the secondary data analysis for turkmenistan child...

TURKMENISTAN

A Report on the Rearing and Care of Young Children

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ABBREVIATIONS

BBP Better Parenting ProgrammeECD Early Childhood DevelopmentNGO Non Governmental OrganizationPAR Participatory Assessment ResearchSESUNICEF United Nations Children’s FundVIPPWES Water and SanitationWHO World Health Organization

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TABLE OF CONTENTS

Abbreviations …………………………………………………………………… 1Forward ………………………………………………………………………….. 3I. Executive Summary …………………………………………………………. 4II. Introduction …………………………………………………………………. 5III. Goals and tasks ……………………………………………………………. 6IV. Methodology ………………………………………………………………… 7Research design ………………………………………………………………… 7Data collection methods ………………………………………………………… 7Target age group ………………………………………………………………… 8Sample size and selection ……………………………………………………… 8Coding and data analysis ……………………………………………………… 8V. Description of process …………………………………………………… 9Preparation of the study ………………………………………………………… 9Pilot testing ………………………………………………………………………. 9PAR……………………………………………………………………………….. 9VI. Research Findings ………………………………………………………… 10Understanding the family Household ………………………………………………………………………. 12Age and education of parents .………………………………………………… 14Caretakers ….…………………………………………………………………… 16Fathers’ involvement in child rearing ………………………………………… 18Conditions related to childrenEnvironment ……………………………………………………………………… 21Discipline, conflicts, authority ……………………………………………………. 27Recreational activities ……………………………………………………………. 33Health, Nutrition, HygieneHealth ……………………………………………………………………………… 35Nutrition ……………………………………………………………………………. 38Hygiene practices ………………………………………………………………… 39VII. Focus group and workshop findings 46Workshop 1 ………………………………………………………………………. 46Workshop 2 …………………………………………………….………………… 48Workshop 3 ……………………………………………………………………… 49Workshop 4 ……………………………………………………………………… 56VIII. Recommendations for programme initiatives in Turkmenistan 59Development of Programme Plan ……………………………………………… 61Next steps ………………………………………………………………………… 63Annexes ………………………………………………………………………….. 64

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ACKNOWLEDGEMENT

The present report is the outcome of the joint work with the national specialists from various sectors and output of conducted workshops in Dashoguz velayat. I would like herewith to convey my sincere appreciation to those who contributed to the process of the study, development of questionnaires and recommendation for further improvement of the ECD project in Turkmenistan.

I would like to use this opportunity to thank the community members and education specialists of Dashoguz velayat for their cooperation in the whole process. Particularly I would like to thank the officials of the Main Department of Education in Dashoguz velayat, namely the Acting Head Mr. Khudaikuly Yaryev and Chief Inspector Mr. Agamurat Gumyshov for his help in organizing four workshops in Dashoguz velayat to presentation the findings of the Study to the Community members and the focus group discussions for the final analyses.

I would also like to thank Mr. Atamurad Matgeldyev, Chairman of the National Children’s Fund for his efforts in mobilizing the community members for participation in the study in Dashoguz velayat and administering the whole data collection and data entry efforts.

Ms. Nurper Ulkuer as well as education colleagues from UNICEF Turkmenistan provided full support in clearing administrative and logistical issues, without which the study itself and the workshops in particular would not be a success. I also appreciate very much support all UNICEF Turkmenistan Team provided during my mission, for their collaboration and guidance during the work in Turkmenistan.

Selim IltusConsultantChild Rearing Study

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I. EXECUTIVE SUMMARYUNICEF ECD programme in Turkmenistan encompasses a two-prong approach; services to families and services to children.

Better Parenting Programs (BBP) that targets families, will equip parents with basic skills that they will be able to bring up their children in a caring, gender sensitive manner so that they will be healthy, well nourished, happy, socially competent, emotionally secure and mentally alert.

Community-based Pre-schools initiative was designed to improve the quality of education in these pre-schools and attempt to turn them into comprehensive ECD centres that alternative ECD programs would be offered to parents in the community.

UNICEF, in collaboration with local and central government, is currently carrying out health, education and WES projects in Dashoguz and Balkanabad Velayats, in order to link to the existing projects, and sustain the gains, ECD will start in the same project sites. As a result, it was decided to carry out the study in Dashouz Velayat, the most remote and rural of the two, to understand the child rearing beliefs and practices.

This research project seeks to discover the conditions of care for and education of children under seven-years-old in rural districts of Turkmenistan and to 7provide recommendations for their improvement. This age was selected as it is of key importance to the child’s future development, both in terms of physical health and mental acuity. It carried this by researching conditions in the Tagta Etrap within the Dashoguz Velayat. This region is part of the ecologically dangerous Aral Sea region, and is of particular concern at the present time. Local parents were selected randomly from three dayhan associations to be polled through a questionnaire, interviews and focus group discussions. 1,029 people from 180 families were polled in total.

On the whole parents are concerned for their children and feel responsible for them. Rural Turkmen families tend to be large and extended in structure with several generations and branches of a family living together. Because of this structure there is seldom an opportunity for young children to be away from the supervision of adults, older siblings or cousins. While the area is economically depressed, with fathers drawn away from home in search of work for increasingly long periods of time, children are not affected as dramatically as they could be. Their access to such relative luxuries as toys may be limited, but on the whole they are properly fed and cared for. This is because rural families generally have their own private gardens and livestock as supplemental income. Also, Turkmen national tradition is to breast-feed infants, although not necessarily as would be medically recommended.

The extended family structure is also provides a favourable situation for the education of young children. The constant adult supervision and easy access to

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grandparents offers many opportunities for children to learn about the world, their customs, and appropriate behaviour in addition to more academic issues. Large Turkmen families also generally have at least five children being raised at a time. Because of this children are able to play games and learn important social skills that will help them adapt to life outside of the family as they get older.

Despite these positive aspects of rural life in Turkmenistan, there is room for improvement. Parents require more information about child development, with extra attention being paid to their role in the process. Parents require training on child health, as well as the physical and emotional needs of young children. Informational programmes should be organised to accentuate the inter-connection of issues pertaining to children. Educational programmes should address health, education, welfare and development simultaneously to as great an extent as possible.

Special training courses should also be arranged for both young mothers and young fathers, preparing them for the responsibilities of parenthood. In addition, trainings are required in alternative educational methods that parents could use to help prepare their children for school and teach them general life skills. Also, specific programmes on breast-feeding, hygiene and nutrition. All of these are concepts that are recognised as important but nevertheless remain poorly understood.

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II. INTRODUCTIONThis report is prepared as a follow-up to the original data analysis report submitted by UNICEF Turkmenistan. It intends to carry the analysis one step further by looking at the relationship between demographic variables against a set of outcome variables. Critical findings from the initial report are also incorporated here. The report will also attempt to determine which different patterns exist in terms of childrearing practices among the families. The second part of the report describes the action research phase conducted in the field and the programmatic implication of the overall process.

This report has three purposes. First, it will summarize the process used in Turkmenistan from start to finish. From the initial design of the research instruments to traditional data collection and analysis ending with the action research model, it was possible to use research to make decisions for programming.

Second, the report presents the findings of the research in a systematic manner and discusses each finding with respect to its program implications and action strategies.

Finally, the report will describe the consensus that was reached at the end of the action research process that was conducted in Turkmenistan with the participation of government counterparts, parents and NGO's. This description will include the intervention domains that were identified and strategies and resources that would be used to move ECD forward in the country.

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III. GOALS AND TASKSThe goal of the study was to use the findings to help design and implement the models of home and community-based and family focused early childhood development programs.

It was necessary to have comprehensive knowledge regarding the parental practices and ideas including the daily life and social ecology of the Turkmen family, especially in the regions where the interventions will take place.

In the project proposal, the goals of the study are listed as follows:

1. To understand child-rearing practices, patterns, beliefs and values and the ways they affect day to day life of the child, and to reinforce the positive practices.

2. To analyze the gender roles and socialization process for girls and boys at early ages.

3. Identify the status of young children with disabilities.4. To identify the ways in which the children with disabilities are cared in the

family and the community.5. To provide support and information to and the communities about most

effective child rearing and care practices that ensure child’s right to survive, grow and develop in a protective environment.

6. To assess the health, nutrition and developmental level of the children and to design the most appropriate intervention with the communities.

7. To develop a process by which the community produces a set of agreed upon goals from which the community can develop indicators for monitoring.

The way it is designed, the study achieved most of these goals with the exception of the focus on children with disabilities. Despite all efforts, researchers were not able to identify and interview families with children who have disabilities. This may be due to relatively low number of disabled children in the target group or to parents' unwillingness to admit that their children have any disabilities.

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IV. METHODOLOGY

Research designChild Rearing Study in Turkmenistan was carried out in the Dashoguz Vilayat of Turkmenistan. Dashoguz is located in the northern section of the country near the Uzbekistan border, and travel to this region is only possible through special permission. The study was carried out in rural areas, where the density of settlements is very low. Partially open-ended interview schedules, as well as home assessment observation sheets were used to collect data. In addition, some workshops with community groups were conducted.

While the interviews include questions on health, nutrition and sanitary habits, the main focus of the interview was the cognitive, social and psychological development of the child. The interview includes questions on national practices, family ecology and play. (See Attachments)

Interview topic areasEach interview is broken into basic topic areas. These are:1. Demographic information: family members, ages, education, occupation,

income, etc.2. Health; common health-related practices of the family3. Nutrition; breastfeeding practices, child nutrition4. Hygiene; hygiene habits of the child5. Cognitive, social and psychological development; stimulation, interaction, play6. Environmental assessment; evaluation of the home and its surrounding in

terms of availability of facilities, objects, safety and negative environmental factors

7. Social ecology of the family; who does what, responsibilities, conflicts, etc.8. Child’s readiness to school

Main sections of the interviewEach interview is designed as a modular one and includes:1. A set of basic questions that are asked to everyone2. A set of “age-specific” questions broken into ages; (0-1), (1-3), (3-6) and

(6-7). Only the appropriate one was selected and used by the interviewers.3. Four or five close-ended questions designed to understand the parental

knowledge on child development. These are also age-specific and included in the age-specific section. These questions are directly derived from the parent training materials.

4. A home assessment tool that includes questions to the mother about the availability of developmentally important objects, tools, books etc. combined with an observational tool that requires the interviewer to take a tour of the house and record his/her observations.

Data Collection MethodsA four-part family interview schedule has been developed by the participation of all the researchers. The workshop participants who developed most of the questions and received the training were mostly able to conduct the interviews.

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One member of this group needed to be replaced, however they have received their own training by observing the trained staff conducting interviews.

The interviews were conducted by the “primary caretaker” of the target child in each family. Primary caretaker is defined as the adult person who spends most of the time taking care of the child. For the entire research sample, this turned out to be the mother of the target child

A small reward was given to the families for their time.

Interviewers went to homes in pairs. The team leader for the interviewers was Atamurad Matgeldyev, the Chairman of the Children's Fund of Turkmenistan. He was in charge of administering the whole data collection and data entry efforts.

