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Associations between paternal engagement and child development outcomes in Lebanon: a multilevel cross-sectional analysis of national data.

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Title: Associations between paternal engagement and child development outcomes in Lebanon: a multilevel cross-sectional analysis of national data.
Authors: Henry J; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA junita.h13@gmail.com.; Institute for Lifecourse Health Research, Global Health and Population, Stellenbosch University, Stellenbosch, South Africa., Al Sager A; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.; Department of Social and Behavioural Sciences, Kuwait University, Safat, Kuwait., Charafeddine L; Pediatrics and Adolescent Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon., Yarparvar A; Nutrition and Child Development Section, United Nations Children's Fund, Beirut, Lebanon., Petry N; GroundWork, Fläsch, Switzerland., Obeid O; Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon., El Mallah C; GroundWork, Fläsch, Switzerland., Miratrix LW; Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA., Najjar J; Nutrition and Child Development Section, United Nations Children's Fund, Beirut, Lebanon., Hartvig Blomberg J; Nutrition and Child Development Section, United Nations Children's Fund, Beirut, Lebanon., Zgheib P; Mother and Child Health Unit, Lebanon Ministry of Public Health, Beirut, Lebanon., Yousafzai AK; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Source: BMJ paediatrics open [BMJ Paediatr Open] 2026 Oct 06; Vol. 10 (1). Date of Electronic Publication: 2026 Oct 06.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101715309 Publication Model: Electronic Cited Medium: Internet ISSN: 2399-9772 (Electronic) Linking ISSN: 23999772 NLM ISO Abbreviation: BMJ Paediatr Open Subsets: MEDLINE
Imprint Name(s): Original Publication: London : BMJ Publishing Group, [2017]-
MeSH Terms: Fathers*/psychology , Child Development* , Father-Child Relations*, Humans ; Lebanon ; Cross-Sectional Studies ; Male ; Infant ; Child, Preschool ; Female ; Socioeconomic Factors ; Adult
Abstract: Background: Fathers play meaningful and often under-recognised roles in supporting early child development (ECD) but evidence from crisis-affected settings is limited. In Lebanon, ongoing economic and social instability places pressure on the conditions that support children's development, emphasising the value of examining caregiving practices that promote ECD. We examined whether paternal engagement (PE) in caregiving relates to children's developmental outcomes and whether these relationships vary by socioeconomic context.
Methods: We used cross-sectional data from the 2023 Lebanon Micronutrient, Anthropometric and Child Development Survey (N=1181). Children, caregivers and households were nested within sampling units. The outcome was a pooled, age-standardised ECD z-score using the Global Scales of Early Development-Household Form (0-23 months) and the Early Childhood Development Index-2030 (24-59 months), constructed by standardising scores by age in months within each instrument and then pooling across instruments as a relative index of developmental status. PE was a composite of five stimulation and three caregiving activities (α=0.73). Hierarchical linear models estimated variance, individual associations, cross-level interactions with cluster-level household assets and PE decomposition within and between clusters. Analyses used weights and multiple imputation.
Results: PE was associated with higher ECD z-scores. Each one-unit increase in engagement was associated with a 0.22 SD rise in child ECD (SE 0.11; p<0.05), with sensitivity estimates from 0.13 to 0.32 SD. We found no evidence that the association differed by cluster-level household assets or by household nationality. Engagement components within and between clusters were positive but not significant.
Conclusions: In Lebanon, PE modestly correlates with higher ECD, with little variation across communities or levels of household assets. These findings emphasise fathers' contributions to early development and suggest that supporting PE, alongside broader social protections, may help strengthen child development.
(© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
Competing Interests: Competing interests: None declared.
