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Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, Perez-Escamilla R, Rao N, Ip P, Fernald LCH, MacMillan H, Hanson M, Wachs TD, Yao H, Yoshikawa H, Cerezo A, Leckman JF, Bhutta ZA. Nurturing care: promoting early childhood development. Lancet 2017; 389:91-102. [PMID: 27717615 DOI: 10.1016/s0140-6736(16)31390-3] [Citation(s) in RCA: 705] [Impact Index Per Article: 100.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 01/09/2023]
Abstract
The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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Affiliation(s)
| | - Stephen J Lye
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada; Departments of Physiology, Obstetrics and Gynecology, and Medicine, University of Toronto, ON, Canada
| | - Kerrie Proulx
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Stephen G Matthews
- Fraser Mustard Institute for Human Development, University of Toronto, ON, Canada; Departments of Physiology, Obstetrics and Gynecology, and Medicine, University of Toronto, ON, Canada
| | - Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, CT, USA
| | - Nirmala Rao
- Faculty of Education, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Lia C H Fernald
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Harriet MacMillan
- Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Mark Hanson
- Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton, UK
| | - Theodore D Wachs
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Haogen Yao
- Teachers College, Columbia University, New York, NY, USA
| | | | - Adrian Cerezo
- Department of Biology, University of Missouri, St Louis, MO, USA
| | - James F Leckman
- Yale Child Study Centre, Yale School of Medicine, Yale University, CT, USA
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
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602
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Richter LM, Daelmans B, Lombardi J, Heymann J, Boo FL, Behrman JR, Lu C, Lucas JE, Perez-Escamilla R, Dua T, Bhutta ZA, Stenberg K, Gertler P, Darmstadt GL. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet 2017; 389:103-118. [PMID: 27717610 PMCID: PMC5880532 DOI: 10.1016/s0140-6736(16)31698-1] [Citation(s) in RCA: 393] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023]
Abstract
Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.
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Affiliation(s)
- Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Jody Heymann
- UCLA Fielding School of Public Health and WORLD Policy Analysis Center, University of California Los Angeles, CA, USA
| | | | - Jere R Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chunling Lu
- Division of Global Health Equity, Brigham & Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jane E Lucas
- Consultant in International Health and Child Development, New York, NY, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Karin Stenberg
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Paul Gertler
- Haas School of Business and the School of Public Health, University of California Berkeley, CA, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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603
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Li Q, Liang F, Liang W, Zhang J, Niu M, Han Y. The Influence of Different Caregivers on Infant Growth and Development in China. Front Pediatr 2017; 5:243. [PMID: 29201862 PMCID: PMC5696336 DOI: 10.3389/fped.2017.00243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE An increasing number of parents in China ask grandparents or babysitters to care for their children. Modern parents are often the only child in their family because of China's One-Child Policy and thus may lack interaction with siblings. Accordingly, the present study aimed to explore whether different caregivers affect the physical and development of infants in China. METHODS In total, 2,514 infants were enrolled in our study. We assessed their weight-for-age, supine length-for-age, weight-for-length, occipital-frontal circumference, and Denver Developmental Screening Test (DDST) results and recorded their general parental information and their primary caregivers. RESULTS The weights and lengths of 12-month-old infants under the care of babysitters were significantly lower than those of infants under the care of parents or grandparents (P < 0.05). Additionally, 12-month-old infants under the care of babysitters had the lowest DDST pass rate (75%) among the three groups (χ2 = 11.819, P = 0.012), especially for the fine motor-adaptive and language domains. Compared to 12-month-old infants under the care of parents and babysitters, infants under the care of grandparents were more likely to be overweight or obese (P < 0.001). CONCLUSION The study showed that caregivers had a dominant role in the physical and cognitive development of the infants. Specifically, compared with infants raised by grandparents and parents, 12-month-old infants under the care of babysitters had partially suppressed lengths and weights and lagged cognitively. The 12-month-old infants under the care of grandparents were more overweight than those cared for by parents and babysitters.
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Affiliation(s)
- Qinrui Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Furong Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Weilan Liang
- Department of Child Health Care, Peking University First Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Manman Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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604
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Abbas JJ, Smith B, Poluta M, Velazquez-Berumen A. Improving health-care delivery in low-resource settings with nanotechnology: Challenges in multiple dimensions. Nanobiomedicine (Rij) 2017; 4:1849543517701158. [PMID: 29942391 PMCID: PMC5998261 DOI: 10.1177/1849543517701158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/07/2017] [Indexed: 01/07/2023] Open
Abstract
In the two decades after 1990, the rates of child and maternal mortality dropped by over 40% and 47%, respectively. Despite these improvements, which are in part due to increased access to medical technologies, profound health disparities exist. In 2015, a child born in a developing region is nearly eight times as likely to die before the age of 5 than one born in a developed region and developing regions accounted for nearly 99% of the maternal deaths. Recent developments in nanotechnology, however, have great potential to ameliorate these and other health disparities by providing new cost-effective solutions for diagnosis or treatment of a variety of medical conditions. Affordability is only one of the several challenges that will need to be met to translate new ideas into a medical product that addresses a global health need. This article aims to describe some of the other challenges that will be faced by nanotechnologists who seek to make an impact in low-resource settings across the globe.
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Affiliation(s)
- James J Abbas
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Barbara Smith
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - Mladen Poluta
- Western Cape Department of Health, Cape Town, South Africa
| | - Adriana Velazquez-Berumen
- Essential Medicines and Health Products Department, Health Systems and Innovation Cluster, World Health Organization, Geneva, Switzerland
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605
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Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial. J Dev Behav Pediatr 2017; 38:753-764. [PMID: 28991146 PMCID: PMC5668186 DOI: 10.1097/dbp.0000000000000510] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Early childhood development programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these 2 components in a cluster-randomized controlled trial to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers. METHODS Two hundred twenty-one HIV-exposed but uninfected child (2-3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation or (2) Uganda Community Based Association for Child Welfare (UCOBAC) program that delivered health and nutrition training. Children were evaluated at baseline, 6 months, 1 year (training conclusion), and 1-year posttraining with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell Home Observation for the Measurement of the Environment (HOME) was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. RESULTS Mediational Intervention for Sensitizing Caregivers resulted in significantly better quality of caregiving compared with UCOBAC midintervention with an adjusted mean difference (MadjDiff) of 2.34 (95% confidence interval [CI]: 1.54-3.15, p < .01), postintervention (MadjDiff = 2.43, 95% CI: 1.61-3.25, p < .01), and at 1-year follow-up (MadjDiff = 2.07, 95% CI: 1.23-2.90, p < .01). MISC caregivers reported more problems on the BRIEF for their child at 1-year posttraining only (p < .01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance 1-year posttraining for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. CONCLUSION Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared with health and nutrition training. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01640561.
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606
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Brittain K, Mellins CA, Phillips T, Zerbe A, Abrams EJ, Myer L, Remien RH. Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa. AIDS Behav 2017; 21:274-282. [PMID: 27052843 DOI: 10.1007/s10461-016-1389-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression, HIV-related stigma and low levels of social support may be particularly prevalent and adversely affect health and treatment outcomes among HIV-infected pregnant women. We examined factors associated with social support and stigma among pregnant women initiating antiretroviral therapy in the Western Cape, South Africa; and explored associations with depressive symptoms (Edinburgh Postnatal Depression Scale; EPDS) in linear regression models. Among 623 participants, 11 and 19 % had elevated EPDS scores using thresholds described in the original development of the scale (scores ≥13 and ≥10, respectively). Social support and stigma were highly interrelated and were associated with depressive symptoms. Stigma was observed to moderate the association between social support and depression scores; when levels of stigma were high, no association between social support and depression scores was observed. Elevated depression scores are prevalent in this setting, and interventions to reduce stigma and to address risk factors for depressive symptoms are needed.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Elaine J Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
- College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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607
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Powell RM, Parish SL. Behavioural and cognitive outcomes in young children of mothers with intellectual impairments. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:50-61. [PMID: 27306542 DOI: 10.1111/jir.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/12/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite an increase in international studies examining the experiences of parents with intellectual impairments and their children, few have utilised population-based data. This study investigated the behavioural and cognitive outcomes of 3-year-old US children of mothers with intellectual impairments compared with children of mothers without intellectual impairments. METHODS This study employed a secondary analysis of the Fragile Families Child and Wellbeing Study, a longitudinal birth cohort study in the US. Our analytic sample included mothers with intellectual impairments (n = 263) and a comparison group of mothers without intellectual impairments (n = 1298), as well as each sampled mother's focal child. When weighted, Fragile Families is representative of all births in US cities with populations over 200 000. RESULTS Children of mothers with intellectual impairments had poorer behavioural and cognitive outcomes in comparison to same-age children of mothers without intellectual impairments. Notably, however, children of mothers with intellectual impairments were not at increased risk of being aggressive unless their family income was below 200% of the federal poverty level. Further, families headed by mothers with intellectual impairments experienced multiple hardships related to socioeconomic factors, limited social supports and poor self-reported health. CONCLUSION Appropriate policies and programmes must be developed and implemented to effectively support these families, such as increased financial benefits.
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Affiliation(s)
- R M Powell
- Brandeis University, Lurie Institute for Disability Policy, Waltham, MA, United States
| | - S L Parish
- Brandeis University, Lurie Institute for Disability Policy, Waltham, MA, United States
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608
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Converging on child mental health - toward shared global action for child development. Glob Ment Health (Camb) 2017; 4:e20. [PMID: 29230316 PMCID: PMC5719480 DOI: 10.1017/gmh.2017.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/25/2022] Open
Abstract
We are a group of researchers and clinicians with collective experience in child survival, nutrition, cognitive and social development, and treatment of common mental conditions. We join together to welcome an expanded definition of child development to guide global approaches to child health and overall social development. We call for resolve to integrate maternal and child mental health with child health, nutrition, and development services and policies, and see this as fundamental to the health and sustainable development of societies. We suggest specific steps toward achieving this objective, with associated global organizational and resource commitments. In particular, we call for a Global Planning Summit to establish a much needed Global Alliance for Child Development and Mental Health in all Policies.