Target age groupThe age group targeted for this study ranges from birth (pre-natal period included) to seven years of age. A further differentiation of ages was necessary, and the age categories were defined as; 0-1, 1-3, 3-6 and 6-7.

Sample size and selectionIt was critical to have a randomized sample be used for the study. To achieve this, the researcher approached the health care worker in each village. The healthcare workers were not only familiar with each family, but they had access to the records so a balanced as well as randomized sample could be selected. (It was necessary to "balance" the sample in terms of age and gender of the target child). The sample size was 180 families.

Coding and Data AnalysisInitial coding and data analysis was conducted by the Children's Fund of Turkmenistan. A secondary data analysis was then conducted by Dr. Selim Iltus and the results are presented in this report.

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V. DESCRIPTION OF PROCESS

Preparation for the study: development of questionnaire and training of the research groupPrior to the workshop in Turkmenistan, UNICEF consultant Dr. Selim Iltus reviewed the project proposal, prepared topic areas for the questionnaire development, worked on outlining the activates and agenda of the workshop as well as preparing for the group training for focus groups.

A meeting was conducted with Niki Abrishamian from UNICEF New York to review the research plan and objectives.

UNICEF Turkmenistan office also prepared the list of workshop participants and made necessary arrangements prior to the workshop. The participant list included representatives from the Departments of Education and Health, as well as education and health specialists from universities and hospitals and members of research institutes.

In March of 2002, Dr. Selim Iltus visited the UNICEF Turkmenistan country office during the week of March 18, 2002. Activities conducted during the series of workshops conducted with the participants included:

Discussion of the objectives of the study Logic Model Development exercise – Identifying goals, activities, and

outcomes Finalizing the methodologies to be used in the study Identifying the target age groups Identifying the research topic areas Development of the interview questions Family Focus Group Exercises Community Focus Group Exercises Focus Group Training Pilot testing the interviews/observations in four separate families Modification of interviews Inter-coder reliability check Action planning, sample size and strategic planning with the whole

group Internal strategic planning

Pilot TestingPilot testing of the study was conducted in various locations in Ashgabat. Four families have been selected for piloting.

The six-person research team divided up into two teams of three persons each. During the pilot interviews, three members of the team divided up the interview and all did a section. They all coded the full interview.

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The interviews lasted approximately 40 minutes.

Upon completion of the pilot interviews, the group discussed overall impressions as well as each specific question. While a significant number of questions were adjusted, these changes mostly related to stylistic and language issues. Age appropriateness of some questions were also discussed and issues were resolved.

To ensure inter-coder reliability, three members of each group compared their answers. A very high reliability over 98% was achieved. The discrepancies were all in observational questions where the physical environment was assessed. Interviewers developed new criteria to ensure compatibility in this area.

A second methodology that was to be used to collect information from families and the community groups was the focus groups. Research team was trained to use a focus group methodology that was supported by a visual method. Due to time limitations, only a small portion of these focus groups were conducted in the field. The results from these focus groups are not available. It is strongly recommended however that these focus groups should be carried out in target communities as a starting point of a community-based intervention. (During the action research phase of this project, two such groups were conducted and the results clearly demonstrated the value of this approach).

Participatory action research Once the findings are organized in a format that could be presented to the government representatives and other stakeholders, a second phase has started. The goal of this phase was to use the research findings to develop a consensus on programming decisions and implementation strategies. During this phase it was also critical to meet directly with parents and community members so they could provide input on program and strategy options.

This second phase that could also be titled "the participatory action research phase was conducted in May 2003. During this phase a number of meetings with government representatives and families in the field were conducted. Each meeting was designed to reach a specific objective. The activities conducted during this phase included the following:- Presentation of findings and workshop with high-level government

representatives and other stakeholders- Individual meetings at Velayet and Etrap level- Workshops in the villages with parents- Velayat level workshop with government representatives and high-level

professionals- Synthesis of the findings and development of program plans

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VI. RESEARCH FINDINGS

The section on research findings is organized to look at various child development domains covered by the survey questionnaire. As such it will look at issues including health, nutrition, emotional development, cognitive development, safety, play, school readiness, etc.

This report is not intended to be a mere academic investigation of child rearing knowledge and practices. The main objective is to produce a document that could be used to identify the major gaps in the effective child-rearing practices in particular regions of the country and help UNICEF and other practitioners to develop community-based actions strategies to deal with these issues.

To achieve this purpose, each analysis section is followed by three headings to tie the findings with practical outcomes. These are:

1. An interpretation of the finding: In many cases, a survey result is widely open to interpretation. People who are familiar with the setting and culture are usually the best ones who can interpret results accurately. For example, when the results indicate that a very large portion of the children were involved in household work, it is not appropriate to jump to a conclusion without clearly understanding what this finding means. It is clear that a very large range of activities could be labeled as "work". This can range from carrying wood, supervising or taking care of younger siblings. This activity is also dependent on cultural practices as well as environmental conditions. The ideal way to interpret the results would be to follow up the issue in the field with a range of qualitative methodologies including focus groups with residents.

2. Program implications: It is extremely critical that the findings from these research projects are used to implement program models, adjustments and changes. At a minimum, for interventions that adopt any type of parent training or education, the findings could be used to influence the material content. They could also help to shift the focus of the intervention from all of child development areas, to more targeted deficiencies identified in the community. For example if the findings indicate that almost all the children studied are fully immunized while the sanitary practices in the community leaves a lot to be desired, program interventions can stress the second area while spending less time and material on the first.

3. Action Strategies: Some findings can provide strong clues on how to approach an issue. In addition to training or educational material adjustments, they can give us ideas and options for creative forms of intervention. These could be through governmental actions, community-based strategies or other organizational means. Again, improving sanitary practices in the community is a good example for such a strategy. Even if the findings indicate that practices such as washing hands before meals are not implemented, the interpretation of this finding can point us to the fact that underlying reason for such outcome is not necessarily due to lack of knowledge on parents' side but more an outcome of

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the lack of necessary facilities and availability of water. In such a circumstance, it would be much more appropriate to deal with the issue by mobilizing the community to design, build and install simple water-storage substructures rather than trying to deal with the issue through more educational materials.

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UNDERSTANDING THE FAMILY

HouseholdWithout going into too much detail, it would be important to understand what kind of family structures we are dealing with in the targeted Dashoguz Velayat of Turkmenistan. If we look at the demographic variables on family size, number of children and income we see the following picture.

Family sizeThe average family size of the sample was seven persons. The families ranged from four people to thirteen people. However, the median was also seven, showing that very large families of nine and more people were not that common.

Number of childrenThe total number of children in the family ranged from 2 to 7. However, as seen in the graph below, majority of the families have two to four children.

InterpretationIt is possible to assume that the families are getting larger as new children are being added to the family. To test this hypothesis, the correlation between the mother's age and the family size was checked out and no relationship was found. This indicates that family size is a characteristic which is mostly shaped by the presence of elderly and other relatives in the family. As expected, data indicates a strong correlation between the mother's age and the number of children in the family.

Programmatic implicationsDealing with large families requires special intervention approaches since the caretaker functions are likely to be divided among various adults and older siblings in the family. In these cases, only targeting the mother may not be as effective.

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Chart 1: Family size Chart 2: Total number of children

Action strategiesStrategies that involve multiple family members, especially the primary and secondary caretakers should be explored. Furthermore, the flow of information within the family becomes critical. For example, who trains the older siblings on how to take care of the younger ones? Is there an elder "family leader" who makes child development decisions? These are all critical questions that has major impact on the strategies that need to be used.

Age and education of the parents Analysis of the target population shows that unlike some other developing countries, the parenting age in Turkmenistan is significantly high. None of the mothers in the study was younger than 20, with the mean being 32. Only 15 of the 180 mothers in the study was younger than 25. The distributions of the mothers' ages are shown below.

The mean fathers' age in the study was 33 and it ranged from 21 to 57. Most of the father's were between the age of 28 to 35.

In terms of, education, as typical of many Central Asian Republics, all mothers have at least incomplete secondary education. Of those, 16% has specialized secondary education while 11% has higher education.

For the fathers, incomplete secondary education is at 64% and specialized secondary education is at 7%. 27% of the fathers in the study had higher education.

InterpretationThe target group in this case could be defined as mature and educated people, who would be willing in getting involved in intellectually stimulating activities related to childrearing.

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Chart 3: Mother’s age

Program implicationsA unique aspect of this population is, while they are mature and relatively well educated, this is not necessarily reflected in their employment or income. The chart below shows the distribution of the mother's profession. While 42% of the mothers were labeled as "housewife" a significant number (25%) is defined as "farmers"

Distribution of the fathers' profession shows similar trends where 22% of the fathers are described as manual laborers, 25% are shown as farmers.

Interestingly, the data indicates that if the mother is defined as a farmer, this does not mean that the father is also one. In only about 11% of the families, both the mother and the father are defined as farmers.

Also, data shows that if the father is a manual laborer, it is likely that the mother is defined as a housewife.

InterpretationIn an economy as complex as Turkmenistan's, it is not logical to expect that people will only hold one job or stick to a single profession. In rural areas almost everybody does seasonal farm work, and many do a variety of jobs. Therefore one should be careful while equating the housewife category in mother's profession, with the mother "being at home" at al times. It would be useful to clarify this phenomenon during the work in the field.

Programmatic implicationsWhile dealing with a relatively well educated and mature audience, traditional training methodologies may backfire. While these parents are likely to be hungry

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Chart 4: Mother’s profession

for quality information and are eager and sincere to do the best for their children, it is important to factor in the amount of intellectual curiosity and pride that is involved. As a result, simplistic and "didactic" approaches may be faced by a cool reception.

Action strategiesAny strategy that is involving and especially challenging the parent are likely to be more successful. The nature and scope of his "challenge" should be decided within the communities, with the participation of parents and other community leaders.

CaretakersThe data clearly indicates that in all of the families, the child's mother is described as the primary caretaker. However, when the identity of the secondary caretaker is explored, we see a wide range of people taking that role. As seen in the chart below, older children and grandmothers emerge as the two most frequent caretakers with grandfathers being the close third.

This picture, however interesting could be misleading. The data shows that the secondary caretaker role shifts dramatically as children grow. The chart below illustrates how the responsibility of taking care of the child shifts from the grandmothers to the older siblings as the child grows up. It looks like until the age of three, grandmothers and sometimes grandfathers are given primary responsibility as the secondary caretaker. This changes after the age of three, and we see less of a role for grandmothers, while the responsibility is now with the older siblings.

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Chart 5: Secondary caretaker

An analysis of secondary caretaker assignment against gender did not reveal any significant findings indicating that gender is not playing a role on who in the family takes the responsibility of being the secondary caretaker.

InterpretationDefining the mother as the primary caretaker does not necessarily mean that the mother is the one who spends most of the time with the child. Especially, in families with four and more children and large households where mothers' duties are overwhelming, one can expect that a significant amount of time a child spends is either alone or with other family members.

