Background

The importance of optimal early childhood development is widely documented. Children attain optimal developmental potential by acquiring essential key skills across physical, cognitive, social-emotional, and language domains, which lay the foundation for lifelong learning, health, and well-being [1]. However, evidence indicates that more than 250 million children, particularly in low- and middle-income countries (LMICs), are at risk of failing to attain their full developmental potential [2]. Children from sub-Saharan Africa (SSA) are vulnerable to developmental delays and disabilities due to a constellation of risk factors, such as poverty and malnutrition, infections, and lack of stimulating home environments [1,2]. Children living in marginalized regions such as the Arid and Semi-Arid Lands (ASALs) face additional vulnerabilities including extreme poverty, chronic insecurity due to conflicts, inadequate access to food, clean water and other basic resources and amenities [3]. However, there is insufficient empirical evidence on the factors that influence child development in this context and especially qualitative work is lacking that takes into consideration perceptions and voices of community members.

ASALs cover roughly 88% of Kenya’s landmass [4]. Although there has been marked improvements in child developmental indicators over the years in Kenya, glaring disparities still exist with children living in the ASAL regions facing a disproportionately higher risk than those from most regions within the country [5]. These regions represent the country’s poorest [5] and contend various challenges such as food insecurity, undernutrition, and climate change effects [6]. Climate change is recognized as a major global health threat, with growing evidence, indicating its adverse effects on young children [6]. For instance, extreme heat and drought because of climate change have been reported to be linked with malnutrition in children due to the associated food insecurity [3,4,7–9]. Other effects reported include reduced breastfeeding, neonatal mortality, still birth, spread of infectious diseases and negative impact on cognitive ability [9].

Children in ASALs often face challenges such as limited access to healthcare services, including vaccinations and treatment for common illnesses, leaving children vulnerable to preventable health issues that can hinder their growth and development [5]. National statistics show that mortality rates for children under-five years mortality rates in Kenya’s ASAL counties can be double the national average [10]. Inadequate sanitation facilities and limited access to clean water are prevalent in ASALs, increasing the risk of diarrhoeal diseases and other infections [11,12]. Socio-economic challenges, including poverty and limited access to resources, create a disadvantaged environment. Furthermore, children in ASAL face limited access to quality education [13], a crucial factor in cognitive and social development [14] which further exacerbates the situation. These and other combined factors create a complex web of challenges that can have a lasting negative impact on child development in ASAL regions.

Despite the various risks that children face there are children who grow up and overcome the challenges. Resilience has broadly been defined as the ability to successfully adapt to adversity and demonstrate positive developmental outcomes despite risks [15,16]. Several protective factors have been documented, ranging from individual factors to family and community factors [17]. Resilient individuals have been found to exhibit positive outcomes in various aspects such as mental health and academic achievement [18]. However, there is limited data available on sources of resilience in children, especially those from ASAL regions in Kenya. Understanding the factors that enhance resilience in children from these communities will be crucial in implementing targeted interventions that can help promote resilience and mitigate the negative impact of the risk factors experienced.

To gain a deeper understanding of the factors, both risk and resilience, that impact child development in Kenya, we utilized the Bronfenbrenner’s ecological systems theory as an interpretative lens [19], as it provides a comprehensive framework for understanding human development. This theory acknowledges the intricate layers of influence that shape a child’s growth and development, emphasizing the complex and dynamic interplay between children and their environment. It advocates for a comprehensive and holistic approach to understanding child development by considering these multiple levels of influence [20]. Additionally, there has been a growing concern to integrate theories, particularly from social sciences, into global public health [21]. Therefore, to fully understand child development, we need to look at how children and various aspects of their environment interact.

The Bronfenbrenner’s ecological systems theory model postulates five interconnected environmental systems: the microsystem, mesosystem, ecosystem, macro system and chronosystem. All these systems collectively exert direct or indirect impact on child development, which explains the various forms of risk and protection. Moreso, there is a continuous interplay of factors across these domains explaining the complexity of factors impacting child development. This theory has been effectively used to study child development in Sub-Saharan Africa, particularly in understanding how various factors across multiple systems influence outcomes. For example, Edburg et al applied the theory to investigate factors contributing to violence against children in South Africa [22]. Similarly, other studies conducted limited resource-settings have used this approach to understand factors affecting child development [23,24] as well as adolescent health and well-being [25–27]. These studies demonstrate the relevance of the framework in examining how interactions across systems shape child well-being in resource-constrained contexts. It underscores the critical importance of fostering nurturing care environments and adopting a multi-sectoral approach to understand the diverse factors influencing child development and to effectively responding to children’s evolving needs.