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609
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Sobrino M, Gutiérrez C, Alarcón J, Dávila M, Cunha AJ. Birth interval and stunting in children under five years of age in Peru (1996-2014). Child Care Health Dev 2017; 43:97-103. [PMID: 27804155 DOI: 10.1111/cch.12420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/08/2016] [Accepted: 10/02/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Examine the evolution of stunting in <5 years of age in Peru and its relationship with birth interval (BI), and associated factors from 1996 to 2014. METHODS Data were extracted from the National Demographic and Health Survey of Peru (DHS) for the years 1996, 2000, 2005, 2010 and 2014 on children <5 years of age for stunting (height / age ≤ 2DS). The main independent variable of interest was BI dichotomized by interval between date of last and penultimate birth (≤24 months vs. >24 months) and others sociodemographic variables. Crude and adjusted odds ratios with 95% confidence intervals were estimated in logistic regression for the effect of BI and other variables on stunting by each survey year. RESULTS Between 1996 and 2014, stunting declined in both BI groups: ≤24 months: 35.8% to 21.8%; >24 months: 29.5% to 14.3%. BI was associated with stunting after adjustment for other variables in each survey except 2005. Of the other factors, sex, birth order (fourth child or more), maternal education and poverty were independently associated with stunting in all survey years. Residence in rural areas and in Amazon forest and highland regions was associated with stunting 1996 and 2000. Maternal age was not independently associated with stunting. CONCLUSIONS While stunting showed a decreasing trend from 1996 to 2014, birth interval exceeding 24 months exerted a protective effect on stunting across the years surveyed. Poverty, low maternal education and high birth order were associated with stunting in all survey years.
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Affiliation(s)
- M Sobrino
- Pediatría, Facultad de Medicina, Universidad de Sevilla, Spain
| | - C Gutiérrez
- Sección Epidemiologia, Instituto Medicina Tropical, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Peru
| | - J Alarcón
- Sección Epidemiologia, Instituto Medicina Tropical, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Peru
| | - M Dávila
- Organización Panamericana de la Salud, Paraguay
| | - A J Cunha
- Pediatría, Faculdade de Medicina, Universidad Federal de Río de Janeiro, Brazil
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610
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Abstract
OBJECTIVE To investigate the association between dental caries and early childhood development in 3-year-olds from Talca, Chile. METHOD A pilot study with a convenience sample of 3-year-olds from Talca (n = 39) who attend public healthcare centers. Child development was measured by the Psychomotor Development Index (PDI), a screening tool used nationally among pre-school children to assess language development, fine motor skills and coordination areas. Dental caries prevalence was evaluated by decayed, missing, filled teeth (DFMT) and decayed, missing, filled tooth surfaces (DFMS) ceo-d and ceo-s indexes. The children were divided into two groups according to the PDIscore: those with a score of 40 or more were considered developmentally normal (n = 32), and those with a score below 40 were considered as having impaired development (n = 7). RESULTS The severity of caries (DMFT) was negatively correlated with PDI (r = -0.82), and children with the lowest TEPSI score had the highest DFMT values. The average DMFT in children with normal development was 1.31, and 3.57 for those with impaired development. CONCLUSION This pilot study indicates that the severity of dental caries is correlated with early childhood development.
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Affiliation(s)
- F Loreto Núñez
- Departamento de Salud Pública, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile.
| | - B Javier Sanz
- Departamento de Salud Pública, Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - L Gloria Mejía
- Australian Research Center for Population Oral Health (ARPOCH), University of Adelaide, Australia
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611
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Pereira LM, Viera CS, Toso BRGDO, Carvalho ARDS, Bugs BM. Validação da escala Índice de Estresse Parental para o português do Brasil. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Apresentar a adaptação cultural e validação do instrumento Parental Stress Index para o português do Brasil. Métodos Pesquisa metodológica com a aplicação da escala em validação à 53 mães de prematuros no ambulatório de seguimento de um hospital público de ensino no Paraná, no período de novembro de 2013 a julho de 2014. A análise de dados utilizou estatística descritiva e inferencial. Resultados A confiabilidade do instrumento foi satisfatória em seu conjunto (α=0,91) e em seus domínios: Domínio da criança (α=0,87) e domínio dos pais (α=0,88). Os componentes principais explicaram 64,57% da variação total dos itens, sendo 45,16% do domínio da criança e 17,80% do domínio dos pais. Conclusão A escala mostrou-se adequada para avaliar o estresse materno após a alta hospitalar, referendando-se seu uso no contexto brasileiro em novos estudos para ampliar sua confiabilidade e validade.
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612
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Pereira KR, Valentini NC, Saccani R. Brazilian infant motor and cognitive development: Longitudinal influence of risk factors. Pediatr Int 2016; 58:1297-1306. [PMID: 27084989 DOI: 10.1111/ped.13021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infant developmental delays have been associated with several risk factors, such as familial environmental, individual and demographic characteristics. The goal of this study was to longitudinally investigate the effects of maternal knowledge and practices, home environment and biological factors on infant motor and cognitive outcomes. METHODS This was a prospective cohort study with a sample of 49 infants from Southern Brazil. The infants were assessed three times over 4 months using the Alberta Infant Motor Scale and the Bayley Scale of Infant Development (Mental Development Scale). Parents completed the Daily Activities Scale of Infants, the Affordances in The Home Environment for Motor Development - Infant Scale, the Knowledge of Infant Development Inventory and a demographic questionnaire. Generalized estimating equation with Bonferroni method as the follow-up test and Spearman correlation and multivariate linear backward regression were used. RESULTS Cognitive and motor scores were strongly associated longitudinally and increased over time. Associations between the home affordances, parental practices and knowledge, and motor and cognitive development over time were observed. This relationship explained more variability in motor and cognitive scores compared with biological factors. CONCLUSIONS Variability in motor and cognitive development is better explained by environment and parental knowledge and practice. The investigation of factors associated with infant development allows the identification of infants at risk and the implementation of educational programs and parental training to minimize the effects of developmental delay.
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Affiliation(s)
- Keila Rg Pereira
- School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nadia C Valentini
- School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raquel Saccani
- School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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613
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Mufdi M, Núñez L, Ochoa JP, Mejía G. Relationship between overall child development and caries severity in Chilean three-year-old preschool children. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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614
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Rabbani A, Khan A, Yusuf S, Adams A. Trends and determinants of inequities in childhood stunting in Bangladesh from 1996/7 to 2014. Int J Equity Health 2016; 15:186. [PMID: 27852266 PMCID: PMC5112749 DOI: 10.1186/s12939-016-0477-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We explore long-term trends and determinants of socioeconomic inequities in chronic childhood undernutrition measured by stunting among under-five children in Bangladesh. Given that one in three children remain stunted in Bangladesh, the socioeconomic mapping of stunting prevalence may be critical in designing public policies and interventions to eradicate childhood undernutrition. METHODS Six rounds of Bangladesh Demographic and Health Survey data are utilized, spanning the period 1996/97 to 2014. Using recognized measures of absolute and relative inequality (namely, absolute and relative difference, concentration curve and index), we quantify trends, and decompose changes in the concentration index to identify factors that best explain observed dynamics. RESULTS Despite remarkable improvements in average nutritional status over the last two decades, socio-economic inequalities have persisted, and according to some measures, even worsened. For example, expressed as rate-ratios, the relative inequality in under-five stunting increased by 56% and the concentration index more than doubled between 1996/97 and 2014. Decomposition analyses find that wealth and maternal factors such as mothers' schooling and short stature are major contributors to observed socio-economic inequalities in child undernutrition and their changes over time. CONCLUSIONS Reflecting on recent success around socioeconomic and gender equity in child mortality, and the weak legacy of nutrition policy in Bangladesh, we suggest that nutrition programming energies be focused specifically on the most disadvantaged and applied at scale to close socioeconomic gaps in stunting prevalence.
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Affiliation(s)
- Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - Akib Khan
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Sifat Yusuf
- Health Systems and Population Sciences Division, International Center for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Alayne Adams
- Health Systems and Population Sciences Division, International Center for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
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615
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Otto HWR, Schuitmaker N, Lamm B, Abels M, Serdtse Y, Yovsi R, Tomlinson M. Infants' Social Experiences in Three African Sociocultural Contexts. Child Dev 2016; 88:1235-1250. [PMID: 27861748 DOI: 10.1111/cdev.12661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study introduces a peri-urban context of poverty to the study of child development in Africa in contrast to the more typical assessments in middle-class and rural contexts. Spot observations were used to assess universal caregiving behaviors toward seventy-six 3-month-old infants. Results show that middle-class infants experienced distal parenting behaviors instantiated by mothers, whereas rural children experienced proximal parenting practices in interactions with others. Infants growing up in poverty had mothers and other caretakers involved at mostly low levels. They experienced low levels of body contact, body stimulation, and object stimulation, and high levels of face-to-face positions. The study indicates that caregiving in the context of poverty does not necessarily follow familiar pathways and needs to be contextualized accordingly.