Program implicationsFindings indicate that interventions for early years need to take into account the grandmothers and grandfathers as major players. From three to six years of age, older siblings play a significant role and need to be targeted. At the preschool age of six, the child seems to become more independent and the role of secondary caretakers are being minimized.

Action strategiesReaching multiple members of the family could be done in a variety of ways. While one option includes meting/training different members at the same time, the availability of older children may pose a question. It is recommended that a more playful strategy be developed in order to reach this young group.

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Chart 6: Child’s age

Fathers' involvement in childrearingThe study closely looks at the nature and frequency of the father's involvement with the child. When we look at all the families, we see that in 14 percent of the families there is no involvement of the father with the child.

There is no direct relationship with the father's involvement with the child and any of the demographic variables of the family. In other words, father's involvement is not a factor of education, age, income or family size. However, a trend becomes apparent, when we look at the age of the child. As illustrated in the chart below, a slight increase in the fathers' involvement in the child is documented for the age range of 3 to 6.

As for the gender of the child, while statistically not significant, there seems to be a slight favoritism towards the male child. As seen from the chart below, number of fathers who are involved in their male children are more (n=86) than the ones involved in female children (n=67). Similarly, while 11 fathers never get involver with male children, the number for females is 14.

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Chart 7: Father’s involvement


When the father's involvement is explored in terms of quality, we see the same pattern, where the so called "superficial" involvement is highest in early ages where the father's ability to interact with the child is limited. The emotional and educational involvement reaches its peak between the ages of 3 to 6. The following chart summarizes this finding.

InterpretationA surprisingly high level involvement by the father is indicated by the data. This seems to be consistent across three questions exploring this topic. There is no reason to doubt the reliability of the data on this issue. There is however, a small percentage of fathers (14%) that remain totally uninvolved with the child. Analysis of data was not able to pinpoint these fathers based on any of the

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Chart 9: Gender of the target child


demographic criteria. Further research is necessary to identify the exact phenomenon that excludes fathers from getting involved in the child.

Program implicationsThe high level of involvement by the father at ages 3 to 6 and on to age 7 can present some interesting program opportunities. The research indicates that educational involvement is a big part of this interaction. Training and program materials that can help this activity, by presenting fathers with ideas and tools so they can conduct joint projects with their children could be an effective way for increasing this involvement.

Alternatively, the lack of involvement by the fathers in early ages may seem as a "gap" in the child development system, and programmatically one may decide to target that "gap" through a variety of interventions. There may be a variety of reasons that could keep the fathers away form very young children. Some of these could be traditional while others may be related to limited range of activities possible with young children. Again, this issue could be dealt with creatively, by developing engaging approaches that would result in increased involvement by the fathers.

Historically, in many cultures it has always been a challenge to involve fathers in child development. However, in Turkmenistan, there seems to be a solid tradition to that effect and there are opportunities for programs to build on this foundation.

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CONDITIONS RELATED TO CHILDREN

EnvironmentThe immediate physical environment of the families are likely to have a major impact on the child-rearing practices of the parents as well as on the development of the child. To assess these conditions fully, a number of questions were asked that were related to the physical environment. In addition, one member of the interview team acted as an observer and systematically recorded various environmental qualities based on the criteria developed during the training sessions and inter-coder reliability exercises.

The homes range from 60 square meters to 210 square meters. The average home is 130 square meters. As expected, there is a very significant relationship between the size of the home and the size of the family. As the families get larger so does the home.

All homes are single story structures. 72 percent of the homes have a bathroom and 83 percent of them has a shower. However, 7.2% of the homes did not have either a bath or a shower.

In a traditional Turkmen home, it is not easy to label rooms according to their function in a western fashion. The rooms are used much more economically and flexibly. The same room can be converted into a dining room during mealtimes and then becomes a bedroom at night when the bedding in the closets are taken out and put on the floor. Therefore the section of the data that assigns labels to the rooms could not be used effectively.

All of the homes have central heating except a few (n=3) that use gas furnaces. None of the homes have a central sewage and they all get their water from the wells.

As for provisions for the children's play, all homes have an outdoor play area in the form of a backyard. Many homes also have an open porch (51%), enclosed porch (66%), garden (87%) and central courtyard (76%). The ratings related to

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Chart 11: Bath or shower

their safety and cleanliness was very consistent, and all the observers indicated that these spaces that they have observed were clean and safe. The only exception to this rule was the adjacent street that was used for play. 78% of the homes had an adjacent street that children play on. While 44% of them are rated safe and clean, 56% was identified as dangerous and dirty.

The data shows that the observers spotted dangerous objects or areas in 19% of the homes. The dangers were described as hot surfaces (17%), open fire (9%) and sharp objects (3%).

Who are the families that are at risk in terms of dangers in the home? The number of dangers identified by observers clearly seems to relate to mother's education and family income. As seen below, as the mother's education level and family income increases, the number of injury risks in the home does decrease.

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Chart 12: Mother’s education

Observers also checked the availability of items such as child reading materials or toys in the home. In these categories, availability of the child reading materials was one of the more critical variables. Findings show that while 24% of the homes have no child reading materials, 42% only have a few.

However, it would be more accurate to look at the availability of reading materials across ages. In such a picture, we see some dramatic differences.

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Chart 13: Income of the family

Chart 14: Child Reading material

As it would be expected, availability of child reading materials is very low for the 0-1 age group. Although, this is surprising, since due to the large size of the families, one at least expects to see books that belong to older siblings. The availability of reading materials relatively increase for ages 1 to 3 and then 3 to 6. Still, the percentage of homes with no reading materials are still too high all across the ages (36% for 0-3 group, 20% for 1-3 group, 34% for 3-6 group and 9% for 6-7 group).

The availability of child reading materials in the home is closely associated with the mother's education. For example, 75% of the mothers with high education has many reading materials at home, while this number is 29% and 28% for mothers with secondary and incomplete secondary education.

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Chart 16: Child Reading Materials

A significant percentage (75% many, 22% few) of the families have manufactured toys available for children's play. The availability of handmade toys on the other hand, changes from family to family. This could be an important indicator, because it is possible to assume that presence of handmade toys show special concern and care on the side of the family members as well as that they value play.

Who are the families that are providing their children with many hand-made toys? Are they doing this because they could not afford to buy manufactured toys? Analysis shows that there is no relationship between the availability of handmade toys and the family income, family size, number of children parent's age, or even mother's education. There is a relationship however with the age of the child. We can see, starting from birth, the availability of handmade toys are increasing until the age of 6.

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Chart 17: Handmade toys


As for media resources, 95 percent of the homes have radios and televisions. This however is not an indicator of family income.

98% of the mothers interviewed indicated that there is a dedicated play space for the child inside the home. 92% also had dedicated storage for keeping toys and other materials.

Indicators for environmental quality included clutter in the home, quality of light and quality of air. Observers indicated that only 9% of the homes were highly cluttered, while the others were either a little cluttered (51%) or neat (40%).

Only 1% of the homes were categorized as brightly lit. 92% were defined as shady and 7% were defined as dark. This is most likely an outcome of climatic conditions and architectural style.

As for air quality, 21% were defined as fresh. 66% were rated average, and 12% were defined as stuffy or airless.

According to these results, the norm seems to be a shady home with average quality of air and a little clutter.

InterpretationFamiliarity with this society and many of the results of data analysis forces me to think traditional SES (Socioeconomic status) scores that are used as major demographic variable in western countries are totally meaningless for Turkmenistan. Even the most logical relationships that need to exist between material objects and family income for example, do not seem to exist. This indicates that there is a very unique and special dynamic in place here. All parents seem to have reasonable education, yet the differences in terms of their relationship to the material world do not seem to change much, based on their educational level, profession or income. This brings up the question, "what differentiates these families from each other?" The answer to this question is likely to be "hidden" within much smaller indicators such as the availability of handmade toys or the use of traditional methods for healing.

Programmatic implicationsSince play is so critical for the development of young children, it is possible to think that the unique characteristics of the Turkmen home provides an incredible opportunity for generating a safe and stimulation outdoor environment for the children of all ages. Further analysis may be needed in order to understand the true physical qualities of the outdoor environment. However, as the survey indicates, it would be logical to think that it is a well protected and well supervised environment with a range of natural elements.

The child development programmers could basically use this existing resource to maximum benefit. Through education, distribution of directions for constructing

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various outdoor furniture and props (easels, sandboxes, etc.) it might be possible to create unique and stimulating environments in many backyards.

Action strategiesDeveloping outdoor play equipment and educational props can be organized into a community-based initiative. Parental pride and feeling of competition among families could be used creatively to make a significant impact on the quality of outdoor spaces as play and learning environments in many homes.

Discipline, conflicts and authorityA small set of questions focused on the interactions of the parents among themselves, with their children and to their disciplinary tactics. All these variable are shown to be related to the emotional health and development of the child.

In response to the question related to family quarrels, a significant majority (96%) indicated that they never quarrel in the family. and if so, never in front of the child. While the accuracy of this finding is questionable, it also gives us clues about the importance of family privacy in this culture.

In terms of disciplining the child, when the parents of children one year and older were asked if they needed to punish their child, 78 parents (56%) said "yes".

In terms of punishment styles, parents indicated that they were using three different forms of punishment. These were verbal retribution, corporal (physical punishment) and putting restrictions on the child. For children older than one, the patterns of punishment needed to be explored across different age groups.

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Chart 19: Child punishment

Verbal retribution is seen lowest (at 27%) for ages one to three, while it is highest (43%) for ages 3 to 6.

Both physical punishment and restrictive punishment seems to increase with age as seen in the following charts.

In-depth exploration of punishment strategies used by families revealed interesting results. Of the three different methods, physical punishment, emerged as a very strong indicator of a certain type of parenting "approach".

The avoidance of physical punishment, is very closely related to one demographic and three other seemingly important "indicator variables".

First, data shows that avoidance of physical punishment is related to mother's education. As seen below, physical punishment is dramatically higher for the mothers who did not complete their secondary education.

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Chart 21 and 22: Child’s age

Physical punishment is also very closely related to father's involvement in the rearing of the child. If the father is involved in taking care of the child, the family is less likely to use physical punishment. However in families where the father is never involved in the development of the child, this trend is reversed.

Families who tend to use more traditional healing methods are also the ones who are more likely to use physical punishment. This is not unexpected and may indicate that physical punishment is a part of more traditional form of childrearing.

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Finally, the exercise of physical punishment is closely related to if there are many handmade toys in the family or not. Data indicates that if there are many handmade toys in the home, that family is less likely to be using physical punishment.

When asked who generally punishes the child, mothers responded that most of the time it was them (71%). The number of families where the father takes over this role is 14%.

When we look at the issue of who punishes the child across age groups, we see that father is becoming the main authoritarian figure as the child grows up. At the age of 6, both the mother and the father have a say in the disciplining of the child. Interestingly, the role of other family members as the primary disciplinary figures become less and less important as the child grows up.

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Chart 26: Many handmade toys at home


The mother may be the prime disciplinary figure in the family. However, when it comes to authority, it is the father. To the question, "whose authority does the child follow?" 54% of the respondents said the father and 23% said the mother.

