Assessing the impact of Covid-19 on Nurturing Care in Nairobi Slums: Findings from 5 rounds of cross-sectional telephone surveys

Introduction This study investigates the multifaceted impacts of the Covid-19 pandemic on early childhood in three of Nairobi’s informal settlements or slums. Focusing on the first five years of life, a critical period for human capital development, we analyse how Nurturing Care across five domains (Health, Nutrition, Responsive Caring, Early Learning, Security and Safety) was influenced by the pandemic and the mitigation measures that were implemented. Methods Using a longitudinal design, we conducted five rounds of cross-sectional surveys (with between 578 and 774 respondents in each) over 13 months, correlating with different phases of the pandemic and varying levels of Covid-19 restrictions. Results Our findings reveal significant disruptions in healthcare services, particularly pronounced in early rounds with missed vaccinations (reported by 1 in 5 parents of infants) and therapeutic healthcare seeking (missed by up to 21% of families). The study also highlights persistent food and nutrition insecurity, with a large majority of families struggling to feed their children (up to 72% in Round 1) due to financial constraints. Economic shocks were near-universal, with widespread losses in income and employment reported; 99.7% of respondents reporting earning less since the start of the pandemic. The use of paid childcare initially plummeted but showed a resurgence over time (up to 21% usage by Round 5) as the pandemic and control measures evolved. Young children were commonly left alone in all rounds, but especially earlier in the pandemic; 24% in Round 1, and at least 13% in all rounds, underscoring the enduring challenges in providing consistent nurturing care in these settings. Very few (less than 2%) of study participants reported direct experience of Covid-19 in their family in any round. Conclusion Despite adaptations over time and the decrease in reported disruptions, the prolonged economic shock was associated with multiple adverse effects Nurturing Care. The study’s longitudinal scope provides insights into the dynamic nature of ensuring young children in slums thrive during crises, highlighting the need for tailored interventions and policies that address the compounded vulnerabilities of young children in these communities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The funding for this work was provided by the British Academy (Grant number ECE190134) and Echidna Giving, which supports RH through a linked Clinical Research Fellowship and which provided a Covid Response Grant to support of this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The LSHTM Research Ethics Committee (LSHTM Ref: 22692) and Amref Health Africa’s Ethics and Scientific Review Committees (ESRC) in Kenya (Ref: P777/2020) reviewed and approved the study protocol. The National Commission for Science, Technology and Innovation (NACOSTI) provided research clearance. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The datasets analysed for this study can be found in the LSHTM Data Compass site for the NECS Study(45).