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616
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McDonald SW, Kehler HL, Tough SC. Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort. BMJ Open 2016; 6:e012096. [PMID: 28186930 PMCID: PMC5128911 DOI: 10.1136/bmjopen-2016-012096] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify the combination of factors most protective of developmental delay at age 2 among children exposed to poor maternal mental health. DESIGN Observational cohort study. SETTING Pregnant women were recruited from primary healthcare offices, the public health laboratory service and community posters in Calgary, Alberta, Canada. PARTICIPANTS 1596 mother-child dyads who participated in the All Our Babies study and who completed a follow-up questionnaire when their child was 2 years old. Among participants who completed the 2-year questionnaire and had complete mental health data (n=1146), 305 women (27%) were classified as high maternal mental health risk. PRIMARY MEASURES Child development at age 2 was described and a resilience analysis was performed among a subgroup of families at maternal mental health risk. The primary outcome was child development problems. Protective factors were identified among families at risk, defined as maternal mental health risk, a composite measure created from participants' responses to mental health life course questions and standardised mental health measures. RESULTS At age 2, 18% of children were classified as having development problems, 15% with behavioural problems and 13% with delayed social-emotional competencies. Among children living in a family with maternal mental health risk, protective factors against development problems included higher social support, higher optimism, more relationship happiness, less difficulty balancing work and family responsibilities, limiting the child's screen time to <1 hour per day and the child being able to fall asleep in <30 min and sleeping through the night by age 2. CONCLUSIONS Among families where the mother has poor mental health, public health and early intervention strategies that support interpersonal relationships, social support, optimism, work-life balance, limiting children's screen time and establishing good sleep habits in the child's first 2 years show promise to positively influence early child development.
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Affiliation(s)
- Sheila W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather L Kehler
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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617
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Tomlinson M, Skeen S, Marlow M, Cluver L, Cooper P, Murray L, Mofokeng S, Morley N, Makhetha M, Gordon S, Esterhuizen T, Sherr L. Improving early childhood care and development, HIV-testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial. Trials 2016; 17:538. [PMID: 27829445 PMCID: PMC5103333 DOI: 10.1186/s13063-016-1658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/14/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Since 1990, the lives of 48 million children under the age of 5 years have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, 250 million children younger than 5 years in low- and middle-income countries (LMIC) cannot meet their developmental potential due to poverty, poor health and nutrition, and lack of necessary stimulation and care. Lesotho has high levels of poverty, HIV, and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which provide a setting for inclusive, integrated Early Childhood Care and Development (ECCD) and HIV and nutrition interventions. METHODS We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention program to integrate HIV-testing and treatment services, ECCD, and nutrition education for caregivers with children aged 1-5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session 1 month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic book-sharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. All children aged 1-5 years and their primary caregivers living in study villages are eligible for participation. Caregivers and their children will be interviewed and assessed at baseline, after completion of the intervention, and 12 months post intervention. DISCUSSION This study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study. TRIAL REGISTRATION The Mphatlalatsane: Early Morning Star trial is registered on the International Standard Randomized Controlled Trial Number database, registration number ISRCTN16654287 ; the trial was registered on 3 July 2015.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Skeen
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Marguerite Marlow
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, Oxford University, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Peter Cooper
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- University of Reading, Reading, UK
| | - Lynne Murray
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- University of Reading, Reading, UK
| | - Shoeshoe Mofokeng
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Nathene Morley
- Leadership Management and Governance Project, Management Sciences for Health, Pretoria, South Africa
| | - Moroesi Makhetha
- Leadership Management and Governance Project, Management Sciences for Health, Pretoria, South Africa
| | - Sarah Gordon
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Tonya Esterhuizen
- Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa
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618
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Gleason KM, Valeri L, Shankar AH, Hasan MOSI, Quamruzzaman Q, Rodrigues EG, Christiani DC, Wright RO, Bellinger DC, Mazumdar M. Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years. Environ Health 2016; 15:103. [PMID: 27809911 PMCID: PMC5096334 DOI: 10.1186/s12940-016-0190-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/26/2016] [Indexed: 05/02/2023]
Abstract
BACKGROUND Lead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows. METHODS Whole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20-40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses. RESULTS Median (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6-6.3) μg/dl and 4.2 (1.7-7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20-40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02-1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94-1.00). CONCLUSIONS There is a significant association between stunting and concurrent lead exposure at age 20-40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20-40 months is needed.
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Affiliation(s)
- Kelsey M. Gleason
- Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA 02215 USA
| | - Linda Valeri
- Department of Psychiatry (Biostatistics), McClean Hospital, Belmont Campus, North Belknap, Room 310A, Belmont, MA 02478 USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - A. H. Shankar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 2, Room 331A, Boston, MA 02115 USA
| | | | - Quazi Quamruzzaman
- Dhaka Community Hospital, 190/1, Wireless Railgate Bara Moghbazar, Dhaka, 1217 Bangladesh
| | - Ema G. Rodrigues
- Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA 02215 USA
- Department of Neurology, Boston Children’s Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA 02115 USA
| | - David C. Christiani
- Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA 02215 USA
| | - Robert O. Wright
- Department of Preventive Medicine, Mount Sinai School of Medicine, 17 East 102nd Street, New York, NY 10029 USA
| | - David C. Bellinger
- Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA 02215 USA
- Department of Neurology, Boston Children’s Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA 02115 USA
- Department of Neurology, Harvard Medical School, 300 Longwood Ave, Children’s Hospital Farley Basement Box 127, Boston, MA 02115 USA
| | - Maitreyi Mazumdar
- Department of Environmental Health - EOME Program, Harvard T.H. Chan School of Public Health, Landmark Center, 401 Park Drive, 3rd Floor East, Boston, MA 02215 USA
- Department of Neurology, Boston Children’s Hospital, 651 Huntington Avenue, FXB, Room 102, Boston, MA 02115 USA
- Department of Neurology, Harvard Medical School, 300 Longwood Ave, Children’s Hospital Farley Basement Box 127, Boston, MA 02115 USA
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619
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SHERR L, SKEEN S, HENSELS IS, TOMLINSON M, MACEDO A. The effects of caregiver and household HIV on child development: a community-based longitudinal study of young children. Child Care Health Dev 2016; 42:890-899. [PMID: 27514630 PMCID: PMC6086490 DOI: 10.1111/cch.12387] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Many studies that document child outcomes in the context of parental HIV - which has been established as a risk factor for child development - focus on older children/adolescents. Studies also concentrate on the status of the primary caregiver, not other household members who might be infected. DESIGN This study examined the effects of caregiver and household HIV on child development (4-13 years) in South Africa and Malawi (2011-2014). METHODS Data were gathered from 989 children and their primary caregivers at baseline and repeated at 12-15 months follow-up (86.5% follow-up rate). Only caregivers of a single child and caregiver/child dyads without missing data were included, providing a sample of 808 dyads for analysis. Children were divided into three groups according to caregiver-reported HIV burden: having an HIV-positive primary caregiver (19.8%), having HIV in the household (14.2%) or no HIV (66%). RESULTS The HIV burden was positively associated with an array of negative child outcomes, often mediated by caregiver depression levels. Family HIV burden at baseline affected child behavioural problems at follow-up indirectly through carer depression (B = 0.02; CI = 0.003, 0.06). Internalizing (B = 0.02; CI = 0.002, 0.05) and externalizing problems at follow-up (B = 0.01; CI = 0.0002, 0.03) were also indirectly affected by family HIV burden through caregiver depression. CONCLUSIONS The data suggest that family HIV can affect child development, emphasizing the important role of depression in the pathway to such an effect. Community-based interventions directed at alleviating parental depression in the presence of HIV may help to interrupt the cycle of family HIV and adverse child outcomes.
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Affiliation(s)
- Lorraine SHERR
- Department of Infection and Population Health, University College London, United Kingdom,Corresponding author: Prof Lorraine Sherr, Rowland Hill Street, London, NW3 2PF, United Kingdom,
| | - Sarah SKEEN
- Department of Psychology, Stellenbosch University, South Africa,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Imca S. HENSELS
- Department of Infection and Population Health, University College London, United Kingdom,School of Psychological Sciences, University of Manchester, United Kingdom
| | - Mark TOMLINSON
- Department of Psychology, Stellenbosch University, South Africa
| | - Ana MACEDO
- Department of Infection and Population Health, University College London, United Kingdom
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620
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Milne S, McDonald J, Kayrouz N. Determinants of developmental progress in pre-schoolers referred for neuro-developmental diagnosis. J Paediatr Child Health 2016; 52:1004-1011. [PMID: 27599109 DOI: 10.1111/jpc.13274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 11/29/2022]
Abstract
AIM To determine factors associated with change in developmental progress in pre-schoolers referred to a developmental clinic. METHODS Of 360 pre-schoolers referred to a Child Assessment clinic for neuro-developmental diagnosis before 3.6 years, 190 (53%) were reassessed prior to school entry and recruited to this study. They were assessed with the Bayley Scales of Infant and Toddler Development (3rd edn) before 3.5 years and the Griffiths Mental Development Scales before school entry. The influence of medical and environmental variables on improvement or deterioration in scores (±0.5 SD) was examined using logistic regression. RESULTS Consistent scores were present in 51.6% of children, and associated with environmental variables. Children with stable scores were more likely to live in a suburb of social advantage (OR = 3.2; 95%CI = 1.37-7.64, P = 0.008) or to come from families dependent on welfare or public housing (OR=4.8; 95%CI = 2.19-10.49, P < 0.001). Improvement was seen in 18.1% of children; they were more likely to have commenced therapy after the first assessment (OR = 2.4; 95%CI = 1.05-5.58, P = 0.038). Deterioration of scores was seen in 30% of children. Children with a mild delay on initial assessment were less likely to deteriorate (OR = 2.9; 95%CI = 1.16-7.04, P = 0.022), while lower scores were more likely in children with neuro-motor disabilities (OR = 10.8; 95%CI = 2.64-44.58, P < 0.001), and chromosomal variations of both known and unknown significance (OR = 4.4; 95%CI = 1.54-12.76, P = 0.006). CONCLUSIONS Socio-economic advantage and disadvantage are associated with stable scores, but introducing intervention is associated with improved scores. Deterioration is most likely in children with chromosomal variations or neuro-motor disabilities, and regular reassessment of these children is recommended.
