AN INVESTIGATION OF THE PROGRAMS AND EQUIPMENT USED BY CAREGIVERS AND DAY MOTHERS FOR THE AGE GROUP 0 ? 36 MONTHS IN LIMPOPO PROVINCE, SOUTH AFRICA Margaretha J. Grey Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Masters of Science in Occupational Therapy. Johannesburg, 2006 Ethical Clearance number: M03-06-12 DECLARATION I, Margaretha J. Grey declare that this dissertation is my own work. It is being submitted for the degree Masters of Science in Occupational Therapy in the University of the Witwatersrand, Johannesburg. It has not been submitted before for any degree or examination at this or any other University. M.J. Grey day of , 2007. ii For my husband, companion and best friend Louis A. Grey THANKS iii ABSTRACT This study investigated the quality of care provided to children between 0 and 36 months in Limpopo Province. A non-experimental, quantitative, cross sectional descriptive design was used. The researcher developed two research instruments: ? a questionnaire which collected information on registration, training, services provided stimulation programs, referral and equipment. ? an observation sheet which recorded information on the premises, the staff, equipment and office, toys, outdoor play area, sleeping and dining areas. 111 subjects participated in the study- 19 day mothers in urban areas and 92 caregivers in more rural areas. Descriptive statistics were used to summarize the data in the questionnaire and the mean values for the two samples from the observation were compared using a t test. Results suggest that the quality of care provided by both day mothers and caregivers is below the accepted overall mean of 3 for all variables examined except day mother?s premises. Caregivers at care centres were better trained and offered more stimulation programmes than day mothers. They also scored better than day mothers with respect to staff and equipment with toys and dining areas being significantly better. Day mothers scored marginally higher than caregivers with respect to outdoor play and sleeping areas. iv ACKNOWLEDGEMENTS Louis Grey, my husband, who sponsored all the financial expenses and assisted me in all possible ways. Pat de Witt who supervised, encouraged and assisted me in every aspect to prepare this dissertation. Denise Franzsen who assisted me with valuable comments, advice and support of especially the statistical challenges of the research. Prof. Piet Bekker who gave valuable advice on statistics and who assisted in the preparation of the data analysis. PEPPS ECD TRAINING (Project for the Establishment of Pre-primary and Primary Schools; Early Childhood Development Training) provided contact details and assistance to complete the research instrument. Research assistants who completed the research instruments without asking any remuneration. Caregivers at day care centres who participated in this research. v TABLE OF CONTENTS Page DECLARATION ii DEDICATION iii ABSTRACT iv ACKNOWLEDGEMENTS v TABLE OF CONTENTS vi 1. INTRODUCTION 1.1 Introduction to the study 1 1.2 Problem Statement 3 1.3 Purpose of the study 3 1.4 Importance of the study 4 1.5 Assumptions 4 1.6 Objectives of the study 4 1.7 Definition of terms 5 1.8 Abbreviations 6 2. LITERATURE REVIEW 2.1 Introduction 7 2.2 Different trends in child care 7 2.3 Effects of early child care 9 2.4 Quality, type and quantity of early child care 11 2.4.1 Quality 11 2.4.2 Type 12 2.4.3 Quality 13 2.5 Need for purpose and function of day care facilities 13 2.6 Regulations regarding day care 16 2.7 Measuring the quality of child care 17 2.8 Programs, equipment and skills used to promote vi Page normal development of the child aged (0 ? 