Looking at how authority shifts over the age groups, it is possible to see that the other adults (grandmother and grandfather) quickly lose their dominance as the child grows. Mother's authority is consistent, but slowly diminishes as the child grows. The father on the other hand emerges as the main authority between the ages of three to six.

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Chart 28: Authority follow

The main authority variable also seems to strengthen the patterns described above. For example the data indicates that families where the father is the figure of authority are more likely to use traditional healing methods. The "handmade toys" variable however in this case is replaced with the availability of child reading materials. That is, the families who have the father as the main authority are less likely to have child reading materials around.

InterpretationA unique and useful pattern seems to be developing from the "discipline" issue. The data is pointing to a certain "type" of family that is emerging as a strong pattern. This type of family has a well educated mother, father is heavily involved in child rearing, they do not use traditional healing methods and they provide their children with a lot of handmade toys. From this description, we can also speculate an opposite pattern also exists, more traditional families, using physical punishment where the father is not involved with the child and there are no handmade toys available to the child. This data does not have any information on actual child indicators. Therefore, it is not possible to relate these patterns to actual child outcomes. This however is worth further investigation. Do these patterns have a direct influence on the child? if so what are they? And if needed, how can they be changed?

Program implicationsWhile parental disciplining strategies might have somewhat limited relevance for generating parent training materials for child development, the patterns described above may be very useful in a number of ways. First, they can help us to identify families that are "at risk". In Turkmenistan, it is becoming more and more obvious that traditional SES measures are not enough to identify "at-risk" populations. That is because certain segments of the population are very "homogeneous". They have similar incomes, they live in similar homes and are likely to share similar beliefs and ideologies. With the limited resources for programming, it may be harder and harder to decide on which families the

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programs should focus on. Findings from this research could be useful in such circumstance.

Second, is the issue of "change". How can we achieve change in these patterns, if they would mean a better environment for the children to develop in? The question is, if one component of the pattern is altered, if and how that will impact the remaining components. For example, through various interventions in a family, where the father is never involved in the child, change could be achieved and the father is convinced to start taking some limited responsibility, will this affect the other components of the pattern, such as corporal punishment, handmade toys, etc.?

The answer to these questions could be found through some community-based interventions, using a participatory action research methodology. Going through a series of cycles of intervention and reflection, it would be possible to judge the effects of various interventions on the patterns described above.

Recreational activitiesParents were asked to question how important they think is play for the children. 62% said very important and the remaining 38% said important. None said play is unimportant. When looked across the ages, we see that parents give more and more importance to play, until the child reaches preschool age. Then, the number of mothers who say that "play is very important" drops slightly.

Since all parents said that play is important, and the difference between "important" and "very important" is not so wide, it is possible to conclude that this variable is not necessarily a critical one for the study. However, this simple question unleashed a long set of very significant correlation with other key variables and emerged as a very critical indicator of parenting style.

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Again the findings from this section strengthen the patterns found earlier. The data showed very significant relationship with the answer to the question on the importance of play. As usual, this variable was related to the mother's education. However, it was also very significantly correlated with the following variables; father's involvement with the child, family's use of traditional methods of treatment, availability of child reading materials in the home, availability of handmade toys in the home, the person who acts as the authority figure to the child and the use of physical punishment.

The fully developed pattern now shows us a "type" of family that does things in a consistent manner and seems to be valuing play. As such, the relationship between the family and the child, exercising authority, providing play materials to the child, building toys for the child, fathers involvement, etc. all seem to be regulated (or at least being influenced by) a somewhat ideological stand about the importance of play.

Programmatic implications / strategiesDespite the importance of the finding about play, it is not possible to assume that behavior of parents could be easily influenced by changing their ideas about play. However, this possibility should be explored. It is worthwhile to discuss if lifestyle emerges as a function of ideology or vice versa. Effective program interventions are more likely to have an impact on knowledge and beliefs rather than the lifestyle. As such, teaching about play, involving parents in play, and having them participate in the design of play spaces could become an "entry point" as well as the organizing principle of an effective intervention.

A word about scale: how much is too much?While interpreting the numerical findings in this report, sometimes it is easy to assume that a large positive number in a single variable is also an indication of totally healthy outcome. For example, when we report that 85% of the fathers are in some way involved in care and development of their children, this may struck us as a very positive outcome. However, the 15% of the fathers who never had a contact with their children in actual life constitute a very significant block of families.

Assuming that this survey is nationally representative, a 15% minority in Turkmenistan, with a population of 5.6 million would represent 810,000 people or approximately130,000 families. Even if the finding is not nationally representative, just in Dashoguz Velayet with a population of 1,200,000 people it would correspond to 30,000 families.

While looking at statistics, it is important to consider what the implications of these numbers are and how they could be addressed effectively.

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HEALTH, NUTRITION AND HYGIENE

HealthWhen asked about their child's health, an overwhelming majority (94%) indicated that their child was totally healthy. The remaining parents said that they were fairly healthy. Only one parent (out of 180) indicated that their child was not healthy. Similarly, when asked about genetic and chronic diseases, only 6% reported any. But upon closer examination of this group, it was apparent that many of the conditions cited were not serious or alarming. Parents included allergies and wearing glasses in this category.

Practice of going to the doctor also seems to be very easy and regular. For example, 70% of the parents indicated that they would seek a doctor's help in the case of fever or coughing.

Findings indicate that the use of traditional methods of treatment is a significant phenomenon and should not be overlooked. About half of the participants (49%) indicated that they have been using some form of traditional method for healing their children. The breakdown of these methods is shown below.

At 29%, uzarlik or smoke of uzarlik (the plant Peganum Harmala, believed to fend off evil eye) is the first choice of families in traditional healing methods. At the first look, a more disturbing trend may be the 19% of the families who are using exorcism or other faith-based approaches. However, when evaluated together with the other data on doctor visits and referrals to professionals, it is possible to conclude that traditional methods are being used in addition to professional medical help, not as a replacement for it.

Who are these families that use traditional methods of healing? The data failed to reveal any clear answers. The phenomenon is not related to the age, education and profession of the parents. Neither is family income a factor. The only two demographic variables that seem to be correlated are the child's age and family size.

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Chart 31: Traditional methods used for treatment

As seen in the chart above, the use of traditional methods seem to drop once the child reaches the age of 3. While the trend is not very significant, it tells us the most common period for using traditional healing methods is between the ages of 1 and 3.

The family size also shows another trend that is not easily explainable. Small families (4 and 5 members) are likely not to use traditional methods. The trend then gets more significant as the family size increases and peaks at 6 and 7-member families. It then drops as the family size gets bigger. This is shown in the chart below.

As for the main source of health information, all the parents indicated the doctor or the nurse. Additional sources referred to included relatives (31%), mass

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Chart 33: Family size

media (20%), healers (11%), neighbors (9%), friends (8%), and schoolteachers (6%).

As for vaccination, all but one parent indicated that their children were fully vaccinated. But when asked if they knew the purpose of vaccination, 31 parents (17%) could not answer the question.

InterpretationOverall health practices and reliance on medical professionals seem satisfactory. There seems to be frequent contact with doctors and nurses and all children are immunized. The reliance on traditional methods as a secondary measure is somewhat perplexing. The program team should discuss this and decide if this practice is any way hinders the efforts for children's health.

It should be also noted that the information related to disabilities, defects etc. could be very much influenced by the sensitivity towards these issues in the culture. The interviewers were originally cautioned about this and were asked to conduct a follow-up visit and/or ask specific questions if they had encountered an child with disabilities during their visits. Not surprisingly, this has not happened. Most likely the family avoided any possible contact. It is important to develop an effective strategy to address this issue in the future.

Program implicationsIn the light of the findings, UNICEF Turkmenistan may decide that it might not be necessary to heavily focus on health issues in new programming. However, monitoring of the situation should continue.

Action strategiesAn interesting finding in this section is the use of mass media by 20% of the population in this region. This can be a significant number. Data indicates that families with high incomes are the ones that are mostly using the media as a source of information. This may be related to having a radio or television in the home. Unlike many societies however, health practices are not a variable of income for this study group. Therefore, it would be possible to consider media campaigns as a limited but viable alternative in communicating child health-related messages.

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The chart below shows how income is related to using media as a source for child health information.

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Chart 34: Relation of income to media

NutritionAll of the mothers surveyed acknowledged the importance of breastfeeding an they have indicated that on average breastfeeding should last about two years (mean=22 months, Median=24 months). When asked how long they have breastfed, the median was 18 months. 22% of the parents stopped breastfeeding at one year. Only seven percent stopped it before 6 months.

An inverse relationship between the mother's education and the length of breastfeeding seems to exist. The mothers who have the high school education are the ones who stop breastfeeding earliest, while the parents who did not complete their secondary education did continue breastfeeding much longer.

As for giving supplemental food to the child during the first year, majority (84%) of the mothers indicated that they had given supplemental food to their children during the first year.

When do mothers start to give supplemental food to their children? Data indicates that 6 months is a breaking point in this. 45% of the parents do start supplemental food at this time.

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The chart below shows this trend clearly.

InterpretationThe parental knowledge and practices of the parents regarding breastfeeding indicates positive thinking and practices related to child nutrition. The breastfeeding practices and start of the supplemental food seems to follow UNICEF and WHO recommendations. However, by interpreting the above chart literally, it is also possible to conclude that more than half the mothers are not really following the recommendations to the letter. This brings the issue of setting goals and concrete and measurable objectives for any intervention. What needs to be done? Is there a need and urgency to interfere with the practice outlined above? If so, how much improvement is targeted by what time? These are all policy questions that need to be answered probably with the aid and participation of the national partners.

Program implicationsWhile the practices are promising, the data suggests that there is still quite a room for improvement in this area, and it should be targeted by interventions.

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Chart 36: Start of supplementary food

Hygiene practicesMothers' were asked a series of questions related to the hygiene habits of their children. When asked if they teach hygiene habits to their children, 95% of the parents with target children older than one-year-old said they do. When actual hygiene habits of children older than one-year-old were explored, the following trends were discovered.

As seen above, while 79% of the children have the habit of washing hands and face, only 33 percent of the children are brushing their teeth and percent who bathe regularly is 21.

When this data is broken into age groups, the trends become clearer. The data indicates that especially in hand and face washing, the practice is not common in early ages. The practice raises to 90 percent at ages 3-6 and reaches 100% by the ages of 6-7.

While the same trend is not as strong in the other functions brushing teeth and bathing. Especially for the age group of 3-6, the numbers seem to be significantly low; 24% and 19% respectively.

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Chart 37: Brush teeth

When asked what hygiene habits they teach their children, parents identified washing before meals, regularly washing hands, washing the body, cutting nails, to be neat and clean, brushing teeth, and combing hair. The following charts show the percent of parents who teach these habits to their children.

The data indicates that the two critical hygiene habits being thought by the mother to the children, washing hands before meals and after toilet and brushing teeth are inversely related to the father's involvement in raising the child.

