Parenting, the other oldest profession in the world – a cross-sectional study of parenting and child outcomes in South Africa and Malawi

Figures & data

Table 1. Child measures.

Variable	Tool/scale	Items	Scoring range	Reliability (α)	Item example	Reference	Validation/previous use of scale in similar setting
Quality of life	Paediatric Quality of Life Inventory	15	0–100	N/A	In the past ONE month how much of a problem has your child had with worrying about what will happen to him or her	Varni, Seid, and Kurtin (2001)
Behavioural problems	Strengths and Difficulties Questionnaires	10	0–20	N/A	(In the past six months) is your child often unhappy downhearted or tearful?	Goodman (1997)	Cluver and Gardner (2006)
Depression	Child Depression Inventory	10	0–20	0.63	I have plenty of friends/I have some friends but I wish I had more/I don’t have any friends	Kovacs (1992)	Mueller et al. (2011); Snider and Dawes (2006)
Self-esteem	Rosenberg Self-Esteem Scale	10	0–30	0.61	On the whole, I am satisfied with myself.	Rosenberg (1965)	Mueller et al. (2011); Schmitt and Allik (2005)
Trauma	Trauma Symptom Checklist for Children	10	0–30	0.74	I remember things that happened that I didn’t like.	Briere (1996)
Educational risk	Child Status Index, Paediatric Quality of Life Inventory school functioning subscale	4	0–4		How do teachers report your child is doing in school?	Nyangara et al. (2009); Varni et al. (2001)
Digit span	Junior South African Individual Scales (JSAIS) and Senior South African Individual Scale – Revised (SSAIS-R)	8 (4–5y only)	0–16 (4–5y only)		N/A	Madge and Robinson (1985)	Madge and Robinson (1985)
Draw-a-person score		15 (6–13y)	30 (6–13y only)
	73 items (Man)
71 items (Woman)	0–144		N/A	Harris and Goodenough (1963)

Table 2. Sample characteristics, including demographics on the children and the caregivers.

Variable name	M (SD) or N (%)
Carer age	43.45 (15.01)
Carer gender	903 (94.9%)
Carer HIV status	185 (19.4%)
Carer mental health	112 (11.8%)
Biological parent	461 (46.6%)
Stigma	0.14 (0.51)
Number of adults in the household	6.42 (2.90)
Living in a shack	152 (15.4%)
Child age	8.91 (2.84)
Child gender	503 (50.9%)
Child HIV status	135 (13.7%)

Note: Gender variables display the number of females in the sample. The mental health variable displays the number of carers scoring above the cut-off for depression. The HIV variables display the number of HIV-positive individuals.

Table 3. Linear regression models showing predictors of parenting (continuous variable).

	Unadjusted	Adjusted model
	B (95% CI)	B (95% CI)
Poverty (living in informal dwelling)	6.97 (6.70, 7.23)	−0.30 (−0.52, −0.70)**
Carer mental health	0.31 (0.08, 0.54)**	0.32 (0.08, 0.55)**
Biological parent	0.19 (0.04, 0.35)*	0.20 (0.03, 0.37)*
Stigma	−0.31 (−0.39, −0.24)***	−0.30 (−0.38, −0.23)***
Number of adults in the household	0.02 (−0.01, 0.05)	0.02 (−0.01, 0.06)
Child gender (female)	0.16 (0.007, 0.32)*	–
Child age	−0.004 (−0.03, 0.02)	–
Carer gender (female)	−0.12 (−0.46, 0.23)	–
Carer age	−0.004 (−0.009, 0.002)	–
Country (South Africa)	0.36 (0.16, 0.57)***	–

Note: Analyses are linear regression models showing predictors of parenting (scale 0–10). Adjusted model was controlled for child and carer gender, child and carer age and country.

B = unstandardised coefficient; CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 4. Logistic regression models showing predictors of good parenting (dichotomous variable).