36 months) 18 2.8.1 Programs used in other countries 18 2.8.2 Programs used in South Africa 19 2.8.3 Programs available on the internet 20 2.8.4 Equipment necessary or effective child care 21 2.8.5 Training and skills of Care givers 22 2.9 The needs of the child aged (0 ? 36 months) 23 2.10 Specific issues related to day care in Limpopo Province, South Africa 30 2.11 Summary 32 3. DEVELOPMENT OF A RESEARCH INSTRUMENT 3.1 Introduction 35 3.2 The key environmental factors needed in the day care of the child (0 - 36 months) 35 3.2.1 Regulation and supervision of the caregiver 36 3.2.2 Qualities of the caregiver, specifically training 37 2.3.3 Adult child ratios 38 3.2.4 Quantity of time at a day care facility 38 3.2.5 Nutrition 39 3.2.6 Quality of stimulation to promote development 39 3.2.7 Early intervention 40 3.2.8 Physical surroundings of the child 41 3.2.9 General organization of the day care facility 41 3.3 Review of other questionnaires 41 3.3.1 NICHD Assessment Instrument 42 3.3.2 Questionnaires available in South Africa 43 3.4 The development of the research instruments 43 3.4.1 The Questionnaire 44 3.4.2 The Observation Sheet 45 vii Page 3.5 Reliability and Validity of the questionnaire and observation sheet 48 3.5.1 Validity 48 3.5.2 Resulting changes to research instruments 48 3.5.3 Reliability 49 3.6 Summary 50 4. METHODOLOGY 4.1 Introduction 51 4.2 Research Design 51 4.3 Population 51 4.4 Sample Selection 52 4.5 Research Assistants 54 4.6 Ethical Considerations 55 4.7 Research Procedure 56 4.8 The Research Instruments 57 4.9 Data Collection 57 4.10 Data Analysis 58 4.11 Summary 59 5. RESULTS 5.1 Introduction 60 5.2 Demographics of the sample 60 5.3 The results of the questionnaire 61 5.3.1 Registration of Day mothers and Caregivers 62 5.3.2 Inspection of Day Care Facilities 63 5.3.3 Training of day Mothers/ Caregivers 65 5.3.4 Services provided 67 5.3.5 Stimulation programs 69 5.3.6 Procedure for referral to Professional Services 71 viii Page 5.4 The results of the observation sheet 72 5.4.1 Premises 72 5.4.2 Staff 73 5.4.3 Equipment and Office 74 5.4.4 Toys-indoors 75 5.4.5 Outdoor Play Area 78 5.4.6 Sleeping Area 78 5.4.7 Dining Area 79 5.4.8 Average scores for each section 80 5.5 Summary 81 6. DISCUSSION 6.1 Introduction 83 6.2 Regulation and control 83 6.3 Caregivers 88 6.4 Programs offered 90 6.5 Health and safety 93 6.6 Facilities 96 6.7 Management 99 6.8 Summary 100 7. CONCLUSION 7.1 Child care in South Africa 102 7.2 Child care in Limpopo Province 103 7.3 Day mother versus care centre 104 7.4 Status of care givers 105 7.5 Resulting research 106 REFERENCES 108 APPENDICES AI Questionnaire 112 ix Pages AII Rationale for all the questions included in the Questionnaire 117 AIII Aspects removed from the original questionnaire 118 BI Observation Sheet 119 BII Rationale for factors evaluated on the Observation Sheet 122 BII Aspects removed from the original Observation Sheet 127 C: Guidelines to complete questionnaire and Observation sheet 128 D: Information Sheet 130 Consent Form 131 E: Map of Limpopo province 132 F Ethical Clearance form 133 x TABLES 1 Five sections of the questionnaire 44 2 Factors observed on care of the child 46 5.1 Demographics of the urban sample 60 5.2 Demographics of the rural sample 61 5.3 Education level of sample 61 5.3.1 Registration 62 5.3.2.1 Inspections 63 5.3.2.2 Aspects Inspected 64 5.3.3.1 Training Attended 65 5.3.3.2 Access to Information 66 5.3.4.1 Quantity of Time Child spends at Day Care Centre 67 5.3.4.2 Number of Meals 68 5.3.4.3 Menu 69 5.3.5.1 Stimulation Program 70 5.3.5.2 Aspects of Development covered in Program 71 5.3.6 Procedure for Referral to Professional Services 72 5.4.1 Premises 73 5.4.2 Staff 74 5.4.3 Equipment and Office 75 5.4.4 Toys Indoors 76 5.4.5 Outdoors Play Area 78 5.4.6 Sleeping Area 79 5.4.7 Dining Area 80 5.4.8 Average Scores of Observation Sheet 81 xi