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Chart 39: % of parents teaching hygiene habits to children

The data is consistent for both of these variables, and strongly suggests that if the father is involved in childrearing, the mothers are less likely to teach these behaviors to the children. The hypotheses that could be derived from this finding could be to assume that high level of father's involvement would actually prevent the mother to teach the child these habits. To test this hypothesis, one can look at the actual behavior of the child, related to these habits. The findings are not very conclusive. However, there seems to be a strong link between father's involvement and the habit of washing hands. This trend does not seem to hold true for brushing teeth.

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Chart 40 and 41: Brush teeth

Finally, in order to understand this phenomenon more clearly, we need to look at it across age groups. When looked this way, no significant changes in the pattern were detected in the involvement of the father year to year.

Another interesting question is to see if teaching hygiene habits constitute an integrated pattern or behavior style? In other words, do mothers who teach washing hands are also likely to teach other habits ranging from brushing teeth to cutting nails?

X2 Tests conducted clearly indicate a very high level significance between actual behaviors among observed (by the mother) hygiene behaviors as well as the patterns of teaching hygiene practices.

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Chart 42: Washing face and hands

Chart 43: Brushing teeth

washing face and hands

brushing teeth

Bathing other

Chi-Square

35.000 20.829 50.400 24.029

df 1 1 1 1Asymp. Sig.

.000 .000 .000 .000

a 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 70.0.

Test Statistics wash

before meals and after toilet

washing hands

washing body

Cutting nails

to be neat and clean

to brush teeth

to comb hair

Chi-Square

27.457 99.457 52.829 77.257 4.114 39.114 102.857

Df 1 1 1 1 1 1 1Asymp. Sig.

.000 .000 .000 .000 .043 .000 .000

a 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 70.0.

These relationships clearly indicate that there is a pattern of closely linked behaviors both in children's hygiene habits and the mother's teaching those habits. In other words, if a child is washing hands regularly, he/she is also very likely to brush teeth and bathe regularly. Similarly, if a mother is teaching her child one of the hygiene habits, she is also very likely to teach her/him others.

Program implicationsData clearly suggests that a significant improvement in the hygiene habits of the target population is required. Many of the reasons for the current habits could be attributed to the environmental conditions of the home and its surroundings. While a significant in the subsystem such as central sewage would require a significant state involvement, there are many ways to impact the local or house-to-house conditions through organized community action.

Action strategiesIt is not easy to define a strategy for a physical improvement without full involvement of the community. The data does not give any clues what this would be. While the mothers seem to be the primary force behind the teaching of hygiene habits to the children, it may be the male adults including the fathers who need to be mobilized in order to make a difference in the physical environment. Therefore a full cooperation between different community members might be necessary for a serious improvement on this issue.

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VII. FOCUS GROUP FINDINGS

PLS ELABORATE: INTRODUCTION OF THE PROCESS OF FOCUS GROUP DISCUSSION

FOCUS GROUP 1

Activity: Workshop with government representatives and other stakeholders

Goals: Communicating research findings to all interested parties Generating a discussion about the implications of the findings Identifying priority areas for programs and strategies

Outcomes A voting matrix identifying the priorities of the participants for different

program areas A voting matrix that shows the participants' ideas about appropriate

intervention strategies for Turkmenistan

This workshop which took place in Ashqabat was opened by Ms. Jahan, head of secondary education MoE. After a presentation and the discussion of all the study findings, participants were given a series of intervention strategies compiled from the literature. They were then given some voting stickers and asked to distribute their votes (5 in total) to the most appropriate strategies that they think would work best in Turkmenistan and would make the biggest impact on ECD. The result is shown in the following chart sorted from the strategy that got the highest vote to the least.

Table 1.STRATEGY TOTAL

VOTES

Governmental intervention 16Clubs and organizations for children 15Youth involvement 12Parent groups 12Toy libraries and play centers 11School-community ties 9Direct educational intervention 8Children's active participation as change agents 8Public discussions 8Sports programs 8Action research that leads to change 6Counseling services 6Media programs 6

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Involvement of community based entity in the design and development of service schemes 4Involving individuals to improve their own environments 3Increased access to information 3Systemic government involvement in building infrastructure 2Economic and income generating schemes 1

As expected, based on the existing tradition of Turkmenistan, direct government intervention was rated as the highest. This is based on the belief and the expectation that all major ECD initiatives should be spearheaded by the government. What was surprising was the importance given to clubs and organizations for children. During the visits to the villages, there was no indication of such clubs. Given the very successful adaptation of this concept in some other countries as in the case of Nepal Children's clubs, this idea may worth pursuing.

The next two strategies, youth involvement and parent groups found their way into the program plan developed at the end of this process.

Finally, the next strategy, toy libraries is also a new concept for Turkmenistan.

A holistic analysis of the above chart could lead to two major conclusions. First, while the participants are giving enough weight to existing more traditional strategies that are already tried in the country, they also seem to be excited about new alternatives involving community-based initiatives (School-community ties, public discussions) as well as participatory approaches (Children's active participation, action research).

Another outcome of this exercise is the fact that the votes were distributed in a balanced way. This may indicate that the overall preference is towards using multiple strategies instead of sticking with one or two.

While it should be noted that this exercise was not a scientific research, the high level and variety of participants give every indication that the group is receptive to new concepts and ideas.

The second activity in this workshop was to look at various child development domains and to prioritize them in terms of their significance. In other words, in this exercise, the participants were asked which areas should be targeted for intervention. This exercise was conducted following the presentation of the research results and participants were asked to factor in the things they have learned from the study. The results are shown in the table below:

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Table 2:DEVELOPMENTAL DOMAINS

AGE 0-1

AGE 1-3

AGE 3-6

AGE 6-7

TOTAL

Health 8 5 2 2 17

Nutrition 5 5 2 4 16

Hygiene 7 15 9 4 35

Father's involvement 0 1 4 0 5

Discipline 3 3 7 3 16

Play 2 4 3 3 12

School readiness 4 8 10 10 32

The results of this exercise clearly show the concern that the participants have for school readiness of the children starting as early as ages 1 to 3. Also, the importance given to improving hygiene practices are likely a direct result of the deficiencies identified in the study. On the other hand, relative low scores given to father's involvement and play clearly show overall prevailing trend among government representatives and the health and education professionals.

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FOCUS GROUP 2

Activity:- Series of meetings at Velayet and Etrap level. Meetings were conducted with

representatives of Ministries of Education, Health and social Services. Also there were meetings with Hakim or Deputy Hakim as well as government supported community groups.

Goals:- To inform the government representatives about the UNICEF activities in the

region- Do present and discuss relevant findings for each ministry- To get feedback and commitment from the representatives on different

program initiatives that would be carried out in the region

Outcomes:- Ideas were generated and specific resources were identified for each

program initiative.- Commitment at Velayet and Etrap level was ensured

While these meetings were not workshops in the traditional sense, they were conducted in a give and take format that is not typical for meetings of this kind. Upon presentation of selected key findings to the ministry representatives, they were asked to interpret the findings followed by suggestions to improve the situation. This strategy lead to suggestions for programs as well as the identification of resources in order to carry out these programs. The following is a quick summary of these findings.

Health- The message given to mothers and fathers through "baby-friendly hospitals"

should be expanded to cover issues related to hygiene, mental health, emotional and cognitive development

- The government promotes certain traditional means of healing using local natural herbal remedies

- Media should be used to deliver health messages

Hygiene- Give hygiene messages to parents through mother-father support groups that

already exist

Emotional Development- Give emotional development messages to parents through mother-father

support groups that already exist

School Readiness- Development and distribution of reading materials to children (may need to be

handled at a more central level)

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- Target children who are not attending preschools- Reading materials for ages 3 to 5 are most critical - and missing

Play- Courses / kits to generate hand-made toys- Provide families with materials and instruction to generate toys and facilitate

play

Other general strategies- Use women's association to support program delivery- Training programs should not only target mothers but also other adults- Develop television programs covering multiple domains- Local education departments are willing to participate in book / toy drive- Use existing youth union to reach families

These exercises were extremely useful, because they helped to identify the programs that are likely to get support from local administration.

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FOCUS GROUP 3

Activity:- Workshops with parents (who mostly participated in the study as subjects)

where they were asked to respond to three specific questions by writing the answers on VIPP cards.

- Comparing the boys and the girls- How to carry our programs: realties of the village

Goals:- To get feedback from parents regarding their ideas and concerns about the

future of their children- To get feedback from parents regarding their ideas and concerns about the

school-readiness of their children- To run program ideas by the parents and to get feedback about their

applicability in the village- To get specific logistical information from parents on implementation of

programs (times, locations, volunteer help, other resources, etc.)

Outcomes:- Matrix of desired child characteristics- Matrix of future concerns regarding the child- Matrix of skills needed for school-readiness- Information on program ideas and resources available in the village to support

the programs

These workshops were carried on in two villages with the participation of large number of parents. Two workshops were conducted. The firs workshop was attended only by women. The second workshop included a number of fathers too.

Since the major goal in these workshops was to understand better the parents' desires, and concerns for their children, the parents were asked to answer three questions. These were:

1. What are your hopes for your children? What characteristics would you like them to have when they grow up?

2. What do you want your children to learn before they start school? What skills should they have on the first day of the school?

3. What are your sources of anxiety for the future of your child? What worries you for their future?

To answer the questions, the parents were given VIPP cards, and asked to write their answers on the cards individually. If anyone wanted to use more than one card, they were encouraged to do so.

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Once all the answers are collected, the facilitators sorted the cards, eliminated duplicate answers and generated a list for each question for the parents to vote on. At this step, each parent was given two voting stickers for each question and asked to indicate the two most important features in the list for a boy child, and two most important features for a girl child.

The result of this exercise for the first group is shown below:

Table 3:Group 1Q.1: What characteristics would you like your children to have when they grow up?

BOYS GIRLS

Smart 10 9Brave 6 5Well educated 6 0Healthy 5 4Disciplined 4 7Cheerful and pleasant 2 3Industrious and hard working 0 6

For both boys and girls, parents indicated that being "smart" is the most critical characteristic. When questioned further about the source if this trait, they agreed that it is not inherent from birth but can be developed through nurturing and stimulating the child from young ages. More specifically, the following was mentioned as critical for the parents to do:

Teach the child how to read and write Give the child a broader outlook on life Question the child frequently Communicate with / talk to the child Listen to the child Tell good stories to the child (such as fairy tales) Do not be lazy to answer every question of the child Explain cause and effect relationships and sources of things and events to

the child

Being well prepared for school was another critical dimension.

The group indicated that none of their children ware attending kindergarten because none was available in their village. When asked if children who attend kindergarten are more successful and turn out smarter than the children who do not attend it, all parents agreed that was the case.

This line of thinking brought the discussion to how to achieve the same goals in the absence of kindergartens.

