summary Many children in Jamaica suffer from poor development,inadequate dental care and low immunization status. There is a needfor low-cost innovative programmes to reach these children. Wepiloted an approach to teaching primary-school children basic childhealth and development concepts with the aim of improving theirknowledge and practices and those of their guardians. The programmewas conducted with 89 children from three grade levels in a remoterural school. The topic was taught throughout the school year with anaction-oriented curriculum. Evaluation showed improvement inschool children's knowledge and practices and guardians' knowledge.This approach is seen to be a feasible, low cost way of improving thequality of future child care.

The development of children living in deprived environments is acause for great concern in many parts of both the developing anddeveloped world. This is the case in Jamaica where large numbers ofchildren live in poverty and suffer from poor health, growth anddevelopment.

In particular these children show a marked decline in developmentallevel from 12 months of age, and by 4 years of age they are seriouslybehind their middle-class peers (Powell et al. 1982, Wein 1972a). Thisdecline has been attributed to the quality of their environments. Thehomes lack toys, books and other educational materials, and mothersmake little conscious attempt to improve young children's develop-ment through play (Grantham-McGregor et al. 1983, Leo-Rhynie &Gaynor 1981). Discipline is generally authoritarian (Grant 1974).Rural children have usually been found to have worse physical andmental development than urban children (Wein 1972b).

Health care is inadequate and low levels of immunization (CAREC1980, 1982, Puffer & Serrano 1973) and dental care (Ashworth &

81

82 J. Knight & S. Grantham-MeGregor

Waterlow 1970, Stepfienson 1969) present major public lieafthproblems.

Social and fiealtfi services cannot reacfi all high-risk children, thusthere is a need for innovative low-cost intervention strategies whichfocus on all aspects of the child's development. Using primary-schoolchildren is one such approach, whereby older children are taught howto care more adequately for their younger siblings at home, and also tospread concepts of child health and development to the rest of thefamily.

RATIONALE FOR USING SCHOOL CHILDREN

In Jamaica, families are large and children spread over many years.Frequently, older children are left to care for their younger siblings.This practice is not unique to Jamaica, and other studies (Blanco &Chodorow 1964, Goldberg 1972, Leiderman et al. \911) have shownthat it is a well-accepted practice elsewhere, particularly in third worldcountries.

The school, in spite of its many problems, is still a natural channelthrough which the health and development of the community could beimproved, with school children as natural change agents.

In this paper we report the results of a project carried out in aremote rural Jamaican school. The aims were to improve schoolchildren's and their guardians' knowledge and practices related toimmunization, dental care and child development.

The study was carried out in a school (approximately 400 children)situated in a rural, mountainous area. The school had generally poorfacilities, was overcrowded and short of basic materials and teachingaids. The children's level of literacy was generally low.

METHODS

SamplesThe sample comprised all children in grades 3, 5 and 7 of the schooland their guardians. At the beginning of the project all children on theschool register were chosen. Table 1 gives a description of their ageand sex by class.

Child rearing in Jamaica 83

T A B L E 1. Age and sex distribution of the sample byclass

Class

357Total

Age (years)

Mean

10-0911-0211-96

10-0

s.d.

0-91-321-99

1-6

Boys

242315

62

Girls

119

12

32

Total

353227

94

The mothers or guardians of the school children were identified byvisiting the homes of each project child in the summer vacationpreceding the project. Over one-third of the children (37%) were notliving with their mothers, and both mothers and guardians tended tobe unmarried. This reflects the somewhat unstable family patternsfound in Jamaica. Housing standards were generally poor withinadequate sanitation and overcrowding.

The interventionEach week of the school year the children spent approximately 1 hourlearning about child health and development. Thus the studentsparticipated in approximately 30 sessions over three terms. Theprincipal researcher assisted the class teachers during these periods.

Tbe child development curriculum included the different areas ofthe development of children, important developmental milestones andappropriate child management techniques. The children were taughthow to make toys from waste household materials, and how to playwith them so as to encourage a younger child's development.

The dental care lessons included the care of teeth and informationon foods which are good and bad for teeth.

The immunization curriculum dealt with the purpose of immuniz-ation, the diseases which immunization can prevent and the timeswhen the baby should be immunized.

The curriculum was action-oriented and suitable for the children'slow level of reading and writing. Activities such as role play, groupdiscussions and demonstrations were included. The topics werereinforced with toy-making, drama and poster competitions. An openday was also mounted at the end of the year.

84 J. Knight & S. Grantham-McGregor

EvaluationAt the beginning and end of the project a questionnaire wasadministered to the guardians at home and a test was given to theehildren at sehool. Information was obtained from the guardians ontheir soeial baekground, knowledge of topics taught and eertain oftheir child care activities. The guardians were also asked about thesehool child's activities with the younger ones at home, hi addition, atthe end of the projeet they were asked about the number of projecttoys brought home. The school children were tested on theirknowledge of topics taught.