Building on this model and given the limited research available on the context-specific factors (both risks and resilience) influencing child development in ASAL regions in Kenya, this study aims to qualitatively document the community perspectives on sources of risk and resilience for children residing in these areas. This forms a vital step towards evidence generation and designing contextual strategies and interventions aimed at ensuring that children in these communities not only survive but also thrive, ultimately reaching their full developmental potential.

Methods

Study design and conceptual framework

The study employed a qualitative approach that involved in-depth interviews with key informants and caregivers. A semi-structured interview guide (see S1 File) developed by the study team was administered by well-trained research assistants (BA and MK). We applied the Bronfenbrenner’s ecological systems theory [19] as an interpretive lens to organize and present themes on the factors influencing child development in Kenya’s ASALs. This theory acknowledges the multifaceted layers that impact development. This framework, which emphasizes the layered, interconnected systems shaping human development, guided our analysis across five the key domains: the microsystem, mesosystem, ecosystem, macro system, and chronosystem. Building on this model, we developed a conceptual framework (Fig 1) to guide data collection, thematic mapping and organization of emerging themes during analysis.

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Fig 1. Perceived risks and resilience factors for child development in Kenya’s ASAL.

https://doi.org/10.1371/journal.pone.0316679.g001

Sampling, recruitment, data collection procedures and management

In total, we conducted 103 in-depth interviews with key informants and caregivers. Purposive and snowballing techniques [28] were used to recruit 11 key informants per site. The selection aimed to include a diverse sample of key stakeholders with varied levels of involvement with the ECD sector. In each site, we recruited 11 key informants, including representatives from the Ministry of Health (n = 1), early childhood education (n = 2)), parents or caregivers (n = 2), social service and gender officials (n = 1), security and local administrative representatives (n = 1), a civil society organizations representative (n = 1), a community focal person (n = 1), disaster management (n = 1), and a religious leader (n = 1). This approach was designed to capture a comprehensive participants perspective across sites.

Following approval from the county, the county directors facilitated the identification of a facilitator who assisted in mobilizing the study participants. The facilitators provided the contact details of selected participants to the research assistants, who then reached out to them in advance to schedule the telephonic interviews at their convenience. Despite having received contact information for 110 participants, seven of them could not be reached by phone and, therefore, could not be included in the study.

As part of the conceptualization work, we reviewed relevant literature to guide the development of the interview guide. The socio-ecological theory guided the development of the interview guide by framing child development within a broader context of interconnected systems. The interview guide was designed to explore factors at multiple levels, including individual, family, community, and environmental influences on child development. By incorporating questions related to these different levels, we aimed to capture the complex interplay of factors that shape child outcomes in the ASAL context.

Data collection was conducted from June 15, 2022, to August 29, 2022. The data were collected by two research assistants (BA and MK) who were well-trained in qualitative interviewing techniques and notetaking. Prior to the commencement of the data collection, we piloted the interview guides with 4 participants (2 key informants and 2 caregivers) to ensure clarity of the questions. Based on the positive feedback received, there were no modifications made to the guide. The data collection was done telephonically and at convenient times to the participants. The interviews lasted between 30–60 minutes. Telephonic interviews were selected because of the significant logistical challenges involved in physical travel to all the 10 vast counties, a decision aimed at optimizing both time and resources. All interviews were conducted either in English or Swahili languages which are the two primary languages used for communication in Kenya. With the participants’ permission, the interviews were audio-recorded, and interview summaries were made after the interviews. Notably, no repeat interviews were conducted. To ensure participant’s privacy and confidentiality the interviews were conducted in private rooms at the workplace and the participants were encouraged to take the call in private and quiet places. Additionally, all the voice files were labelled anonymously using unique participant identifiers. Participants socio-demographic data were also collected including age, gender, religion, residence, occupation, ethnicity, number of children, and the level of education. This information is summarized in Table 1.