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Affiliation(s)
- Susan Milne
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Jenny McDonald
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Norma Kayrouz
- Paediatric Allied Health, Campbelltown Hospital, Sydney, New South Wales, Australia
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621
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McDonald S, Kehler H, Bayrampour H, Fraser-Lee N, Tough S. Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 58:20-30. [PMID: 27587353 DOI: 10.1016/j.ridd.2016.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/27/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies. AIMS To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk). METHODS AND PROCEDURES Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses. OUTCOMES AND RESULTS At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction. CONCLUSIONS AND IMPLICATIONS The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction.
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Affiliation(s)
- Sheila McDonald
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada.
| | - Heather Kehler
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Hamideh Bayrampour
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Nonie Fraser-Lee
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
| | - Suzanne Tough
- Department of Pediatrics, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada; Department of Community Health Science, University of Calgary, Child Development Centre, #389 3820 24th Ave NW, Calgary, Alberta T3B 2X9, Canada
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622
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Braun KV, Erler NS, Kiefte-de Jong JC, Jaddoe VW, van den Hooven EH, Franco OH, Voortman T. Dietary Intake of Protein in Early Childhood Is Associated with Growth Trajectories between 1 and 9 Years of Age. J Nutr 2016; 146:2361-2367. [PMID: 27733529 DOI: 10.3945/jn.116.237164] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High protein intake in infancy might lead to a higher body mass index (BMI) in childhood. However, whether these associations differ between different sources of protein is unclear. OBJECTIVE We investigated associations between the intake of total protein, protein from different sources, and individual amino acids in early childhood and repeatedly measured height, weight, and BMI up to the age of 9 y. METHODS This study was performed in 3564 children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, Netherlands. Intakes of total protein, animal protein, vegetable protein, and individual amino acids (including methionine, arginine, lysine, threonine, valine, leucine, isoleucine, phenylalanine, tryptophan, histidine, cysteine, tyrosine, alanine, asparagine, glutamine, glycine, proline, and serine) at 1 y were assessed by using a food-frequency questionnaire. Height and weight were measured at the approximate ages of 14, 18, 24, 30, 36, and 45 mo and at 6 and 9 y, and BMI was calculated. RESULTS After adjustment for confounders, linear mixed models showed that a 10-g higher total protein intake/d at 1 y was significantly associated with a 0.03-SD greater height (95% CI: 0.00, 0.06), a 0.06-SD higher weight (95% CI: 0.03, 0.09), and a 0.05-SD higher BMI (95% CI: 0.03, 0.08) up to the age of 9 y. Associations were stronger for animal than for vegetable protein intake but did not differ between dairy and nondairy animal protein or between specific amino acids. CONCLUSIONS A higher intake of protein, especially animal protein, at 1 y of age was associated with a greater height, weight, and BMI in childhood up to 9 y of age. Future studies should explore the role of growth hormones and investigate whether protein intake in early childhood affects health later in life.
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Affiliation(s)
- Kim Ve Braun
- The Generation R Study Group and.,Departments of Epidemiology
| | | | | | - Vincent Wv Jaddoe
- The Generation R Study Group and.,Departments of Epidemiology.,Paediatrics, Erasmus MC, University Medical Center, Rotterdam, Netherlands; and
| | | | | | - Trudy Voortman
- The Generation R Study Group and .,Departments of Epidemiology
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623
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Andersen CT, Stein AD, Reynolds SA, Behrman JR, Crookston BT, Dearden KA, Penny ME, Schott W, Fernald LC. Stunting in Infancy Is Associated with Decreased Risk of High Body Mass Index for Age at 8 and 12 Years of Age. J Nutr 2016; 146:2296-2303. [PMID: 27683868 PMCID: PMC5086789 DOI: 10.3945/jn.116.234633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/03/2016] [Accepted: 08/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Effects of early-life stunting on adiposity development later in childhood are not well understood, specifically with respect to age in the onset of overweight and obesity. OBJECTIVES We analyzed associations of infant stunting with prevalence of, incidence of, and reversion from high body mass index-for-age z score (BMIZ) later in life. We then estimated whether associations of infant stunting with BMIZ varied by sex, indigenous status, and rural or urban residence. METHODS Data were collected from 1942 Peruvian children in the Young Lives cohort study at ages 1, 5, 8, and 12 y. Multivariable generalized linear models estimated associations of stunting (height-for-age z score <-2) at age 1 y with risk of BMIZ > 1 and BMIZ > 2 prevalence, incidence (moving above a BMIZ threshold between ages), and reversion (moving below a BMIZ threshold between ages) at later ages. RESULTS After adjustment for covariates, stunting at age 1 y was associated with a lower prevalence of BMIZ > 1 at age 8 y (RR: 0.81; 95% CI: 0.66, 1.00; P = 0.049) and 12 y (RR: 0.75; 95% CI: 0.61, 0.91; P = 0.004), as well as a lower prevalence of BMIZ > 2 at age 8 y. Stunting was not associated with incident risk of BMIZ > 1 or BMIZ > 2. Stunting was positively associated at age 5 y with risk of reversion from BMIZ > 1 (RR: 1.22; 95% CI: 1.05, 1.42; P = 0.008) and BMIZ > 2. We found evidence that the association of stunting with prevalent and incident BMIZ > 1 was stronger for urban children at ages 5 and 8 y, and for nonindigenous children at age 8 y. CONCLUSIONS Stunting predicted a lower risk of prevalent BMIZ > 1 and BMIZ > 2, even after controlling for potential confounders. This finding may be driven in part by a higher risk of reversion from BMIZ > 1 by age 5 y. Our results contribute to an understanding of how nutritional stunting in infancy is associated with BMIZ later in life.
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Affiliation(s)
- Christopher T Andersen
- Division of Epidemiology and
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sarah A Reynolds
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Jere R Behrman
- Department of Economics
- Department of Sociology, and
- Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Whitney Schott
- Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Lia Ch Fernald
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
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624
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Bedregal P, Hernández V, Mingo MV, Castañón C, Valenzuela P, Moore R, de la Cruz R, Castro D. [Early child development inequalities and associated factors between public and private providers at metropolitan region in Chile]. ACTA ACUST UNITED AC 2016; 87:351-358. [PMID: 27079995 DOI: 10.1016/j.rchipe.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
Early child development is a population determinant of physical, mental and social health. To know the base line situation prior to the implementation of "Chile grows with you" (Chile Crece Contigo) is key to its evaluation. OBJECTIVE To compare early child development and associated factors at baseline in pre-school children from public and private health sectors. PATIENTS AND METHOD The sample consisted of 1045 children aged 30-58 months, 52% male, and 671 from the public and 380 from the private sector of the metropolitan region in Chile were evaluated using Battelle Developmental Inventory-1 and a household interview of primary carer. RESULTS Abnormal child development was found in 14.4% of children in the private sector compared to 30.4% in the public sector. There were no differences in adaptive area (26.3% vs 29.2%), but there were statistically significant differents in cognitive (8.8% vs 12.1%), social-personal (13.2% vs 32.5%), motor (19.2% vs 35.3%), and communication (19% vs 36.8%) development. The logistic regression showed that, independent of socioeconomic level, the risk factors are: Apgar<7 (OR: 5.4; 95% CI: 1.24-23.84); having childhood chronic diseases (OR: 1.3; 95% CI: 1.11-1.42). Protective factor is: home with resources to learn and play (OR: 0.8; 95% CI: 0.76-0.89). CONCLUSION These results are another input about early child development situation and its importance for paediatric social policy.
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Affiliation(s)
- Paula Bedregal
- Departamento Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Viviana Hernández
- Centro UC de Encuestas y Estudios Longitudinales, Instituto de Sociología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Carla Castañón
- Departamento de Medicina Familiar, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia Valenzuela
- Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rosario Moore
- Departamento de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rolando de la Cruz
- Departamento Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniela Castro
- Departamento de Pediatría, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile
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625
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Amos-Kroohs RM, Davenport LL, Atanasova N, Abdulla ZI, Skelton MR, Vorhees CV, Williams MT. Developmental manganese neurotoxicity in rats: Cognitive deficits in allocentric and egocentric learning and memory. Neurotoxicol Teratol 2016; 59:16-26. [PMID: 27756629 DOI: 10.1016/j.ntt.2016.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Manganese (Mn) is an essential element but neurotoxic at higher exposure levels. The effects of Mn overexposure (MnOE) on hippocampal and striatal-dependent learning and memory in rats were tested in combination with iron deficiency (FeD) and developmental stress that often co-occur with MnOE. Moderate FeD affects up to 15% of U.S. children and developmental stress is common in lower socio-economic areas where MnOE occurs. Pregnant Sprague-Dawley rats and their litters were housed in cages with or without (barren cage (BAR)) standard bedding from embryonic day (E)7 to postnatal day (P)28. Dams were fed a 90% FeD or iron sufficient (FeS) diet from E15-P28. Within each litter, separate offspring were treated with 100mg/kg Mn (MnOE) or vehicle (VEH) by gavage on alternate days from P4-28. Offspring were tested as adults in the Morris and Cincinnati water mazes. FeD and developmental stress interactively impaired spatial learning in the Morris water maze. Developmental stress and MnOE impaired learning and memory in both mazes. MnOE resulted in reduced CA1 hippocampal long-term potentiation (LTP) and increased levels of α-synuclein. Preweaning MnOE resulted in cognitive deficits on multiple domains of learning and memory accompanied by impaired LTP and α-synuclein changes, effects worsened by developmental stress.
