Father and Sibling Involvement in Home Rehabilitation: Longitudinal Effects on Infant Development and Maternal Wellbeing in Bulawayo, Zimbabwe

OBJECTIVE: To determine whether extending home-based rehabilitation beyond the mother-only model to include fathers and siblings is associated with improved developmental outcomes in infants with neuro-developmental delay (NDD) and maternal wellbeing in an urban low-resource setting. METHODS: A prospective observational cohort study was conducted at two public neuro-developmental clinics in Bulawayo, Zimbabwe. Infants aged 3-6 months (N = 481) and their mothers were followed for 3 months across three naturally occurring caregiver participation groups: mother-only, mother-father and mother-father-sibling. Developmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), and maternal wellbeing was measured using Global Quality of Life (QoL) and Mental Health Check-In Visual Analogue Scales. Group differences were analysed using ANCOVA, repeated-measures ANCOVA and multiple linear regression adjusting for baseline scores. RESULTS: Infants in the mother-father-sibling group demonstrated significantly higher baseline-adjusted BSID-III cognitive scores at 3 months than the mother-only group (p < 0.05), with the largest effect observed in this group. Changes in language, motor, socioemotional, and adaptive domains followed the same direction but showed smaller and less consistent effects, with limited pairwise significance after adjustment. Maternal mental health improved significantly over time across groups, while QoL showed small but statistically significant gains only on repeated-measures analysis. CONCLUSION: Involving fathers and siblings in home-based rehabilitation was associated with selective cognitive gains in infants and better maternal mental health over 3 months. These findings provide preliminary support for the integration of father- and sibling-inclusive, family-centred rehabilitation models for paediatric neurorehabilitation in similar low- and middle-income settings.