Contributed Indexing: Keywords: Child Health; Cross-Sectional Studies; Health services research; Low and Middle Income Countries; Psychology
Entry Date(s): Date Created: 20261007 Date Completed: 20261007 Latest Revision: 20261007
Update Code: 20261008
DOI: 10.1136/bmjpo-2025-004385
PMID: 42843852
Database: MEDLINE
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  Data: Associations between paternal engagement and child development outcomes in Lebanon: a multilevel cross-sectional analysis of national data.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Henry+J%22&quot;&gt;Henry J&lt;/searchLink&gt;; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA junita.h13@gmail.com.; Institute for Lifecourse Health Research, Global Health and Population, Stellenbosch University, Stellenbosch, South Africa.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Al+Sager+A%22&quot;&gt;Al Sager A&lt;/searchLink&gt;; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.; Department of Social and Behavioural Sciences, Kuwait University, Safat, Kuwait.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Charafeddine+L%22&quot;&gt;Charafeddine L&lt;/searchLink&gt;; Pediatrics and Adolescent Medicine, American University of Beirut Faculty of Medicine, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Yarparvar+A%22&quot;&gt;Yarparvar A&lt;/searchLink&gt;; Nutrition and Child Development Section, United Nations Children&#39;s Fund, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Petry+N%22&quot;&gt;Petry N&lt;/searchLink&gt;; GroundWork, Fl&#228;sch, Switzerland.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Obeid+O%22&quot;&gt;Obeid O&lt;/searchLink&gt;; Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22El+Mallah+C%22&quot;&gt;El Mallah C&lt;/searchLink&gt;; GroundWork, Fl&#228;sch, Switzerland.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Miratrix+LW%22&quot;&gt;Miratrix LW&lt;/searchLink&gt;; Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Najjar+J%22&quot;&gt;Najjar J&lt;/searchLink&gt;; Nutrition and Child Development Section, United Nations Children&#39;s Fund, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Hartvig+Blomberg+J%22&quot;&gt;Hartvig Blomberg J&lt;/searchLink&gt;; Nutrition and Child Development Section, United Nations Children&#39;s Fund, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Zgheib+P%22&quot;&gt;Zgheib P&lt;/searchLink&gt;; Mother and Child Health Unit, Lebanon Ministry of Public Health, Beirut, Lebanon.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Yousafzai+AK%22&quot;&gt;Yousafzai AK&lt;/searchLink&gt;; Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
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  Data: Background: Fathers play meaningful and often under-recognised roles in supporting early child development (ECD) but evidence from crisis-affected settings is limited. In Lebanon, ongoing economic and social instability places pressure on the conditions that support children&#39;s development, emphasising the value of examining caregiving practices that promote ECD. We examined whether paternal engagement (PE) in caregiving relates to children&#39;s developmental outcomes and whether these relationships vary by socioeconomic context.&lt;br /&gt;Methods: We used cross-sectional data from the 2023 Lebanon Micronutrient, Anthropometric and Child Development Survey (N=1181). Children, caregivers and households were nested within sampling units. The outcome was a pooled, age-standardised ECD z-score using the Global Scales of Early Development-Household Form (0-23 months) and the Early Childhood Development Index-2030 (24-59 months), constructed by standardising scores by age in months within each instrument and then pooling across instruments as a relative index of developmental status. PE was a composite of five stimulation and three caregiving activities (α=0.73). Hierarchical linear models estimated variance, individual associations, cross-level interactions with cluster-level household assets and PE decomposition within and between clusters. Analyses used weights and multiple imputation.&lt;br /&gt;Results: PE was associated with higher ECD z-scores. Each one-unit increase in engagement was associated with a 0.22 SD rise in child ECD (SE 0.11; p&amp;lt;0.05), with sensitivity estimates from 0.13 to 0.32 SD. We found no evidence that the association differed by cluster-level household assets or by household nationality. Engagement components within and between clusters were positive but not significant.&lt;br /&gt;Conclusions: In Lebanon, PE modestly correlates with higher ECD, with little variation across communities or levels of household assets. These findings emphasise fathers&#39; contributions to early development and suggest that supporting PE, alongside broader social protections, may help strengthen child development.&lt;br /&gt; (&#169; Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)
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  Data: Competing interests: None declared.
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