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Affiliation(s)
- Robyn M Amos-Kroohs
- Division of Neurology, Cincinnati Children's Research Foundation and University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Laurie L Davenport
- Department of Environmental Health, University of Cincinnati, 3223 Eden Ave., Cincinnati, OH 45220, United States
| | - Nina Atanasova
- Department of Philosophy and Religious Studies, University of Toledo, Toledo, OH 43606, United States
| | - Zuhair I Abdulla
- Graduate Program in Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 43267, United States
| | - Matthew R Skelton
- Division of Neurology, Cincinnati Children's Research Foundation and University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Charles V Vorhees
- Division of Neurology, Cincinnati Children's Research Foundation and University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Michael T Williams
- Division of Neurology, Cincinnati Children's Research Foundation and University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
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626
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Jia N, Sun Q, Su Q, Dang S, Chen G. Taurine promotes cognitive function in prenatally stressed juvenile rats via activating the Akt-CREB-PGC1α pathway. Redox Biol 2016; 10:179-190. [PMID: 27768969 PMCID: PMC5072153 DOI: 10.1016/j.redox.2016.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 12/28/2022] Open
Abstract
Substantial evidence has shown that the oxidative damage to hippocampal neurons is associated with the cognitive impairment induced by adverse stimuli during gestation named prenatal stress (PS). Taurine, a conditionally essential amino acid, possesses multiple roles in the brain as a neuromodulator or antioxidant. In this study, to explore the roles of taurine in PS-induced learning and memory impairment, prenatal restraint stress was set up and Morris water maze (MWM) was employed for testing the cognitive function in the one-month-old rat offspring. The mitochondrial reactive oxygen species (ROS) level,mitochondrial membrane potential (MMP), ATP and cytochrome c oxidase (CcO) activity and apoptosis-related proteins in the hippocampus were detected. The activity of the Akt-cyclic AMP response element-binding protein (CREB)-peroxisome proliferator-activated receptor–γ coactivator-1α (PGC1α) pathway in the hippocampus was measured. The results showed that high dosage of taurine administration in the early postnatal period attenuated impairment of spatial learning and memory induced by PS. Meanwhile, taurine administration diminished the increase in mitochondrial ROS, and recovered the reduction of MMP, ATP level and the activities of CcO, superoxide dismutase 2 (SOD2) and catalase induced by PS in the hippocampus. In addition, taurine administration recovered PS-suppressed SOD2 expression level. Taurine administration blocked PS-induced decrease in the ratio of Bcl-2/Bax and increase in the ratio of cleaved caspase-3/full-length caspase-3. Notably, taurine inhibited PS-decreased phosphorylation of Akt (pAkt) and phosphorylation of CREB (pCREB), which consequently enhanced the mRNA and protein levels of PGC1α. Taken together, these results suggest that high dosage of taurine administration during the early postnatal period can significantly improve the cognitive function in prenatally stressed juvenile rats via activating the Akt-CREB-PGC1α pathway. Therefore, taurine has therapeutic potential for prenatal stressed offspring rats in future. Taurine attenuates prenatal stress (PS)-induced cognitive impairment. Taurine reduces PS-induced neuronal apoptosis and mitochondrial dysfunction. Taurine maintains the activities of SOD2 and catalase to repress ROS. Taurine activates PS-suppressed Akt-CREB-PGC1α pathway.
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Affiliation(s)
- Ning Jia
- Department of Human Anatomy, Histology and Embryology, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi 710061, PR China.
| | - Qinru Sun
- Institute of Forensic Medicine, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi 710061, PR China.
| | - Qian Su
- Division of Neonatology, First Affiliated Hospital, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Shaokang Dang
- Division of Neonatology, First Affiliated Hospital, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi 710061, PR China
| | - Guomin Chen
- Department of Human Anatomy, Histology and Embryology, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi 710061, PR China
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627
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Jeong J, McCoy DC, Yousafzai AK, Salhi C, Fink G. Paternal Stimulation and Early Child Development in Low- and Middle-Income Countries. Pediatrics 2016; 138:peds.2016-1357. [PMID: 27600319 DOI: 10.1542/peds.2016-1357] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Few studies have examined the relationship between paternal stimulation and children's growth and development, particularly in low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of paternal stimulation and to assess whether paternal stimulation was associated with early child growth and development. METHODS Data from the Multiple Indicator Cluster Surveys rounds 4 and 5 were combined across 38 LMICs. The sample comprised 87 286 children aged 3 and 4 years. Paternal stimulation was measured by the number of play and learning activities (up to 6) a father engaged in with his child over the past 3 days. Linear regression models were used to estimate standardized mean differences in height-for-age z-scores and Early Childhood Development Index (ECDI) z-scores across 3 levels of paternal stimulation, after controlling for other caregivers' stimulation and demographic covariates. RESULTS A total of 47.8% of fathers did not engage in any stimulation activities, whereas 6.4% of fathers engaged in 5 or 6 stimulation activities. Children whose fathers were moderately engaged in stimulation (1-4 activities) showed ECDI scores that were 0.09 SD (95% confidence interval [CI]: -0.12 to -0.06) lower than children whose fathers were highly engaged; children whose fathers were unengaged showed ECDI scores that were 0.14 SD lower (95% CI: -0.17 to -0.12). Neither moderate paternal stimulation nor lack of paternal stimulation was associated with height-for-age z-scores, relative to high stimulation. CONCLUSION Increasing paternal engagement in stimulation is likely to improve early child development in LMICs.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
| | - Dana Charles McCoy
- Graduate School of Education, Harvard University, Cambridge, Massachusetts
| | - Aisha K Yousafzai
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan; and
| | - Carmel Salhi
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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628
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Altare C, Delbiso TD, Mutwiri GM, Kopplow R, Guha-Sapir D. Factors Associated with Stunting among Pre-school Children in Southern Highlands of Tanzania. J Trop Pediatr 2016; 62:390-408. [PMID: 27122480 PMCID: PMC5040832 DOI: 10.1093/tropej/fmw024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Stunting is a major public health problem in Africa and is associated with poor child survival and development. We investigate factors associated to child stunting in three Tanzanian regions. METHODS A cross-sectional two-stage cluster sampling survey was conducted among children aged 6-59 months. The sample included 1360 children aged 6-23 months and 1904 children aged 24-59 months. Descriptive statistics and binary and multivariate logistic regression analyses were used. RESULTS Our main results are: in the younger group, stunting was associated with male sex (adjusted odds ratio [AOR]: 2.17; confidence interval [CI]: 1.52-3.09), maternal absence (AOR: 1.93; CI: 1.21-3.07) and household diet diversity (AOR: 0.61; CI: 0.41-0.92). Among older children, stunting was associated with male sex (AOR: 1.28; CI: 1.00-1.64), age of 4 and 5 (AOR: 0.71; CI: 0.54-0.95; AOR: 0.60; CI: 0.44-0.83), access to improved water source (AOR: 0.70; CI: 0.52-0.93) and to a functioning water station (AOR: 0.63; CI: 0.40-0.98) and mother breastfeeding (AOR: 1.97; CI: 1.18-3.29). CONCLUSIONS Interventions that increase household wealth and improve water and sanitation conditions should be implemented to reduce stunting. Family planning activities and programmes supporting mothers during pregnancy and lactation can positively affect both newborns and older siblings.
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Affiliation(s)
- Chiara Altare
- Centre for Research on the Epidemiology of Disasters, Catholic University Louvain, Clos Chapelle-aux-Champs 30, Bte B1.30.15, Brussels 1200, Belgium Action Contre La Faim, Research and Analysis Unit, 14/16 Boulevard De Douaumont, Paris 75854, France
| | - Tefera Darge Delbiso
- Centre for Research on the Epidemiology of Disasters, Catholic University Louvain, Clos Chapelle-aux-Champs 30, Bte B1.30.15, Brussels 1200, Belgium
| | | | - Regine Kopplow
- Concern Worldwide, 52-55 Camden Street, Dublin 2, Ireland
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Catholic University Louvain, Clos Chapelle-aux-Champs 30, Bte B1.30.15, Brussels 1200, Belgium
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629
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Early nutrition, growth and cognitive development of infants from birth to 2 years in Malaysia: a study protocol. BMC Pediatr 2016; 16:160. [PMID: 27687906 PMCID: PMC5043613 DOI: 10.1186/s12887-016-0700-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first 2 years of life is a critical period of rapid growth and brain development. During this period, nutrition and environmental factors play important roles in growth and cognitive development of a child. This report describes the study protocol of early nutrition, growth and cognitive development of infants from birth to 2 years of age. METHODS/DESIGN This is a prospective cohort study of mothers and infants recruited from government health clinics in Seremban district in Negeri Sembilan, Malaysia. Infants are followed-up at 6, 12, 18 and 24 months of age. Pre-natal factors that include mother's pre-pregnancy body mass index, gestational weight gain, blood glucose and blood pressure during pregnancy, infant's gestational age, birth weight and head circumference at birth are obtained from patient card. Post-natal factors assessed at each follow-up are feeding practices, dietary intake, anthropometric measurements and cognitive development of infants. Iron status is assessed at 6 months, while infant temperament and home environment are assessed at 12 months. Maternal intelligence is assessed at 18 months. DISCUSSION Early life nutritional programming is of current interest as many longitudinal studies are actively being conducted in developed countries to investigate this concept. The concept however is relatively new in developing countries such as Malaysia. This study will provide useful information on early nutrition and infant development in the first two years of life which can be further followed up to identify factors that track into childhood and contribute to growth and cognitive deviations.