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OUTCOME/RECOMMENDATIONS OF FOCUS GROUP DISCUSSION

The following plan was then developed by the parents in terms of parent education that would work in their village:

Strategy 1: Organize training sessions with parents

Trainers: Health workers, educated people (young mothers in the village) who could be trained for thisLocation: Best locations are the school and village health center. Mothers would easily come to these locationsBest times to conduct trainings: For working mothers, 12PM - 2 PM (Lunchtime)For housewives, Around 10AMBest days for training: Mondays through Wednesdays

Strategy 2: Create original TV programs

For example, somebody from the village appearing on TV as an instructor would generate an incredible interest.

Strategy 3: Use billboards to give simple messages

Provide billboards to communicate simple messages. These should be located in meeting places such as the water collecting location (There are only four of them in the village)

Strategy 4: Distribute books, picture books and toys to families

Provide families with developmentally appropriate books and toys. Information on instructions and how to use them with the child could be disseminated through the school and also from neighbor to neighbor.

Strategy 5: How to reach the fathers

The following have been suggested as a way to involve fathers in child development activities:- Develop programs so that the elders could talk to fathers in village gathering

locations- All fathers listen to radio all they long while working in the fields. Develop

radio programs to reach them- Generate programs that would allow fathers to work with their children in the

garden - Provide or manufacture child-sized gardening tools

The value of this exercise was mostly to illustrate the power of doing participatory program planning at community level. The example cited above shows that it is possible to start wit most general concepts (the future of the child) and through

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community interaction to carry it out into a program type, action strategy all the way to specific information such as the scheduling of training sessions.

Another striking finding that emerged from the exercise was the bias against the girls in terms of parents' thinking of their future. as seen in the table, while being well educated is considered very important for the boys, none of the mothers thought that it is important enough to be one of the two features of a girl. Similarly, while being industrious and hard working is critical for a girl, it is not an important trait for boys. Similarly, girls are expected to be more well-disciplined compared to boys.

This bias, that came out very strongly in a focus group / workshop format did not appear in the results of the survey. This is another indication that it is necessary to validate quantitative methodologies like the survey, with follow-up methods that include qualitative data.

The second group responded to the same question as follows. This group also had a number of fathers, and their votes are calculated separately and shown in columns M (males/fathers) and F (females / mothers).

Table 4:Group 2Q.1: What characteristics would you like your children to have when they grow up?

BOYS GIRLS

M F M FSmart individuals 4 8 3 5Disciplined individuals 1 4 2 6Well educated people 1 2 0 3Helpful to people around themselves 1 3 0 0Devoted to family and country 0 5 2 7Helpful and supportive to their parents 0 5 0 6Joyful, cheerful and happy persons 0 3 0 5Honest individuals 0 6 0 2Individuals who are likely to be good example for others 0 4 0 4

As in the first group, being smart and disciplined seems to be the most important features for children. The bias seen against girls in terms of education did not appear in this group. This may or may not be attributed to the presence of the fathers in the group.

As for the skills that should be given to children before school, the results were as follows:

Table 5: Group 1Q.2: What skills should your children have on the day they start school?

BOYS GIRLS

Keeping himself neat and clean 9 1356

Eager to study 6 6Knowing the letters of the alphabet 4 2Respecting elders 4 1Know how to wash their teeth 2 0Learning handcrafts 0 12Ability to read the books 0 2

The chart indicates that it is important for the child to be neat and clean as they attend the school. While the reason for this need to be explored further, it is not hard to gess that given the educational system that this is probably a requirement for school attendance. It can also be cultural, since we have always observed that all school children in CARK countries are sent to school in extremely clean and elaborate clothes. For examples, while boys have clean pressed jackets, girls usually have sparkling white collards and lace hair bands.

The results indicate that the parents are not expecting their children to be able to read prior to first grade. However, familiarity with letters of the alphabet is expected.

It is also not very clear that many parents expect the girls to learn handcrafts as a preparation to school. Apparently, this is not a requirement for boys.

Table 6:Group 2Q.2: What skills should your children have on the day they start school?

BOYS GIRLS

M F M FCan speak clearly 0 12 1 16Eager to go to school 3 12 3 10Knows a foreign language 3 10 3 6Being able to draw 0 6 0 5Can identify letters of the alphabet 2 5 1 5Can read and write his name and surname 0 1 0 1Familiar with the school environment 0 0 0 0

For this group, child's ability to speak clearly is most important to the mothers while fathers did not think this was that important. For them, as with many mothers, it was important for the child to be eager to go to the school. For the first time, this group raised the issue of foreign language. With the complexities of language in Turkmenistan, the language mentioned here may be interpreted as the Russian language. However, this issue was not explored in the workshop.

When asked, what is the earliest age that children should be given books and other reading materials, parents first said four or five and then changed it to three to four. It was clear that parents did dot think reading materials, picture books or drawing items are appropriate for earlier ages. Program materials in the villages should address this issue.

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As for kindergarten attendance, we learned that there was a kindergarten in the village operated by the collective. Yet, many of the parents said that they were not sending their children to the kindergarten, because the conditions in there were bad. These "bad" conditions were defined as:

lack of toys inferior quality of food ages are mixed (older and younger children are together)

Further exploration of this topic revealed that despite the shortcomings, all parents believed that in terms of the range of activities, they could not match the kindergarten no matter how hard they try at home. The consensus was that children attending the kindergarten were developing better. The activates done in kindergartens but could not be repeated at home include:

learning letters dance stories games role playing reading

In contrast, mothers admitted that the children who were at home mostly watch TV.

If mothers believe that kindergarten activities are so much superior, why do they keep their children at home. In addition to conditions and food, the answer could be economic. If the mother is at home all they, they may be feeling that it is a waste to spend money - even if it is a small amount - on kindergarten.

The group then explored the idea of providing children with activities and resources even when they are at home. They have felt that if trained, there are many very bright and well educated young women in the village who can support mothers and conduct activities with the children. Paying them would be an issue however. The group suggested that some of the women would be able to do this free, as long as it is only a few times a week.

Another discussion topic was child disciplining strategies. The discussion indicated that many parents are likely to start some mild form of physical punishment as early as the when the child is one-year old. Restricting access to play and cutting off communication with the child is two other common strategies. The parents stated that talking to the child and explaining to him what he did was wrong can only work after four or five years of age. Again, as the survey also indicated, this topic should be considered an important target while developing parent training materials for this community.

Finally, looking at the concerns that parents have for the future of their children, we saw the following:

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Table 7:Group 1Q.3: What are you concerned about that your child would not have in the future

BOYS GIRLS

To become a good person free from bad behaviors 10 10To be healthy, that is the most important thing 7 8Peace in the Country so that my child can live in peace 6 4To find place in life and have a profession 5 9To have a higher education 4 4

As seen in the table, the differences between boys and girls that were apparent in short-term goals seems to disappear in the long term. In other words, parents concerns in the long run for all of their children seem to be the same - for them to become healthy good people with a good profession.

Table 8:Group 2 Q.3: What are you concerned about that your child would not have in the future

BOYS GIRLS

M F M FWould be undisciplined 0 13 3 10Cannot find employment 2 8 1 7To befriend undesirable people 3 8 0 7May become an unhealthy person 0 7 2 5Would be uneducated 0 4 1 4Would not have higher education 0 3 0 3Turns out to be illiterate 3 2 1 7

Similar to the other group, being undisciplined, associating with undesirable friends and similar concerns are most important for the parents. This is followed by the concerns related to education and employment. There are no major differences between boys and girls, except for the fact that for fathers, having an undisciplined girl seems to be more of a concern than haing an undisciplined boy.

From the above examples, it is clear that community workshops are not only an excellent approach not only in deciding on how programs should be implemented in specific community setting. they are also very effective in the identification of discrepancies and areas that need intervention.

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FOCUS GROUP 4

Activity:- Velayet level workshop with representatives of ministries, educators and

other high-level professionals

Goals:- To inform the participants about the activities conducted in the field- To get feedback on appropriate program actions and strategies in each of the

child development domains- To identify the available resources and governmental support for each of the

program areas- To reach a consensus on all of the items listed above

Outcomes:- Matrix of child development domains vs. programs- List of resources for each program area

Once all the information is completed within the workshops listed above, then it is necessary to bring this information together and move towards an integrated program plan. It was also critical for this plan to be approved and supported by Velayet level officials and professionals. This was the ultimate goal of this workshop.

1) PLS CHANGE WORKSHOP TO FOCUS GROUP DISCUSSION IN THE TEXT.

2) The below part is more related to process description.

The workshop started by a presentation of the activities conducted in the field. this was then followed by an exercise where participants started to use their voting stickers to rate different strategies against developmental domains. To do this, they were presented with a matrix where all the different intervention strategies that emerged in the field are listed. These included options such as mother support groups, TV programs or toy libraries. On the left side of the matrix were the developmental domains that were identified as critical by the study - health, nutrition, hygiene, etc. While filling the matrix, participants needed to think about what strategies would be most effective for each domain. For example, they thought, are TV programs or mother support groups better to give the message on hygiene, and used their votes according to their decision.

Once the voting on strategies is completed, the last step is to identify the available and potential resources in communities. These are also discussed and added to the matrix.At Dashoguz, the result of this exercise was the following matrix.

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Matrix 1:

Col

ored

bo

oks/

piB

Bct

ures

and

re

adin

g m

ater

ials

for

pare

nts

TV p

rogr

ams

for

child

ren

Pup

pet s

how

Mot

hers

’ sup

port

grou

ps

Hyg

iene

Tra

inin

g

Col

ored

bo

oks/

pict

ures

and

re

adin

g m

ater

ials

fo

r chi

ldre

n

Edu

catio

n of

pa

rent

s

Trai

ning

for

gran

dmot

hers

TV fo

r par

ents

Teac

h pa

rent

s to

pr

oduc

e ha

nd m

ade

toys

Health 6 1 1 2 1 3 8 1 14 2Nutrition 2 0 0 14 2 0 6 0 2 0Hygiene 5 3 0 2 3 1 7 2 1 1Fathers’ involvement

2 3 2 6 1 4 6 3 1 9

Discipline 7 3 6 3 1 2 14 4 2 2Play 4 3 7 0 1 1 0 8 0 10School Readiness

8 1 2 0 0 2 5 3 2 1

Resources

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Designers in parent centers

Wood painters from parent centers

Department of education

Dept of Ed. Youth union Trained people

from women's union

Existing Mother's support groups from baby friendly hospitals

Dept. of Health

Parents' Center Health Department Youth union

affiliated trainers Mother support

groups

Trainers to meet parents at home in groups of 5-10

Mother support groups to be used to identify families

National TV

Parent's center

Special classes in schools equipped with materials and staffed by skilled instructors

VIII. RECOMMENDATIONS FOR PROGRAM INITIATIVES IN TURKMENISTAN

NEEDS FURTHER WORK/ELABORATION TO REFLECT FINDINGS/ACTIONS/CONCLUSIONS DESCRIBED UNDER EACH OF THE STUDY COMPONENT (E.G RESEARCH FINDINGS, UNDERSTANDING THE FAMILY AND FOCUS GROUP DISCUSSION)

Based on the participatory process described in this report, a multi faceted program plan could be developed for Turkmenistan. The strength of this plan is based on its roots in scientific research that was implemented as a survey of parental practices for child development. The process also ensured governmental buy-in and support for the strategies that were selected for program implementation.

