Impact of COVID-19 on maternal health and child care behavior: evidence from a quasi-experimental study of vulnerable communities in Boa Vista, Brazil

BACKGROUND: COVID-19 related distress has been shown to have negative associations with family well-being. OBJECTIVES: To determine the immediate impact of acute COVID-19 infection on maternal well-being and parenting practices among Brazilian families. PARTICIPANTS AND SETTING: We studied 2'579 mothers (29'913 observations) of young children from vulnerable neighborhoods in Boa Vista, Brazil over 12 months. METHODS: We monitored family health and caregiving behavior including the incidence of COVID-19 infections in the surveyed households through bi-weekly phone interviews over 50 weeks, from June 2020 to May 2021. Primary outcomes were home-based child stimulation, positive parenting behavior, and parenting stress. We used fixed effects panel regressions to estimate the impact of household COVID-19 infections on parenting outcomes. RESULTS: Over the study period, 441 participants (17.1%; 831 (3.0%) observations) reported at least 1 positive COVID-19 infection in their household. Household COVID-19 infections significantly reduced home-based stimulation by 0.10 SDs (95%CI: -0.18, -0.01), positive parenting behaviors by 0.14 SDs (-0.21, -0.01), and increased parenting stress by 0.07 SDs (0.02, 0.12). The impact on home-based stimulation was most pronounced when the mother herself had a COVID-19 infection (-0.16; -0.29, -0.04). Parenting stress responded most strongly to mother or child COVID-19 infections. Effects were relatively short-lived, only children's infections' on parental stress was still detectable 2 weeks after initial infection. CONCLUSION: Our findings suggest that COVID-19 infections cause substantial disruptions in children's home environments - additional short-term support for families with acute infections could attenuate the negative impact on children's home environment during the pandemic.