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Table 1. Participants description.

https://doi.org/10.1371/journal.pone.0316679.t001

Results

Discussion

This study aimed to examine the risks and resilience factors influencing child development in Kenya’s arid and semi-arid regions using a qualitative study design. The data revealed a complex interplay of factors that may impact children’s well-being ranging from biological, social, environmental, climatic, and psychological factors, highlighting disparities in health and well-being across ASAL regions. The bioecological framework highlights that child development is shaped by daily experiences through ongoing reciprocal interactions between the individual and their environment [32]. The interplay of these factors underscores the interconnectedness between ecological systems and the multi-dimensional nature of child development. These findings underscore the urgent need for targeted multi-level interventions that consider the dynamic interplay between these factors across different levels to address the challenges faced by these vulnerable populations.

Malnutrition was identified as a critical issue affecting early childhood development in the ASAL regions. There is consistent evidence that malnutrition continues to be a major public health problem throughout the developing world, particularly in developing countries such as those in sub-Saharan Africa [33]. The consequences of malnutrition, as reported by our participants, are consistent with findings from the literature. Participants reported that malnourished children are more susceptible to infections and illnesses due to a weakened immune system which can further impede their overall development and well-being [34,35]. Poor physical growth and stunted development were also common outcomes of malnutrition which have been previously documented to be linked to adverse outcomes, such as poor developmental and clinical outcomes [36,37]. Moreover, malnutrition was reported to be associated with cognitive impairment [38,39], affecting children’s learning abilities, hindering their educational progress and future opportunities.

Malnutrition in ASALs was identified as a complex issue with multifaceted causes across various ecological levels (individual, family, community, systemic and climate levels). Poverty, a key family-level factor, that limits access to food, was reported as one of the facilitators for poor outcomes which has been documented in previous studies [40]. Climate-related factors such as drought worsen existing poverty and contribute to food insecurity which further exacerbates malnutrition [3,4,7–9]. Cultural practices including food taboos further restrict dietary diversity and affect nutritional outcomes. The interconnectedness of these factors reveals the deep-seated, multi-dimensional nature of malnutrition in ASAL counties, underscoring the structural determinants of health and the systemic inequities that perpetuate disparities within the country. For instance, data from the KDHS highlight significantly poorer nutritional outcomes in ASAL regions compared to the national average [5]. Addressing malnutrition in these regions would require a holistic approach that encompasses poverty alleviation, education, healthcare, and cultural sensitivities.

In this study, maternal age was reported to influence child outcomes in various forms, aligning with previous research findings [41]. Participants highlighted the perception that majorly young maternal age could potentially pose risks to child development. Young mothers were believed to face a higher likelihood of pregnancy or birth complications and may also lack the capacity to adequately care for their children, with potential negative effects on maternal mental health [42]. A few participants suggested that advanced maternal age could also have negative effects on the children they may have reduced the capacity to provide adequate childcare, often due to health-related concerns, such as age-related illnesses. Comparable studies conducted elsewhere have reported similar findings [43]. Within the ASALs, poverty and socio-cultural factors such as early marriages, are some of the key drivers for teenage pregnancies. Therefore, there is a need to reinforce measures aimed at preventing early marriages through awareness campaigns, community outreach, and legislative reforms to improve overall outcomes. Additionally, comprehensive programs empowering young women with education, economic opportunities, and reproductive health knowledge can potentially address these challenges and contribute to overall well-being.

Furthermore, maternal mental health was reported to play a role in child outcomes. Stressed caregivers were reported to be unresponsive to their children’s needs. Caregivers have been reported to perform key tasks which influence a child’s growth and development [44], and when they are not mentally stable, they were reported to neglect child care duties and not adequately stimulate their children. Early interaction between the caregiver and the child is incredibly important in creating a stimulating learning environment [45]. Maternal mental health can affect childbearing behaviours and practices [46]. Caregiver’s depression presents a substantial developmental risk in children as they are dependent on their caregivers for care [42]. Empirical evidence suggests that children of caregivers with depression demonstrate a range of neurocognitive, sociological, emotional, and behavioural issues [47]. Various factors across various levels interact to exacerbate mental health issues.