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630
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Humphrey JH, Jones AD, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Ntozini R, Prendergast AJ, Stoltzfus RJ, Tielsch JM. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods. Clin Infect Dis 2016; 61 Suppl 7:S685-702. [PMID: 26602296 PMCID: PMC4657589 DOI: 10.1093/cid/civ844] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Child stunting and anemia are intractable public health problems in developing countries and have profound short- and long-term consequences. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH). SHINE is a proof-of-concept, 2 × 2 factorial, cluster-randomized, community-based trial in 2 rural districts of Zimbabwe that will test the independent and combined effects of protecting babies from fecal ingestion (factor 1, operationalized through a WASH intervention) and optimizing nutritional adequacy of infant diet (factor 2, operationalized through an infant and young child feeding [IYCF] intervention) on length and hemoglobin at 18 months of age. Within SHINE we will measure 2 causal pathways. The program impact pathway comprises the series of processes and behaviors linking implementation of the interventions with the 2 child health primary outcomes; it will be modeled using measures of fidelity of intervention delivery and household uptake of promoted behaviors and practices. We will also measure a range of household and individual characteristics, social interactions, and maternal capabilities for childcare, which we hypothesize will explain heterogeneity along these pathways. The biomedical pathway comprises the infant biologic responses to the WASH and IYCF interventions that ultimately result in attained stature and hemoglobin concentration at 18 months of age; it will be elucidated by measuring biomarkers of intestinal structure and function (inflammation, regeneration, absorption, and permeability); microbial translocation; systemic inflammation; and hormonal determinants of growth and anemia among a subgroup of infants enrolled in an EED substudy. This article describes the rationale, design, and methods underlying the SHINE trial. CLINICAL TRIALS REGISTRATION NCT01824940.
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631
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Graham H, Tokhi M, Duke T. Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries. Trop Med Int Health 2016; 21:1366-1388. [PMID: 27554327 DOI: 10.1111/tmi.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries. METHODS We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews. RESULTS Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n = 37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n = 23) or task-shifting (n = 15). Few papers addressed the strategies for providing care at the community (n = 10, 15%) or policy (n = 6, 9%) level. Low-income countries were under-represented (n = 24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n = 21). Strategies and summary findings are described and components of future models of care proposed. CONCLUSIONS Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.
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Affiliation(s)
- Hamish Graham
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia.
| | - Mariam Tokhi
- Victorian Aboriginal Health Service, Melbourne, VIC, Australia
| | - Trevor Duke
- Centre for International Child Health, Royal Children's Hospital, University of Melbourne, MCRI, Melbourne, VIC, Australia
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632
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Marphatia AA, Devakumar D, Wells JCK, Saville N, Reid A, Costello A, Manandhar DS, Osrin D. Maternal phenotype, independent of family economic capital, predicts educational attainment in lowland nepalese children. Am J Hum Biol 2016; 28:687-98. [PMID: 27135632 PMCID: PMC5026068 DOI: 10.1002/ajhb.22852] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 02/25/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Factors acting before children are born or reach school-going age may explain why some do not complete primary education. Many relevant factors relate to maternal phenotype, but few studies have tested for independent associations of maternal factors relative to those characterizing the family in general. METHODS Using data from a longitudinal study of 838 children in Dhanusha, Nepal, we used logistic regression models to test whether indices of maternal somatic and educational capital, or family economic capital, were independently associated with children having had ≤2 versus 3+ years of schooling at a mean age of 8.5 years. We also tested whether maternal age, children's early growth, and urban/rural location mediated such associations. RESULTS Children had a higher risk of completing less schooling if their mothers were short, thin, anemic, and uneducated. Independently, lower family material assets and land acreage also increased children's odds of less schooling. There was an indication of gender differences, with the risk of poor educational attainment in girls associated with low maternal somatic and educational capital, whereas in boys the relevant factors were low maternal education and family land ownership. CONCLUSIONS Our analysis demonstrates that, independent of broader indices of family capital such as land or material assets, children's educational attainment is associated with factors embodied in maternal phenotype. Both somatic and educational maternal capital appeared important. A composite index of maternal capital could provide a new measurable proxy, prior to school entry, for identifying children at risk of completing fewer years of schooling. Am. J. Hum. Biol. 28:687-698, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Delan Devakumar
- Institute for Global Health, University College London, London, United Kingdom
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom
| | - Naomi Saville
- Institute for Global Health, University College London, London, United Kingdom
| | - Alice Reid
- Department of Geography, University of Cambridge, United Kingdom
| | - Anthony Costello
- Institute for Global Health, University College London, London, United Kingdom
| | | | - David Osrin
- Institute for Global Health, University College London, London, United Kingdom
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633
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Hartinger SM, Lanata CF, Hattendorf J, Wolf J, Gil AI, Obando MO, Noblega M, Verastegui H, Mäusezahl D. Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal control design. J Epidemiol Community Health 2016; 71:217-224. [PMID: 27612978 PMCID: PMC5318653 DOI: 10.1136/jech-2015-206536] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/07/2022]
Abstract
Objective Stimulation in early childhood can alleviate adverse effects of poverty. In a community-randomised trial, we implemented 2 home-based interventions, each serving as an attention control for the other. One group received an integrated household intervention package (IHIP), whereas the other group received an early child development (ECD) intervention. The primary objective of the study was to evaluate the effect of IHIP on diarrhoea and respiratory infections, the details of which are described elsewhere. Here, we present the impact of the ECD intervention on early childhood development indicators. Methods In this non-blinded community-randomised trial, an ECD intervention, adapted from the Peruvian government's National Wawa Wasi ECD programme, was implemented in 25 rural Peruvian Andean communities. We enrolled 534 children aged 6–35 months, from 50 communities randomised 1:1 into ECD and IHIP communities. In ECD communities, trained fieldworkers instructed mothers every 3 weeks over the 12 months study, to stimulate and interact with their children and to use standard programme toys. IHIP communities received an improved stove and hygiene promotion. Using a nationally validated ECD evaluation instrument, all children were assessed at baseline and 12 months later for overall performance on age-specific developmental milestones which fall into 7 developmental domains. Findings At baseline, ECD-group and IHIP-group children performed similarly in all domains. After 12 months, data from 258 ECD-group and 251 IHIP-group children could be analysed. The proportion of children scoring above the mean in their specific age group was significantly higher in the ECD group in all domains (range: 12–23%-points higher than IHIP group). We observed the biggest difference in fine motor skills (62% vs 39% scores above the mean, OR: 2.6, 95% CI 1.7 to 3.9). Conclusions The home-based ECD intervention effectively improved child development overall across domains and separately by investigated domain. Home-based strategies could be a promising component of poverty alleviation programmes seeking to improve developmental outcomes among rural Peruvian children. Trial registration number ISRCTN28191222; results.
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Affiliation(s)
- Stella Maria Hartinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Instituto de Investigación Nutricional, Lima, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennyfer Wolf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | | | | | - Hector Verastegui
- Instituto de Investigación Nutricional, Lima, Perú.,Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Daniel Mäusezahl
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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634
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Woolfenden S, Eapen V, Jalaludin B, Hayen A, Kemp L, Dissanyake C, Hendry A, Axelsson E, Overs B, Eastwood J, Črnčec R, McKenzie A, Beasley D, Murphy E, Williams K. Prevalence and factors associated with parental concerns about development detected by the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort. BMJ Open 2016; 6:e012144. [PMID: 27609853 PMCID: PMC5020845 DOI: 10.1136/bmjopen-2016-012144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. DESIGN, PARTICIPANTS A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. PRIMARY AND SECONDARY OUTCOMES Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. RESULTS Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. CONCLUSIONS Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.
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Affiliation(s)
- Susan Woolfenden
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Epidemiology Group, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, New South Wales, Australia
| | - Cheryl Dissanyake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, South Australia, Australia
| | - Alexandra Hendry
- Early Years Research Group, Ingham Institute, Sydney South West Local Health District, Sydney, New South Wales, Australia
| | - Emma Axelsson
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bronwyn Overs
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
| | - John Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rudi Črnčec
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Sydney South West Local Health District, Australia,Sydney, New South Wales, Australia
| | - Deborah Beasley
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Elisabeth Murphy
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, South Australia, Australia
- Developmental Medicine, Royal Children's Hospital, Melbourne, South Australia, Australia
- Murdoch Children's Research Institute, Melbourne, South Australia, Australia
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635
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Pell LG, Bassani DG, Nyaga L, Njagi I, Wanjiku C, Thiruchselvam T, Macharia W, Minhas RS, Kitsao-Wekulo P, Lakhani A, Bhutta ZA, Armstrong R, Morris SK. Effect of provision of an integrated neonatal survival kit and early cognitive stimulation package by community health workers on developmental outcomes of infants in Kwale County, Kenya: study protocol for a cluster randomized trial. BMC Pregnancy Childbirth 2016; 16:265. [PMID: 27608978 PMCID: PMC5016984 DOI: 10.1186/s12884-016-1042-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/22/2016] [Indexed: 11/21/2022] Open
Abstract
Background Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development. Method/Design This cluster randomized trial aims at evaluating the impact of volunteer community health workers delivering either an integrated neonatal survival kit, an early stimulation package, or a combination of both interventions, to pregnant women during their third trimester of pregnancy, compared to the current standard of care in Kwale County, Kenya. The neonatal survival kit comprises a clean delivery kit (sterile blade, cord clamp, clean plastic sheet, surgical gloves and hand soap), sunflower oil emollient, chlorhexidine, ThermoSpotTM, Mylar infant sleeve, and a reusable instant heater. Community health workers are also equipped with a portable hand-held electric scale. The early cognitive stimulation package focuses on enhancing caregiver practices by teaching caregivers three key messages that comprise combining a gentle touch with making eye contact and talking to children, responsive feeding and caregiving, and singing. The primary outcome measure is child development at 12 months of age assessed with the Protocol for Child Monitoring (Infant and Toddler version). The main secondary outcome is newborn mortality. Discussion This study will provide evidence on effectiveness of delivering an innovative neonatal survival kit and/or early stimulation package to pregnant women in Kwale County, Kenya. Study findings will help inform policy on the most appropriate interventions for promoting healthy brain development and reduction of newborn morbidity and mortality in Kenya and other similar settings. Trial registration ClinicalTrial.gov NCT02208960 (August 1, 2014)
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Affiliation(s)
- Lisa G Pell
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Lucy Nyaga
- Department of Community Health, Faculty of Health Sciences, Aga Khan University, Mombasa, Kenya
| | - Isaac Njagi
- Department of Community Health, Faculty of Health Sciences, Aga Khan University, Mombasa, Kenya
| | - Catherine Wanjiku
- Department of Community Health, Faculty of Health Sciences, Aga Khan University, Mombasa, Kenya
| | | | - William Macharia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ripudaman S Minhas
- Department of Pediatrics, St Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Amyn Lakhani
- Department of Community Health, Faculty of Health Sciences, Aga Khan University, Mombasa, Kenya
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Robert Armstrong
- Medical College, Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Shaun K Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada. .,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada.