AnalysisThe data were analysed by computing frequeneies of responses on theitems from both the school children's tests and the guardians'questionnaires. Chi-square analyses were then carried out to ascertainthe significance of any differences which may have occurred betweenthe pre- and post-intervention measures. In those instances where thedifferenees between seores were large and the number in the cells wastoo small for this test, statistieal analysis was not done. Five schoolchildren missed their initial test because they were absent fromschool. By the end of the study, nine guardians and another 12 schoolchildren were lost. This was caused by guardians moving from the areaand poor school attendance of ehildren on the day the test was given.

RESULTS

Generally, the project was well received by the teachers, children andhealth personnel involved. Fifteen toys were made throughout theyear.

School children's testThe baseline information revealed that the school children knew littleof the topics to be taught. Responses concerning immunization on thefirst test (Table 2) indieated that the school children's knowledge ofimmunization was poor. Although about half had heard of immuniz-ation, very few knew its purpose or the number of injections or 'drops'which were required. There was a similarly low level of knowledge ofbasic dental care.

The post-intervention test results showed that there was a highly

Child rearing in Jamaica 85

TABLE 2. School children's knowledge of health messages beforeand after the project

Item

ImmunizationHeard of immunizationImmunization protectsfrom diseasesChild needs more than3 immunizations in the1st year

Diseases protected againstPolioLockjawDiphtheriaMeasles

Dental careThings that are bad for teeth:

SweetsAerated waterFeeding bottle(i.e. prolonged sucking)

Things that are good for teeth:CleaningSugar caneCarrotsMilk

% of total

Beforen = 89

53

7

7

3,000

630

1

266

152

giving correct response

After

99"

87"

76"

56"60"44"49"

86"14"

69"

70"70"62"58"

a = not tested; t = P < 0 001

significant improvement in knowledge of both immunization anddental care following the project.

Table 3 shows the school children's knowledge of appropriate childmanagement techniques and play activities for young children. In thefirst test 66% of the school children chose positive motivation as agood teaching tool for young children although very few favoured thisapproach when managing young children's behaviour. A very smallproportion of the school children recognized toys and play as havingeducational value. Similarly, few children knew the suitable conceptsto teach young children with toys.

86 J. Knight & S. Grantham-McGregor

TABLE 3. School children's knowledge ofchild management techniquesand play activities before and after the project

Item

Correct idea of use of -l-ve ratherthan -ve motivation:

When teachingWhen managing child'sbehaviour

Recognize educational value of:ToysPlay

Correct idea of suitable conceptsto teach:

With blocksWith 'pull-along'

% of total

% beforert = 89

66

36

1712

1825

giving correct response

% after*n = ll

97

88

8262

7365

001

The post-intervention results indicated that a significant improve-ment in knowledge in all areas had taken place.

The school children were asked to choose between a number ofmethods which could improve the language development of veryyoung children. Firstly they were asked how to look at a book withyoung children (Table 4). Very few school children knew that talkingabout the pictures and stories were better techniques than insisting onthe child sitting still and reading every word carefully.

They were then asked about talking with young children and playingwith pencil and paper. Here again, the school child chose the moreformal and inappropriate approaches of teaching the alphabet andwriting sentences rather than naming things in the immediateenvironment and drawing pictures.

By the end of the project significantly more children chose thecorrect responses to each item.

GuardiansThe guardians were asked similar but fewer questions about theirknowledge of health care and child development. Many of them wereaware of what caused tooth decay (Table 5). Less than half were aware

Child rearing in Jamaica 87

TABLE 4. School children's choice of appropriate language activity forvery young children before and after the project

Choice of activity

When reading to young childTalk about picturesRead every word carefully

Talk about storyChild to sit still & quiet

% total

Beforen = 89

44

49

giving correct response

After*// = 77

92

81

When talking with young childName things in the yardTeach alphabet

When playing with pencil & paperDraw picturesWrite sentences

32

15

86

88

*P<0-00\

TABLE 5. Guardians' knowledge and practices concerning child care before andafter project

Type of knowledge and activity

Guardians' knowledgeMentions correct causes of tooth decayRecognizes educational value of:

PlayToys

Recognizes the importance of chatting

Guardians' actionsEncourages older child to play withyounger childReads and looks at pictures withyounger childPlays with child and his toys

% of total

Before/I = 94

66

401548

12-

6545

giving correct responses

After*/( = 85

88

725084

52

63 ns64 ns

*P0001;ns = not significant

88 J. Knight & S. Grantham-McGregor

of the educational value of toys and play and recognized theimportance of chatting with children to promote their languagedevelopment.

The guardians' knowledge improved in all the above areas by theend of the project.

