ArticleBMJ paediatrics open2026
Associations between paternal engagement and child development outcomes in Lebanon: a multilevel cross-sectional analysis of national data.
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFathers 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.
methodsWe 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.
resultsPE 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.
conclusionsIn 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.
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