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636
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Scharf RJ, Stroustrup A, Conaway MR, DeBoer MD. Growth and development in children born very low birthweight. Arch Dis Child Fetal Neonatal Ed 2016; 101:F433-8. [PMID: 26627552 PMCID: PMC5494252 DOI: 10.1136/archdischild-2015-309427] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the relationships between growth (birth to age 2 years) and developmental outcomes in children born with very low birthweight (VLBW). DESIGN Motor and mental development in children born with VLBW were regressed on anthropometric measurements at birth, 9 months and 2 years using multivariable regression. SETTING The Early Childhood Longitudinal Study-Birth Cohort, a longitudinal cohort, community sample, designed to be representative of children born across the USA. PATIENTS 950 children born with VLBW (<1500 g). MAIN OUTCOME MEASURES Motor and cognitive scores on the Bayley Scales at 9 months and 24 months chronological age. RESULTS A high proportion of children exhibited poor growth, with length-for-age z-scores <-2 (ie, stunting) in 21.3% of children at 9 months (adjusted for prematurity) and 34.2% of children at 2 years. Compared with children having z-scores >-2, children with growth shortfalls in head circumference, length and weight had a higher adjusted OR (aOR) of low Bayley motor scores at 9 months and 2 years (aOR ranging from 1.8 to 3.3, all p<0.05), while low Bayley cognitive scores were predicted by 9-month deficits in length and weight (aOR 2.0 and 2.4, respectively, both p<0.01) and 2-year deficits in length and head circumference (aOR 2.9 and 2.8, both p<0.05). CONCLUSION Anthropometric measures of growth were linked to current and future neurodevelopmental outcomes in children born with VLBW. While careful length measures may be a particularly useful marker, deficits in all anthropometric measures were risk factors for developmental delays.
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Affiliation(s)
- Rebecca J Scharf
- Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Annemarie Stroustrup
- Division of Newborn Medicine, Department of Pediatrics and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark R Conaway
- Department of Public Health, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
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637
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Puentes E, Wang F, Behrman JR, Cunha F, Hoddinott J, Maluccio JA, Adair LS, Borja JB, Martorell R, Stein AD. Early life height and weight production functions with endogenous energy and protein inputs. ECONOMICS AND HUMAN BIOLOGY 2016; 22:65-81. [PMID: 27026217 PMCID: PMC5001437 DOI: 10.1016/j.ehb.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 02/21/2016] [Accepted: 03/01/2016] [Indexed: 05/03/2023]
Abstract
We examine effects of protein and energy intakes on height and weight growth for children between 6 and 24 months old in Guatemala and the Philippines. Using instrumental variables to control for endogeneity and estimating multiple specifications, we find that protein intake plays an important and positive role in height and weight growth in the 6-24 month period. Energy from other macronutrients, however, does not have a robust relation with these two anthropometric measures. Our estimates indicate that in contexts with substantial child undernutrition, increases in protein-rich food intake in the first 24 months can have important growth effects, which previous studies indicate are related significantly to a range of outcomes over the life cycle.
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Affiliation(s)
| | - Fan Wang
- Department of Economics, University of Houston, United States
| | - Jere R Behrman
- Departments of Economics and Sociology and Population Studies Center, University of Pennsylvania, United States
| | - Flavio Cunha
- Department of Economics, Rice University, United States
| | - John Hoddinott
- Division of Nutritional Sciences and the Charles H. Dyson School of Applied Economics and Management, Cornell University and International Food Policy Research Institute, United States
| | | | - Linda S Adair
- Department of Nutrition, University of North Carolina, United States
| | - Judith B Borja
- USC-Office of Population Studies Foundation, Inc and Department of Nutrition and Dietetics, University of San Carlos, Cebu, Philippines
| | | | - Aryeh D Stein
- Rollins School of Public Health, Emory University, United States
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638
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Rubio-Codina M, Araujo MC, Attanasio O, Muñoz P, Grantham-McGregor S. Concurrent Validity and Feasibility of Short Tests Currently Used to Measure Early Childhood Development in Large Scale Studies. PLoS One 2016; 11:e0160962. [PMID: 27548634 PMCID: PMC4993374 DOI: 10.1371/journal.pone.0160962] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022] Open
Abstract
In low- and middle-income countries (LIMCs), measuring early childhood development (ECD) with standard tests in large scale surveys and evaluations of interventions is difficult and expensive. Multi-dimensional screeners and single-domain tests (‘short tests’) are frequently used as alternatives. However, their validity in these circumstances is unknown. We examined the feasibility, reliability, and concurrent validity of three multi-dimensional screeners (Ages and Stages Questionnaires (ASQ-3), Denver Developmental Screening Test (Denver-II), Battelle Developmental Inventory screener (BDI-2)) and two single-domain tests (MacArthur-Bates Short-Forms (SFI and SFII), WHO Motor Milestones (WHO-Motor)) in 1,311 children 6–42 months in Bogota, Colombia. The scores were compared with those on the Bayley Scales of Infant and Toddler Development (Bayley-III), taken as the ‘gold standard’. The Bayley-III was given at a center by psychologists; whereas the short tests were administered in the home by interviewers, as in a survey setting. Findings indicated good internal validity of all short tests except the ASQ-3. The BDI-2 took long to administer and was expensive, while the single-domain tests were quickest and cheapest and the Denver-II and ASQ-3 were intermediate. Concurrent validity of the multi-dimensional tests’ cognitive, language, and fine motor scales with the corresponding Bayley-III scale was low below 19 months. However, it increased with age, becoming moderate-to-high over 30 months. In contrast, gross motor scales’ concurrence was high under 19 months and then decreased. Of the single-domain tests, the WHO-Motor had high validity with gross motor under 16 months, and the SFI and SFII expressive scales showed moderate correlations with language under 30 months. Overall, the Denver-II was the most feasible and valid multi-dimensional test and the ASQ-3 performed poorly under 31 months. By domain, gross motor development had the highest concurrence below 19 months, and language above. Predictive validity investigation is needed to further guide the choice of instruments for large scale studies.
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Affiliation(s)
- Marta Rubio-Codina
- Social Protection and Health Division, Inter-American Development Bank, Washington, D.C., United States of America
- Centre for the Evaluation of Development Policies, Institute for Fiscal Studies, London, United Kingdom
- * E-mail:
| | - M. Caridad Araujo
- Social Protection and Health Division, Inter-American Development Bank, Washington, D.C., United States of America
| | - Orazio Attanasio
- Centre for the Evaluation of Development Policies, Institute for Fiscal Studies, London, United Kingdom
- Department of Economics, University College London, London, United Kingdom
| | - Pablo Muñoz
- École de Psychologie, Université Laval, Quebec, Canada
| | - Sally Grantham-McGregor
- Faculty of Population Health Sciences, Institute of Child Health, University College London, London, United Kingdom
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639
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Machaira T, Azevedo LB, Hamilton S, Ells LJ, Lingam R, Shucksmith J. Early intervention programs using volunteers for child development and nutrition: a mixed methods systematic review protocol. ACTA ACUST UNITED AC 2016; 14:44-56. [PMID: 27532462 DOI: 10.11124/jbisrir-2016-002665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The overall aim of this mixed methods systematic review is to explore the effectiveness and experience of early intervention programs using volunteers, peer supporters and community champions with the aim of improving one or more of the following outcomes of children from conception to two years:Specifically the review questions are.
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Affiliation(s)
- Theodora Machaira
- 1Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom 2Teesside Centre for Evidence-based Practice: an Affiliate Center of the Joanna Briggs Institute, Middlesbrough, UK 3Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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640
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Bortolini GA, Vitolo MR, Gubert MB, Santos LMP. [Social inequalities influence the quality and diversity of diet in Brazilian children 6 to 36 months of age]. CAD SAUDE PUBLICA 2016; 31:2413-24. [PMID: 26840820 DOI: 10.1590/0102-311x00153414] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 05/11/2015] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to assess dietary patterns in Brazilian children and factors associated with better diet. The authors used data for 2,477 children 6 to 36 months of age from the Brazilian National Survey of Demographic and Health in 2006-2007. Diet was assessed and classified using a composite index. The results showed that 28.2% of the children received a high-quality diet and 20% had a diversified diet. Children from socioeconomically underprivileged families or with serious food insecurity were approximately 40% less likely to have high-quality diets. Children living in homes with food insecurity were 71% less likely to have diversified diets, and those whose mothers had limited education were 43% less likely. Children residing in the North of Brazil were less likely to have diversified and high-quality diets. The dietary quality of Brazilian children is inadequate, and social vulnerability is closely associated with this adverse dietary situation.