The guardians were also asked about their own activities with thechildren (Table 5). After the project a significantly higher proportionof guardians reported that they encouraged the older children to playwith the younger ones. There were no differences in the number ofguardians reading, looking at pictures and playing with the youngerones.

The guardians were also asked about the school child's previousactivities in the home (Table 6). They reported that the older child didnot usually tell the younger ones to clean their teeth. Very fewreported that the children reminded them about immunizing the baby.They also said that the school children infrequently made toys for theyounger ones. The post-intervention results revealed a highly signifi-cant improvement in all these areas.

DISCUSSION

The baseline data support the need for intervention in those areas ofchild development and health care focused on in this project.

TABLE 6. Guardians' reports of school children's activities with younger children

Activities % of total giving correct response

Before After*

School child reminds younger childto clean teethReminds guardian to get youngchild immunizedSchool child plays every day withyounger childSchool child makes toys foryounger child (out of school)

*P0-001

43

14

41

32

72

52

66

50

Child rearing in Jamaica 89

The study school was reasonably representative of remote ruralschools in Jamaica and had no special advantages. It is thereforeprobable that this approach could be reproduced elsewhere.

This model proved to be both feasible and successful; we managedto improve the school children's knowledge of the topics taught, andalso change their practices in certain areas. Some of the informationreached the homes, and we improved the guardians' knowledge;however, we could not detect any concomitant improvement in theiractions. A similar project in Indonesia was successful in improvingparents' knowledge of health matters, but practices were not evaluated(Rhode & Sadjinum 1980).

Our success was obviously limited by the quality of the school, andwe were seriously handicapped by poor attendance, overcrowding anda high noise level. It is probable that in situations where theeducational system has fewer problems this approach would be moresuccessful. There is a great need to improve child care in all areas, andthe curriculum is being extended to include hygiene, nutrition andhealth care. In addition we are presently training teachers rather thanworking with the children ourselves and this will enable us to reachlarger numbers of children at a relatively low cost.

In conclusion, the success of this project suggests that if theexpanded curriculum was incorporated into the government schoolcurriculum for all primary grade levels, there would be a realopportunity to improve the quality of child care in the future.

REFERENCES

Ashworth A. & Watcrlow J.C. (1970) Nuthiion in Jamaica. Dcpartmcnl of Extra Mural Studies.University ol' the West Indies. Jamaiea

Blanco M.G. & Chodorow W.J. (1964) Children's work, and obedience in Ziuacantan.Llnpublished report. Anthropology Department. Harvard University. Massachusetts

CAREC Surveillance Report (1980) Review of Coniinuiucahle Diseases in the Cariijbean.Caribbean Epidemiology Centre. Trinidad

CAREC Surveillance Report (1982) PoUomyeinis Conjinneil in Jamaica Volume 8. CaribbeanEpidemiology Centre. Trinidad

Goldberg S. (1972) Infant care and growth in urban Zambia. Human Development 15, 77-89Grant D.R.B. (1974) Living Conditions of some Basic School Children. Pointers to Disadvant-

age. The Bernard Van Leer Foundation Project for Early Childhood Education, Universityof the West Indies. Jamaica

Grantham-McGregor S.M., Landman J. & Desai P. (1983) Child rearing in poor urban Jamaica.Child: care, lieallli ct developmeiU 9, 51-1 \

Leiderman H.P. & Leiderman G.F. (1977) Economic change and infant care in an East African

90 J- Knight & S. Grantham-McGregor

agricultural community. In Culture and Infancy. Variations in Human Experience, eds P.M.Leiderman, S.T. Tulkin & A. Rosenfield, Academic Press, New York

Leo-Rhynie E. & Gaynor M. (1981) The Caring and Rearing of West Indian Children in the FirstTwo Years of Life. A UNESCO Document. School of Education, University of the West

Indies, Jamaica

Powell C , Grantham-McGregor S. & Ismail S. (1978) Developmental Stimulation: A NewAddition to Primary Health Care. Paper presented at CCMRC, 27th Seientific Meeting,Trinidad and Tobago

Puffer R.R. & Serrano C.V. (1973) Infectious diseases. In Patterns of Mortality in Childhood.PAHO Scientific Publications, Washington

Rhode J.E. & Sadjinum T. (1980) Elementary school pupils as health edueators: role of schoolhealth programmes in primary health care. Lancet 1. I35O-13,'52

Stephenson D. (1969) Dental caries. Environment and diet in Jamaica. West Indian MedicalJournal 8, 116-119

Wcin N. (1972a) Children's performance in middle-class schools with or without PECE lessonguides. University of the West Indies, Institute of Education, Jamaiea

Wein N. (1972b) Urban Rural Study of PECE Schools. University of the West Indies, Institute ofEducation, Jamaica