Proposed programming for Turkmenistan could be summarized as follows.

Expand the scope of Mother Support Groups to include additional messages on hygiene and cognitive/emotional development

Mother support groups are one of the most effective and established program delivery methods in the country. During the community workshops in the villages we have established the fact that in addition to regular meetings the mothers have been contacted with high frequency and regularity to provide them with answers to their questions as well as additional support. In a country like Turkmenistan instead of trying to set up brand new systems it is much more economical to take advantage of established structures. There is no reason why the relatively limited message that is delivered through mother support groups could not be expanded to cover additional messages related to emotional and cognitive development of children as well as hygiene practices.

The Ministry of Health and the baby-friendly hospitals are already supporting this concept. What needs to be done is to identify additional messages that needs to be delivered, to develop materials, conduct training and starting delivery of services. At initial phase, the success of the additional program should be closely monitored and evaluated on a few target sites. Once proven effective, it can be expanded into larger areas.

Book and toy drive to provide households with age appropriate reading materials and instructions for creating and using (with the child) hand-made toys

The lack of appropriate reading and toy materials in homes is a major issue for many families. To solve this problem, it is necessary to attack the issue both on central as well as local level. The reading materials could be designed and created with the resources of the ministry of education. Dissemination of the materials as well as manufacturing of the toys could be handled at a local level. The most important aspect, as always is instructing the parents how to read together with their children and how to play with toys together with their children.

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This could also be achieved by training parents, preferably in small and larger groups.

Using the Youth Union for the local training effort seems most feasible. they are well organized, energetic, have the resources and are enthusiastic about this whole initiative. They can meet and communicate with mothers as well as grandmothers easily.

Developing TV programs to deliver simple but important messages in all developmental domains

The importance of TV as a medium to deliver key child development messages repeatedly came up during the participatory process. This initiative however requires the collaboration of the national TV and cannot be handled at the local level. Among other messages, the participants felt that TV would be an ideal medium to deliver health messages. The survey also supported this view by pointing out the fact that most of the lowest income households are already getting their health information from TV.

Local Better Parenting programs that could be implemented by Youth Union trainers in schools as well as in homes

The mothers we have seen were all very anxious to participate in any program that would give them information on better parenting. Most villages have all of the basic ingredients to make this initiative a reality. A willing and excited audience and educated young women who would be ideal trainer candidates. Schools would have the space to handle sizable groups. in addition, the physical layout of the houses can easily allow to gather parent groups ranging from five to ten parents in a home setting to receive training. If the home setting is used, it would be possible to reach grandmothers, grandfathers, and maybe fathers.

To be effective, this initiative has to include multiple sectors and must approach the parents with a comprehensive curriculum. The findings from the study can be used to fine-tune this curriculum and adopt it in a way to address the significant issues that were identified.

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DEVELOPMENT OF A PROGRAM PLAN Moving from study results to actual program decisions and detailed action plans is always a big challenge. UNICEF Turkmenistan decided to do this process in a participatory manner, using participatory action research techniques. Given the time limitations and the number of workshops that could be conducted in one week, it was not possible to develop full-blown action plans for each of the program domains identified during this process. Yet, it was possible to develop a comprehensive program plan and to identify the basic strategies and resources that would be used to implement these programs.

The basic strategy that was followed in this process could be summarized in the following flowchart:

Organize research findings according to the developmental domains (health, cognitive

development, etc.)

Highlight the findings that are most critical and likely to have the most significant

program impact

Present findings at high-level group consisting of government representatives at

national level

Carry out discussions and exercises to ensure and understand that governmental

priorities match the lessons learned from the study

Identify the intervention strategies that are acceptable for the government

Meet with local level government representatives and present the relevant

findings to each one of them

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Ask the local government representatives to interpret and comment on the findings.

Make sure to acknowledge successes while also talking about shortcomings

Encourage local representatives to come up with solutions identify resources and offer

support

Develop program ideas and approaches based on all the steps listed above

Conduct community-level workshops. Use approaches / exercises to reveal the ideas

and concerns of the parents

Let the community to come up with program ideas as much as possible

For each concern or an idea, discuss various community options, implementation

strategies and community resources

Synthesize the findings and present them to the Velayet level government

representatives and professionals

Generate a program plan by assigning programs to each of the intervention

domains through a workshop

Finalize the program plan by identifying available and potential resources for each

area

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NEXT STEPS

The next steps that need to be completed by UNICEF and the government representatives should include the following:

1. Develop a comprehensive program plan: Based on the information collected so far, it would be possible to develop a comprehensive program plan that could address all developmental domains. Already existing programs should be incorporated into this plan.

2. Test the "logic" of the proposed program by laying it out in the form of a logic-model flowchart. Examine all the assumptions that lie behind the model and make sure that these assumptions are reasonable. A sample logic model would include the following components:

3. Develop detailed action plans for each imitative. The action plans should have major tasks and subtasks. It should include dates and responsible parties. Ideally they should be developed together with government counterparts.

4. Implement the action plans.

Goals/Objectives

Activities

Assumptions

Justifications

Resources

Outcomes

Outputs

Indicators

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Annex 1.

INTERVIEW INSTRUMENTS

I. GENERAL INFORMATION

1. Name of Interviewer___________________________

2. Name of Observer__________________________

3. Name of Interviewee____________________________

4. Date /including day of the week/_____________________

5. Time____________________

6. Location: velayat, etrap,village________________________________________________________________

/Hello,Our names are --------- and ---------- . We are a part of a study where we are trying to understand how parents are raising their children in this part of Turkmenistan. As you know, there are many positive things that parent do for their children, as well as some common mistakes. Our goal in this study is to identify the strengths and weaknesses of child rearing practices, and with the help of UNICEF – an international organization- to develop appropriate training materials for families.

Your names and addresses will not be recorded, and will not be revealed to anybody. Only the research team will have access to the information. The other member of our team will also look around the home and take notes. The interview will take 40-45 minutes. You will be paid a total of 41 600 Manats for your time./

II. DEMOGRAPHIC INFORMATION / I will now ask you some questions about your family/

7. Family Composition:/Please, name all members of your family living in your household /

Age Education Nationality Occupation/profession

Mother ______ __________ ___________________ Father ______ __________ ___________________

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ChildrenGender Age Target Name (target only)1. ______ __________ ( ) _____________________2. ______ __________ ( ) _____________________3. ______ __________ ( ) _____________________4. ______ __________ ( ) _____________________5. ______ __________ ( ) _____________________6. ______ __________ ( ) _____________________7. ______ __________ ( ) _____________________

Age Education Grandmother _______________ ______________Grandfather _______________ ______________

Other adults____________ _______________ __________________________ _______________ __________________________ _______________ ______________

8. How old were you when you gave birth to your first child? _______________________________

9. Who in the family takes care of (name of the child)in the family?___________________________

10. Who else in the family takes care of (child)?1.__________________2.__________________3.__________________

11. Is the father involved in raising (name of the child) /If the father is present/?1. Yes2. No3. Never

if «Yes», specify father's paricipation in raising (child):________________________________________________________________________________________________________________________________________________________________________

When did he do this last time?__________________

12. What is the main language of communication in the family?______________________What other languages are spoken in the family/in order of frequency/?

1. ______________2. ______________

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3. ______________

13. What language do you communicate with (child)?_____________________________What other languages does he/she know?Speak Understand______________ _____________________________ _______________

III. GENERAL QUESTIONS FOR ALL INTERVIEWED

INCOME OF THE FAMILY

14. What is the average monthly income of your family (including all sources)? 1. less than 400 thousand manats

2. 460 thousand manats3. 600 thousand - 1 million manats4. 1 million - 1,5 million manats5. More than 1,5 million manats

15. If the economic situation of your family was much better than it was today, what would you do differently for the development of (child)?___________________________________________________________________________________________

NUTRITION

16.Do you think breastfeeding is essential for the child?1. Yes2. No

17. How long is it necessary to breastfeed the child? Untill___________months old.

18. Did you breastfeed yor child?1. Yes2. No

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19. How long were you breastfeeding your child? ___________ months

20. Did your child get supplementary food during his/her first year?1. Yes2. No

if «Yes», specify:1. Vegetables/fruit2. Cereals3. Diary products4. Meat/poltry/fish5. Confectionary products6. Bakery products7. Greenery

When did you start giving (child) supplementary food? from______________months

21. How often do (did) you feed (child) during the day?1. When required2. 1-3 times 3. 4-5 times4. More (specify how many times)______________

HEALTH

22. Evaluate the state of your child's health?1. Healthy2. Rather healthy3. Not healthy

23. Does you child suffer any genetic or chronicle diseases or has any disabilities?

1. Yes2. No

if «Yes», specify:__________________________________________________________

24. On what cases do you apply with your child for the doctor's assistance?1. Fever2. Cough3. Diarhoea4. Spasms5. Nervousness/restless6. Traumas

25. Do you use traditional national methods of treatment when (child) gets ill?

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1. Yes2. No

if «Yes», specify these methods:_______________________________________________________________________________________________________________________________________________________

26. Has your child been vaccinated?1. Yes2. No

if «Yes», do you know the purpose of vaccination?:____________________________________________________________________________________________________________________________________

27. What is the source of information concerning your child's health?1. Doctor/nurse2. Mass media3. Pre-school teacher4. Relatives5. Neighbours6. Healers7. Friends

28. How often (child) was ill during last 12 months?1. once per month2. once per two months3. once per six months4. once during the whole year

HYGIENE

29. Does your child have daily hygiene habits and use them regularly on his own?

1. Yes2. No

if «Yes», what habits does he/she use regularly:1. Washing his face and hands2. Cleaning teeth3. Bathing4. Other (specify)_____________________________

30. Do you teach (child) hygiene habits?1. Yes2. No

if «Yes», specify what habits_________________________________________________________

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if «Yes», specify how____________________________________________________________

31. Does (child) wash his/her hands before eating?1. Yes2. No3. Don't know

32. Does (child) wash hands after using the toilet?1. Yes2. No3. Don't know

33. How often do you change underwear to your child?1. Every day2. Once per week3. 2-3 times per week4. When necessary

34. Is there a difference how to wash the child's intimate parts of the body?1. Don't know2. Backwards3. Forwards4. No difference

35. What type of water does (child) drink?1. Fresh (from water supply system) 2. Fresh (from the well) 3. Fresh (from the river) 4. Still 5. Boiled 6. Bottled

36. What type of water is used for cooking?1. Fresh 2. Still3. Boiled

37. Which way do you wash vegetables and fruit?1. under running water2. with warm water3. with boiled warm water 4. with boiling water4. clean with a napkin5. Don't wash

________________________________________________________________

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PSYCOLOGYCAL AND PHYSIOLOGICAL STATE OF THE CHILD

38. Do you think your child is physically well?1. Yes2. No3. Don't know

if «No», specify why:1. Short height2. Low weight3. Other _________________

39. Do you think your child is mentally well?1. Yes2. No3. Don't know

if «Yes», how do you know:________________________________________________________