	Unadjusted	Adjusted model
	OR (95% CI)	OR (95% CI)
Poverty (living in informal dwelling)	0.77 (0.50, 1.18)	0.62 (0.39, 0.97)*
Carer mental health	1.91 (1.27, 2.87)**	1.95 (1.29, 2.94)**
Biological parent	1.74 (1.29, 2.34)***	1.58 (1.14, 2.19)**
Stigma	0.67 (0.54, 0.82)***	0.66 (0.54, 0.82)***
Number of adults in the household	1.09 (1.02, 1.14)**	1.09 (1.03, 1.15)**
Child gender (female)	0.79 (0.59–1.06)	–
Child age	0.97 (0.92–1.02)	–
Carer gender (female)	0.96 (0.50–1.88)	–
Carer age	0.99 (0.98−0.99)**	–
Country (South Africa)	1.26 (0.83–1.93)	–

Note: The data are cross-sectional; all variables were measured at baseline. Analyses are logistic regression models showing predictors of good parenting (cut-off > 8). Adjusted model was controlled for child and carer gender, child and carer age and country.

OR = odds ratio; CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 5. Linear regression models showing associations between parenting and child outcomes (continuous outcomes).

	Parenting score		Good parenting (cut-off ≥ 8)
	Unadjusted	Adjusted model	Unadjusted	Adjusted model
	B (95% CI)	B (95% CI)	B (95% CI)	B (95% CI)
Depression score	−0.29 (−0.38, −0.19)***	−0.28 (−0.37, −0.19)***	−0.29 (−0.54, −0.05)*	−0.30 (−0.54, −0.060)**
Self-esteem score	0.61 (0.45, 0.78)***	0.62 (0.46, 0.79)***	1.33 (0.89, 1.78)***	1.40 (0.96, 1.84)***
Digit span score	0.38 (0.14, 0.62)**	0.20 (−0.01, 0.41)	0.29 (−0.32, 0.90)	0.09 (−0.44, 0.63)
Draw-a-person score	1.19 (0.04, 2.34)*	0.14 (−0.82, 1.10)	1.16 (−1.77, 4.09)	0.14 (−2.33, 2.60)
Trauma score	−0.54 (−0.72, −0.37)***	−0.50 (−0.68, −0.32)***	−0.72 (−1.19, −0.24)**	−0.62 (−1.08, −0.16)**
Behavioural problems score	−0.38 (−0.52, −0.24)***	−0.39 (−0.53, −0.26)***	−0.71 (−1.05, −0.36)***	−0.74 (−1.08, −0.40)***
Educational risk score	−0.13 (−0.19, −0.06)***	−0.11 (−0.17, −0.05)***	−0.19 (−0.35, −0.03)*	−0.17 (−0.33, −0.02)*
Quality of life score	0.50 (−0.08, 1.07)	0.62 (0.05, 1.19)*	0.52 (−0.93, 1.97)	0.57 (−0.97, 2.01)

Note: Analyses are linear regression models conducted separately for each continuous outcome at baseline. For all analyses, the predictor variable was parenting scale score (range 0–10) or good parenting. Adjusted model was controlled for child and carer gender, child and carer age and country.

B = unstandardised coefficient; CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 6. Logistic regression models showing associations between parenting and child outcomes (binary outcomes).

	Parenting score		Good parenting (cut-off ≥ 8)
	Unadjusted	Adjusted model	Unadjusted	Adjusted model
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
% with stunting	0.87 (0.77, 0.99)*	0.92 (0.80, 1.04)	0.73 (0.52, 1.01)	0.73 (0.52, 1.03)
% with wasting	1.22 (0.97, 1.70)	1.24 (0.88, 1.75)	1.92 (0.90, 4.09)	2.02 (0.94, 4.35)
% underweight	0.72 (0.56, 0.93)**	0.78 (0.60, 1.00)*	0.53 (0.23, 1.23)	0.54 (0.23, 1.25)
% that went to bed hungry	0.74 (0.62, 0.87)***	0.75 (0.63, 0.89)***	0.50 (0.29, 0.84)**	0.49 (0.29, 0.83)**

Note: Analyses are logistic regression models conducted separately for each binary outcome at baseline. For all analyses, the predictor variable was parenting scale score (range 0–10) or good parenting. Adjusted model was controlled for child and carer gender, child and carer age and country.

OR = odds ratio; CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Figure 1. Multiple mediation analyses exploring good parenting and child development.

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