Jan. 12, 2021

Nursing research helps improve health, development of Pakistani children by addressing parent interaction

Nursing professor's expertise in ‘serve and return’ builds bridge between Calgary, Karachi for international scholars to address risk
Almina and nurse trainees
Almina and nurse trainees

Around the world, nearly 53 million preschool-age children are at risk of not achieving their full developmental potential. Most of them — approximately 50.2 million — live in South Asia.

The extremes of the socio-economic and cultural conditions in a low-to-middle income (LMI) country like Pakistan may impede a child’s development, contributing to an intergenerational cycle of poverty that limits societal advancement. UCalgary Nursing’s Dr. Nicole Letourneau, PhD, is building a bridge between Calgary and Karachi to help address risk to these children’s health and development.

  • Pictured above: Almina Pardhan with nurse trainees at the Aga Khan University Institute for Educational Development in Karachi

“With Dr. Shahirose Premji, from York University, I have been working on a CIHR-funded, first-ever LMI country study on the impact of maternal prenatal distress (anxiety, depression, stress) in pregnant Pakistani women and following them to birth,” says Letourneau, explaining that maternal prenatal distress is predictive of poor child cognitive and social-emotional development. 

“Depression has been observed to be as high as 48 per cent in pregnant Pakistani women, double or triple the rates observed in higher-income countries such as Canada. This depression can continue after a child’s birth and result in a poor outcomes for both the mother and the infant.”

In a related followup study, led by Pakistani researcher Sharifa Lalani and Premji, on the impact of prenatal distress on child development, Letourneau trained Queen Elizabeth Scholar Dr. Almina Pardhan from the Aga Khan University Institute for Educational Development in Karachi in how to assess parental "serve and return."

Serve and return is the interaction between parents and their children where a parent positively responds to a noise, a gesture, a laugh, a cry made by their child through a returned smile, words or look.

Considered essential for healthy childhood brain development, this communication helps build and strengthen the brain cell connections a child needs to learn new skills in all areas of their development.

Dr. Almina Pardhan's class in Pakistan

Almina Pardhan teaches a class in Pakistan.


Pardhan came to UCalgary in the fall of 2019 to receive training from Letourneau, a certified instructor for more than 25 years, in the Parent-Child Interaction Teaching and Feeding Scales — tools that assess parental serve and return. This training was the necessary first step for Pardhan herself to become an instructor. She has since gone on to become the first-ever instructor in serve and return assessment in Pakistan.

Now training others to be able to assess serve and return, Pardhan says it is imperative to have assessors who understand the unique cultural, economic and health system context in Pakistan.

“Both maternal prenatal distress and children’s development are global health issues. If we have more educators who can work with parents to limit unintended adverse effects, parents and children will benefit.”

Letourneau agrees that the health and well-being of women and children here at home and globally is an issue Canada cannot ignore.

“CIHR has stated it is our global responsibility to address health priorities of LMI countries through research and research-capacity development in these countries. Our study is the first to consider psychosocial and physiological burdens, as well as the underlying mechanism — serve and return — that links maternal prenatal distress to children’s development in a LMI country.”