Domestic violence was reported to be common in ASALS and has been consistently reported to lead to poor outcomes not only for the mothers but also for the children [48]. Some of the drivers of domestic violence such as drug abuse and poverty were also noted as key factors that lead to impaired child development. Illiteracy is also very high in these communities which was also reported as a risk factor as it limits their knowledge capacity to take good care of the child and also health-seeking patterns [49]. According to KHDSS 2022 [5], the ASAL regions in Kenya have lower literacy levels compared to the national average rates which is attributable to various issues including early marriage, poverty, teenage pregnancies and limited access to resources among others. Inadequate paternal involvement also emerged as theme impacting on child development which in these communities is attributable to various factors including nomadism where fathers go for long time in search of the pasture during the droughts. Additionally, single parenthood which was reported to be caused by various factors including insecurity remains a challenge. Data show that paternal involvement leads to higher socio-emotional, behavioural and cognitive development [50–52], hence children lacking it may have poorer outcomes.

Our study provided valuable insights into the multifaceted impact of climate change on child health outcomes in the ASAL counties aligning with existing literature on climate change and child health [53–55]. Key informants in this study emphasized the presence of several climate change-related extreme weather events, notably including droughts, floods, and extreme temperatures, such as heat stress and extreme cold [56,57]. Drought, in particular, emerged as a complex challenge with far-reaching consequences, consistent with studies documenting the adverse effects of drought on child health [57]. It contributes significantly to food insecurity and subsequent malnutrition among children which is common in the ASAL communities, disrupts education due to a lack of essential resources and compromises hygiene (WASH), increasing the risk increasing the vulnerability of children to waterborne diseases [4,55].

Extreme heat (heat stress), another major climate change effect was reported to cause diverse health effects including dehydration, fatigue, headache, skin disorders, malnutrition, blood pressure fluctuations, and complications during pregnancy and breastfeeding [56,58–60]. The association between high temperatures and reduced productivity and increased fatigue affects both children and their caregivers [56,61]. Importantly, heat stress also poses a cognitive challenge, as elevated temperatures can potentially impact a child’s brain development [62]. Beyond these immediate effects, our study also revealed the cascading effects of climate change which extend beyond their immediate health consequences. Mothers, who often in the ASAL are responsible for fetching firewood and water face physical strain and discomfort, especially during pregnancy, due to the necessity of traveling long distances for water and resources. Moreover, the competition for scarce resources, intensified by climate change-induced resource scarcity, further exacerbated insecurity and instability, significantly impacting children’s well-being. These findings contribute to a deeper understanding on the dynamics of climate change child health in ASAL and underscores the need for addressing these multifaceted challenges through comprehensive strategies encompassing climate resilience, healthcare provision, education support, and conflict mitigation.

Our study also revealed the socio-cultural factors significantly shaping early childhood development in the ASAL counties encompassing FGM, early marriages, polygamy, food taboos, and nomadism which altogether underscore the complex relationship between cultural practices and child well-being in this region. FGM, despite being illegal and acknowledged for its detrimental effects, persists in certain communities, posing great risks to girls and women [63,64]. The consequences extend to birth complications, endangering the health of both mothers and children. Similarly, early marriages remain a concerning issue, particularly in rural/interior communities, where some children are married off as young as 10 years old. These marriages are often tied to dowry payments and the persistence of FGM, leading to birth complications and compromising child development [48]. Addressing these issues requires a critical public health approach to tackle structural inequities that perpetuate FGM and early marriages, emphasizing education, community empowerment, and enforcement of laws to curb harmful practices.

Despite the myriad challenges that children may encounter, there are those who not only persevere but thrive, demonstrating remarkable resilience [65,66]. One of the central pillars of resilience observed in our study is the significance of responsive parenting and robust family support systems [65,67]. Children thrive when they receive consistent emotional support and have their basic needs met. Parents and caregivers who are actively involved in their children’s lives play a pivotal role in nurturing resilience [68]. Responsive caregiving not only ensures the physical well-being of children but also fosters emotional security, which is essential for coping with adversity [69]. Our findings emphasize the importance of the parent-child relationship in building resilience and underscore the need to empower caregivers to improve developmental outcomes.