SOCIAL ECOLOGY OF THE FAMILY

40. How often do quarrels/disputes happen in your family?1. Daily2. Several times per week3. Monthly4. Almost never

41. What are the most common reasons for the quarrels/disputes in your family?________________________________________________________________________________________________________________________

42.Do you quarrel at the presence of (child)?1. Often2. Seldom3. Never

43. Does it happen that your child behaves in such manner that your feel he/she should be punished?

1. Yes2. No3. Sometimes

if «Yes», how do you punish (child):1. Verbally2. Physically3. not permitting to do something

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44. Who generally punish (child)?1. Mother2. Father3. Other members of the family (specify)_________________________________

45. Who's authority the child follows in the family?1. Mother's2. Father's3. Other member's of the family (specify)____________________4. Other person's (specify)________________________

46. How do you praise the child’s positive actions?1. Verbally (more often_____ less often____)2. Physically (more often_____ less often____)3. giving something (more often_____ less often____)

47. Do you choose or are you planning to choose your child's friends?1. Yes2. No

if «Yes» on what principle: ________________________________________________________________________________________________________________________________________________________________________

PLAY

48. How important do you think play is for the development of the child?1. Very important2. Important3. Not important

49. What kind of games does (child) play)?1. Drawing/painting2. Looking at books3. with toys4. with household objects5. Active games (running, jumping, etc.)6. Puzzle, blocks, etc.7. Pretend plarПридумывает свои игры, включая воображение8. Social, national games9. organized games/sport10. Table games11. Other (specify)_________________________________

50. How many hours per day does (child) spend for watching TV?________________

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What programs does he/she watch more frequently?_______________________________________

51. Who in the household plays with (child)?1. Mother2. Father3. Siblings4. Other adults (specify)________________

52.When was the last time you played with your child?1. Today2. Yesterday3. Several days ago4. Last week5. Don't remember

53. How did you play?____________________

54. Does the father play with (child)?1. Yes2. Sometimes3. No

55. Did the child play with the father yesterday?1. Yes2. No

NATIONAL TRADITIONS

56. Do you follow national traditions in child rearing?1. Yes2. No

if «Yes», which ones:1. Not to show the child to anybody during his/her first 40 days2. Protection against bad eye with the help of some specific symbols3. Use of national craddle4. First cut of hair at one year old5. Circumcision6. Ear piercing7. National holidays8. Other (specify)________________________________________

57. When you were pregnant with (child) did you wish that he/she was?1. of the same sex2. of the opposite sex3. no difference

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Annex 2

QUESTIONNAIRE FOR THE OBSERVER



2. Name of Observer__________________________


4. Time____________________

5. Location: velayat, etrap,village______________________________________________________________________________________

II. PHYSICAL SPACE OF THE DWELLING

1. What is the total size of the home (in sq.m.)-___________________________________What floor is the flat (house) on?______________________

2. List of rooms in the home:Type Number

1.Living rooms ___________2. Kitchen ___________3. Bathroom ___________4. Toilet____ outside ( ) ___________5. Other (specify)____________________________________________________

3. Are there pets or domestic animals?1. Yes2. No

if «Yes», specify________________________________________________________

4. Does (child) play with pets or domestic animals?1. Yes2. No

4. Is there centralised heating?1. Yes2. No

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if «No», specify what type of heating is used ____________________________________________________________________________________________________________________________________ 5. Is there centalised sewage system?

1. Yes2. No

if «No», specify what type of sewage is used ____________________________________________________________________________________________________________________________________

6. Is there running water at home (inside the dwelling)? 1. Yes2. No

if «No», explain what sources of water are used____________________________________________________________________________________________________________________________

7. Is there a nearby outdoor play space available for the child?1. Yes2. No

if «Yes», all that apply to the following characteristics:Clean Dangerous

1. Open porch _____ ______2. Enclosed porch _____ ______3. balcony/terrace _____ ______4. Garden _____ ______5. Backyard _____ ______6. Central courtyard _____ ______7. Adjacent street _____ ______8. Nearby empty lot _____ ______9. Nearby Park _____ ______10. Other _____ ______

8. Are there dangerous objects accessible to the child?1. Yes2. No

(check all that apply)1. Sharp objects (scissors, knives, etc.)2. Poisonous objects (household cleaners, medicine, etc.)3. High unprotected windows4. Open fire5. Hot surfaces6. Other (specify)_____________________________________

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9. Which ones of the following are available: No Few

Many1. Books ________ ____________2. Children's books and other reading materials

________ ____________3. Newspapers/magazines ________ ____________4. Calendar ________ ____________5. Pictures/posters on the wall ________ ____________6. Paper for drawing/crayons ________ ____________7. Toys ________ ____________8. Hand-made toys ________ ____________9. Radio (number) ________ ____________10. Television (number) ________ ____________11. Musical instruments ________ ____________12. Table games ________ ____________

10. Is there a dedicated space for the child to play?1. Yes2.No

11. Is there a special place for the child to store his/her toys, things/? 1. Yes2. No

12. How cluttered is the home?1. A lot2. A little3. Not cluttered at all

13. Is the home lit?:1. Bright2. Shady3. Dark

14. What is the air quality inside home:1. Stuffy2. Average3. Fresh air

3. Airless

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Annex 3.

AGE SPECIFIC INFORMATION 0-1



2. Name of Observer__________________________



5. Time____________________


II. AGE SPECIFIC QUESTIONS: 0-1 year

1.Did you change your habits and practices when you were pregnant?1. Yes2. Noif “Yes”, what did you change?1._________________________2._________________________3._________________________

2. Did you change your diet when you were pregnant? 1. Yes2. Noif “Yes”, how?____________________________________________________

3. Did you change your daily routine activities when you were pregnant? 1. Yes2. Noif “Yes”, what did you change?

4. Who answered your questions concerning pregnancy?1. Family member2. Friend3. Village elder4. Professional5. Mass media6. Other (specify)

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5. During breastfeeding do you:1. touch the child2. talk to the child3. sing to the child4. look into the eyes of the child

6. What do you do when your child cries for no apparent reason?1. pick up immediately2. try to calm him/her3. ignore4. talk/sing/interact5. try to find a reason6. other

7. What do you do if it does not work? ___________________________________________________________

8. How can you tell if your child is developing well?1. child is alert2. is not sick3. good weight4. child is happy5. other ____________________________________

Now I will read you several statements and you should answer “Agree” “Disagree” “Not sure” “Don’t understand” .

9. Breastfeeding should not begin soon after birth; it should be postponed.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

10. If a mother is concerned that she is not producing enough milk, she should breast feed her baby less. Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

11. If a baby’s first movements are jerky and uncoordinated, a mother should be concerned.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

12. Most babies will pull themselves up and walk before their first birthday and a mother should be concerned if their baby has not done this.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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13. A baby develops faster during the first year than at any other time of life. This process is enhanced by close and warm responses from those around them.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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Annex 4.




2. Name of Observer__________________________



5. Time____________________


II. AGE SPECIFIC QUESTIONS: 1-3 years

1. Do you let your child to hold/touch and play with objects that are safe? 1.Yes2. No

What are these objects? Can you give examples _____________________________________________________________________

2. Did your child play with any play materials yesterday?1.Yes2. Noif “Yes”, with what?

3. How do you discipline your child when he/she is naughty?

1. disciple2. do not discipline3. yell reprimand4. tell that inform about this the other parent5. isolate6. discuss/explain the wrong7. smack8. other

(specify)_________________________________________________________________________

4. Do you set rules for (child)? 1.Yes

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2. Noif “Yes”, give one example ___________________________________________________________

5. Do you think there should be different rules for boys and girls at this age (1-3)?1.Yes2. Noif “Yes”, why________________________________________________________

6. When did the child start:1. to dress on his/her own2. to differentiate colors3. to get interested in pictures, books, etc.

Now I will read you several statements and you should answer “Agree” “Disagree” “Not sure” “Don’t understand”.

7. By the time a child reaches two years of age, brain development is complete.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

8. The first words usually appear during the first twelve to eighteen months and they are usually the names of things which are important and meaningful to the child.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

9. Problem solving tasks are frustrating for children and they tend to loose interest in them rapidly.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

10. Activities like sorting and grouping objects by colour, shape, and size are fundamental to later learning and thinking.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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Annex 5.




2. Name of Observer__________________________



5. Time____________________



1. Do you think the character of the child can be easily spoiled at this age? 1. Yes2. No

if “Yes”, why? ______________________________________________________________________________________________________

2. Overall how many hours does your child play during the day?

1. less than 2 hours2. 2-4 hours3. 4-6 hours4. more than 6 hours

3. Do you think he/she plays:1. less than needed2. enough3. more than necessary

4. Do you control what your child does when he/she goes out of home without an adult?

1. always2. sometimes 3. neverHow do you control him/her?

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____________________________________________________________________________________________________________

5. Is your child attending pre-school?1. Yes2. No

if “Yes”, how many days per week?1 2 3 4 5

if “No”, why?1. no pre-school nearby2. nobody to take the child3. child sick/handicapped4. food is not nutritious enough5. unsuitable environmental conditions (heating/cooling, etc.)6. quality of education is not satisfactory7. child can get better education at home8. other

________________________________________________________

if “No”, Are you planning to send the child to pre-school sometime soon?1. Yes2. No3. I don’t know

6. Do you involve (child) into household activities?1. Yes2. Noif “yes”, what does he do:1. Helps around the house2. Helps in the garden3. Takes care of the pets and domestic animals4. Takes care of the younger siblings


7. Although some learn more slowly, most three years olds are good talkers.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

8. Each child develops at a particular rate and so children at age three can be expected to vary tremendously in their accomplishments.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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9. Four year olds are attracted to new things-people, places and activities.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

10. The best way to encourage future success in school is to promote repetition and mastery of previously learned tasks.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

11. Four year olds play often involves the use of household object in imaginative ways.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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Annex 6.




2. Name of Observer__________________________



5. Time____________________



1. Do you think your child is ready for school?1. Yes2. No

2.How do you know that your child is ready for school?________________________________________________________________

3. What are you doing at home to prepare your child for school?________________________________________________________________

4. What skills and behaviors do you teach your child to adapt at school?________________________________________________________________

5. What do you think will change in your home once your child starts school?________________________________________________________________

6. Do you involve (child) into household activities?1. Yes2. Noif “yes”, what does he do:5. Helps around the house6. Helps in the garden7. Takes care of the pets and domestic animals8. Takes care of the younger siblings

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7. In order to perform well in school, children need frequent feedings of protein-rich foods, fruits, and vegetables.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

8. Children learn about numbers when they sort, count and match patterns.Agree____________ Disagree__________ Not sure___________ Don’t understand ______________

9. The best way for a teacher to promote learning is to encourage memorisation.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

10. Scribbling should be discouraged since it can indicate that a child is having difficulty learning to write.Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

11. Activities should be adjusted to needs of each child since all children learn at a different rate. Agree____________ Disagree___________ Not sure___________ Don’t understand ______________

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