At the community level, several factors were highlighted to foster child resilience in ASAL counties including communal support, socio-cultural practices, and shared responsibility. Cultural norms, such as the practice of "traditional maternity leave," ensure that mothers have sufficient time to recover after childbirth and allows them to provide adequate care for their infants and enhance the well-being for both mother and child. The ASAL communities in Kenya have active participation in cultural activities, including songs and dances, fosters a positive environment that encourages talent discovery and development among children. Moreover, the sense of community cohesiveness and mutual support within these regions leads to the practical sharing of resources and interventions to safeguard children from harm [70]. This shared responsibility alleviates various challenges faced by families. Despite the decline in communal discipline, it remains a distinctive feature of community-related factors. It signifies the collective effort to guide and nurture children into responsible citizens, imparting moral teachings and serving as a source of inspiration and motivation. Understanding the role of these factors is essential for designing culturally sensitive interventions that enhance child development.

Religion was also a key theme reported to be a significant source of resilience for children in ASAL areas. Both Islamic and Christian faiths provide moral guidance, educational support, and a sense of purpose, contributing to the overall well-being and resilience of children in these communities [71]. These faith-based organizations, actively engage in relief efforts especially during droughts, build boarding schools tailored for pastoralist communities, and sponsor programs to support these children. In the Islamic culture, the Madrassa and Duksi programs provide children with religious education, impart moral and ethical values, offer social support, and instil a sense of discipline. Early exposure to the programs where children learn to read and write in Arabic and memorize religious texts like the Quran, was seen as beneficial to the children’s cognitive development. However, a challenge was identified that most young children in Muslim communities within ASAL areas attend these Duksi and Madrassa programs until later ages, potentially delaying or missing out on early childhood education. This highlights the need to integrate these programs into the formal education curriculum to ensure a holistic approach to early learning and address existing educational inequalities. Recognizing the positive impact of religious institutions is vital for designing holistic approaches to support children’s development and resilience in these unique regions [72].

Furthermore, our study highlighted the critical role of biological factors in enhancing resilience among children in Kenya’s ASAL regions. Specifically, immunization and nutritional support, breastfeeding, emerge as pivotal contributors to children’s resilience. Immunization programs targeting children under five are essential interventions that fortify their immune systems, providing robust protection against various health threats. This proactive safeguarding of their physical health not only reduces the risk of illnesses but also strengthens their overall capacity to withstand adversity and enhance future outcomes [73]. Furthermore, in those experiencing food insecurity, nutritional support, including the provision of food supplements, proves vital. These supplements, enriched with essential vitamins and protective minerals, ensure optimal nourishment, consequently promoting growth and overall well-being in children. Moreover, breastfeeding was identified as a practice that significantly enhances child outcomes and resilience [74–76]. Beyond its nutritional benefits, breastfeeding fosters a strong maternal-child bond, supports cognitive development, and emotional security, and serves as a protective measure against various health issues, thereby laying a firm foundation for a child’s resilience [74,77].

Drawing on the socio-ecological theory, this study highlights the complex interplay of factors (both risks and resilience) affecting child development, extending beyond individual-level factors to include the wider determinants of health. The multifaceted risk factors and systemic inequities observed in ASAL regions resonate with the broader global health challenges, emphasizing the critical role of structural determinants and the need for interdisciplinary approaches that integrate social science perspectives to achieve equitable public health outcomes [78]. Hence there is need to contextualize the children’s development within their ecological system to understand the structures the barriers and enablers that influence their ability to thrive, underscoring the need to implement health promotion programs targeting the wider determinants of child health and wellbeing [79]. Additionally, there is a need to identify synergies and leverage intermediaries across various levels within the ecological system to facilitate the implementation of health promotion programs.

Building on these insights and drawing from the results of this study, we propose some practical actions to address the challenges facing children in Kenya’s arid and semi-arid regions (ASALs). To improve child developmental outcomes, a comprehensive multi-sectoral approach is needed. Interventions should target health, nutrition, education, families, social protection, responsive caregiving, and climate resilience [80]. We propose programs and interventions targeting the reduction of malnutrition that address the root causes such as poverty alleviation, food taboos, and food insecurity, particularly in the context of climate change [80]. Addressing these challenges requires comprehensive policies that go beyond individual responsibility and tackle structural determinants of poverty, as La Placa et al critiques neo-liberal approaches to parenting [81]. Policies should prioritize reducing material deprivation, promoting equitable access to resources, and fostering supportive community networks to empower caregivers and improve child outcomes in ASAL regions. For example, comprehensive nutritional programs should be developed to address malnutrition, complemented by strengthened healthcare access to provide essential services and support for caregivers. Implementing multi-dimensional poverty alleviation programs such as social safety nets, economic empowerment, diversification of livelihoods, supporting small-scale businesses, and enhancing resource governance will be key to reducing vulnerability and improving outcomes [82,83]. There is evidence that effective investment in early childhood development can help mitigate the negative impacts of poverty, malnutrition, and limited learning opportunities, reducing inequalities and promoting equitable development [84].

Furthermore, there is a need to strengthen community–based primary healthcare to enhance maternal and child health services [85]. These services should integrate mental health support into routine maternal care to improve overall maternal and child health outcomes [86]. The study also highlights the importance of legislative reforms and community-based interventions to prevent early harmful cultural practices such as FGM and early marriages. Additionally, policies should strengthen community resilience by fostering communal support systems and recognizing the positive role of religious institutions and families in promoting child development [87,88]. It is essential to incorporate indigenous knowledge and practices in the co-creation of context-specific interventions. Interdisciplinary engagement and investment in climate resilience measures is essential to mitigate the impacts of drought, floods, and extreme temperatures. This involves promoting sustainable agriculture practices, improving water management, increasing funding on climate and health programs, and building climate-resilient infrastructure [89]. Furthermore, there is need to incorporate indigenous knowledge and practices in the cocreation of contextual interventions. Continued research and monitoring are essential to track progress, identify emerging challenges, and inform policy adjustments. This will ensure that interventions are evidence-based and responsive to the evolving needs of children in ASALs.

Conclusion

Children residing in ASAL counties confront a complex interplay of factors at different socio-ecological layers that significantly impact their development including, insecurity, socio-cultural factors, malnutrition, domestic violence, drug abuse, mental health issues, poverty, and climate-change-related factors like drought and heat stress. Despite the risks, some resilient children overcome the challenges and grow up successfully. Effectively addressing these challenges, many of which are modifiable, requires targeted and holistic interventions that adopt a comprehensive multi-sectoral approach. This involves leveraging community strengths and resources drawing upon community support, positive socio-cultural practices, and tapping into the positive influence of religious factors to enhance children’s overall development and well-being. To mitigate the impacts of climate change, there is a need for investments in community climate resilience. Adopting a multi-sectoral strategy that integrates health, education, social protection, and climate resilience measures will be key to addressing the complex challenges faced in the ASAL regions, ultimately improving child development outcomes. These efforts align with the global commitments outlined in the Sustainable Development Goals (SDGs). Further research is needed to quantify the impact of these factors, including longitudinal studies to evaluate the effects of heat on maternal and child health.

Strengths and limitations

The qualitative approach enabled us to collect rich and detailed data on the experiences and perceptions of participants. By conducting interviews with a diverse sample of key stakeholders in the ECD sector across various ASAL regions, we captured a wide range of perspectives and deep insights into the factors affecting child development in ASALs. The systematic data collection and analysis approach further strengthened the study’s, ensuring rigorous and reliable findings. While telephonic interviews provided flexibility and convenience for data collection across various study regions, we acknowledge several limitations. The absence of face-to-face interactions may have resulted in missing non-verbal cues that could have enriched participants’ responses. Additionally, we were unable to reach 7 participants despite repeated call attempts and in some instances faced network challenges that affected the clarity of some audio recordings, potentially affecting data quality. While telephonic interviews offered flexibility, they may have limited our ability to observe non-verbal cues, potentially affecting data richness.

Supporting information

Acknowledgments

We would like to thank all the study participants for volunteering to take part in this study. We would also like to thank the field enumerators who supported with transcription (Valentine Minayo, Tom Joe Omollo, Damaris Nguyo, Maurine Okoth and Kevin Wekesa). We would also like to thank Paul Otwate for playing a key role in liaison with government officials of the study sites and Vibian Angwenyi for her technical support. Additionally, we extend our thanks to the respective counties for granting approval to conduct the study and the facilitators who supported with participant mobilization.