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641
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Prado EL, Abbeddou S, Adu-Afarwuah S, Arimond M, Ashorn P, Ashorn U, Brown KH, Hess SY, Lartey A, Maleta K, Ocansey E, Ouédraogo JB, Phuka J, Somé JW, Vosti SA, Yakes Jimenez E, Dewey KG. Linear Growth and Child Development in Burkina Faso, Ghana, and Malawi. Pediatrics 2016; 138:peds.2015-4698. [PMID: 27474016 DOI: 10.1542/peds.2015-4698] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We aimed to produce quantitative estimates of the associations between 4 domains of child development and linear growth during 3 periods: before birth, early infancy, and later infancy. We also aimed to determine whether several factors attenuated these associations. METHODS In 3700 children in Burkina Faso, Ghana, and Malawi, growth was measured several times from birth to age 18 months. At 18 months, language, motor, socioemotional, and executive function development were assessed. In Burkina Faso (n = 1111), personal-social development was assessed rather than the latter 2 domains. RESULTS Linear growth was significantly associated with language, motor, and personal-social development but not socioemotional development or executive function. For language, the pooled adjusted estimate of the association with length-for-age z score (LAZ) at 6 months was 0.13 ± 0.02 SD, and with ΔLAZ from 6 to 18 months it was 0.11 ± 0.03 SD. For motor, these estimates were 0.16 ± 0.02 SD and 0.22 ± 0.03 SD, respectively. In 1412 children measured at birth, estimates of the association with LAZ at birth were similar (0.07-0.16 SD for language and 0.09-0.18 SD for motor development). These associations were weaker or absent in certain subsets of children with high levels of developmental stimulation or mothers who received nutritional supplementation. CONCLUSIONS Growth faltering during any period from before birth to 18 months is associated with poor development of language and motor skills. Interventions to provide developmental stimulation or maternal supplementation may protect children who are faltering in growth from poor language and motor development.
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Affiliation(s)
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | | | - Per Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth H Brown
- Departments of Nutrition, and Bill & Melinda Gates Foundation, Seattle, Washington
| | | | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Eugenia Ocansey
- Departments of Nutrition, and Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé/DRO, Bobo-Dioulasso, Burkina Faso; and
| | - John Phuka
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Steve A Vosti
- Agricultural and Resource Economics, University of California Davis, Davis, California
| | - Elizabeth Yakes Jimenez
- Departments of Individual, Family, and Community Education and Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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642
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Prado EL, Adu-Afarwuah S, Lartey A, Ocansey M, Ashorn P, Vosti SA, Dewey KG. Effects of pre- and post-natal lipid-based nutrient supplements on infant development in a randomized trial in Ghana. Early Hum Dev 2016; 99:43-51. [PMID: 27391572 DOI: 10.1016/j.earlhumdev.2016.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal and infant undernutrition is negatively associated with infant development. AIMS We tested the hypothesis that provision of small-quantity lipid-based nutrient supplements (SQ-LNS) to pregnant women and infants positively affects infant development. STUDY DESIGN In a partially double-blind randomized controlled trial, we compared the following daily maternal supplements during pregnancy and until 6months post-partum: iron/folic acid capsule (IFA), capsule containing 18 micronutrients (MMN), or 20g SQ-LNS. Children in the SQ-LNS group also received SQ-LNS from age 6 to 18months. The study is registered as NCT00970866. SUBJECTS 1320 pregnant women in Ghana enrolled in the trial; 1173 of their children participated in developmental assessment. OUTCOME MEASURES We monitored the acquisition of 10 developmental milestones monthly by parental report, observed the attainment of 6 motor milestones at 6, 12, and 18months, and conducted detailed assessment of motor, language, socio-emotional, and executive function at 18months. RESULTS By researcher observation, a greater percentage of children in the SQ-LNS group (53%) was able to walk alone at 12months than in the IFA group (43%; RR=1.23, 95% CI=1.02-1.49; p=0.025). We found no significant differences between groups in milestone acquisition by parent report or in any scores at 18months. The difference in mean z-scores between groups ranged from 0.03-0.13 for motor (p=0.84), 0.01-0.08 for language (p=0.46), 0.01-0.02 for socio-emotional (p=0.75), and 0.00-0.02 for executive function (p=0.95). CONCLUSION While provision of maternal and child SQ-LNS in Ghana may affect walking at 12months, it did not affect infant development at 18months.
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Affiliation(s)
- Elizabeth L Prado
- Department of Nutrition, University of California Davis, 3253 Meyer Hall, One Shields Ave, Davis, CA, 95616, USA.
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Box LG, 134, Legon, Accra, Ghana
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Box LG, 134, Legon, Accra, Ghana
| | - Maku Ocansey
- Department of Nutrition, University of California Davis, 3253 Meyer Hall, One Shields Ave, Davis, CA, 95616, USA; Department of Nutrition and Food Science, University of Ghana, Legon, Box LG, 134, Legon, Accra, Ghana
| | - Per Ashorn
- Center for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Arvo building, FIN33014, University of Tampere, Finland; Department of Paediatrics, Tampere University Hospital, POB 2000, FIN33521 Tampere, Finland
| | - Steve A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, 2135 Social Sciences and Humanities, One Shields Ave, Davis, CA, 95616, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California Davis, 3253 Meyer Hall, One Shields Ave, Davis, CA, 95616, USA
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643
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General intelligence is associated with subclinical inflammation in Nepalese children: A population-based plasma proteomics study. Brain Behav Immun 2016; 56:253-63. [PMID: 27039242 PMCID: PMC4929134 DOI: 10.1016/j.bbi.2016.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 01/25/2023] Open
Abstract
Improving child cognition in impoverished countries is a public health priority. Yet, biological pathways and associated biomarkers of impaired cognition remain poorly understood and largely unknown, respectively. This study aimed to explore and quantify associations between functional plasma protein biomarkers and childhood intellectual test performance. We applied proteomics to quantify proteins in plasma samples of 249 rural Nepalese children, 6-8years of age who, 1year later at 7-9years of age, were administered the Universal Nonverbal Intelligence Test (UNIT). Among 751 plasma proteins quantified, 22 were associated with UNIT scores, passing a false discovery rate threshold of 5.0% (q<0.05). UNIT scores were higher by 2.3-9.2 points for every 50% increase in relative abundance of two insulin-like growth factor binding proteins (IGFBPs), six subclasses of apolipoprotein (Apo) and transthyretin, and lower by 4.0-15.3 points for each 50% increase in relative abundance of 13 proteins predominantly involved in inflammation. Among them, IGFBP-acid labile subunit, orosomucoid 1 (ORM1), Apo C-I, and pyruvate kinase isoenzymes M1/M2 jointly explained 37% of the variance in UNIT scores. After additional adjustment for height-for-age Z-score and household socio-economic status as indicators of long-term nutritional and social stress, associations with 6 proteins involved in inflammation, including ORM1, α-1-antichymotrypsin, reticulocalbin 1, and 3 components of the complement cascade, remained significant (q<0.05). Using untargeted proteomics, stable, constitutive facets of subclinical inflammation were associated with lower developmental test performance in this rural South Asian child population. Plasma proteomics may offer opportunities to identify functional, antecedent biomarkers of child cognitive development.
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644
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Black MM, Fernandez-Rao S, Hurley KM, Tilton N, Balakrishna N, Harding KB, Reinhart G, Radhakrishna KV, Nair KM. Growth and development among infants and preschoolers in rural India. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1177/0165025416644690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Economic inequities are common in low and middle-income countries (LMIC), and are associated with poor growth and development among young children. The objectives are to examine whether maternal education and home environment quality: 1) protect children by attenuating the association between economic inequities and children’s growth and development, or 2) promote children’s growth and development, regardless of economic inequities. The sample includes 512 infants and 321 preschoolers in 26 villages in rural India (Project Grow Smart). Data for children: physical growth (weight and length/height measured) and development (Mullen Scales of Early Learning); for mothers/households: economic inequities measured by household assets, education, depressive symptoms, and home environment (HOME Inventory). Data are analyzed with linear mixed models (LMM) for infants and preschoolers separately, adjusted for village/preschool clustering, including asset-by-education/home interactions. Among infants, but not preschoolers, the education/home factor attenuates relations between assets and growth, eliminating differential relations in infant growth between high/low-asset families, suggesting protection. Among infants and preschoolers, the education/home factor is significantly or marginally associated with most child development scales, regardless of economic inequities, suggesting promotion. Strategies to enhance maternal education and home environment quality may protect infants in low-asset families from poor growth, promote development among infants and preschoolers, and prevent early disparities.
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Affiliation(s)
- Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sylvia Fernandez-Rao
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India
| | - Kristen M. Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas Tilton
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nagalla Balakrishna
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India
| | | | - Greg Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH, USA
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645
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Knauer HA, Kagawa RMC, García-Guerra A, Schnaas L, Neufeld LM, Fernald LCH. Pathways to improved development for children living in poverty. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1177/0165025416652248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conditional cash transfer programs (CCTs) have shown mixed effects on child development outcomes in the context of poverty. Direct parenting support integrated with CCTs may improve the effectiveness of CCTs for children’s development, and benefits could occur via improvements in parenting practices or the home environment. Here, we use data from a randomized effectiveness trial to examine the pathways connecting parenting support and child development. The parenting program ( EI: Educación Inicial) was implemented at scale among beneficiaries of Prospera (a CCT, previously Oportunidades and Progresa). Participants included children between the ages of 3 and 5 years old ( n = 1,362) from 91 rural communities in three Mexican states. Communities were stratified by indigenous classification and randomized to one of three arms: (T0) Comparison group (CCT benefits only); (T1) CCT benefits plus availability of EI in the community; or (T2) CCT benefits plus promotion and encouragement by the CCT program to participate in EI. Findings were that participation in the T2 arm of the study was associated with a 13% increase in the number of play activities that parents engaged in with their children, particularly shared storybook reading and singing. Parents in T2 showed nearly two times greater odds of reading daily to their children. In mediation analyses, the amount of play activities and shared book reading explained up to 32% of the effects of the EI parenting program on child development outcomes. In this study, collaboration and integration of two social programs was critical for program impact, which occurred through pathways relating to parental engagement in reading and play.
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Affiliation(s)
- Heather A. Knauer
- School of Public Health, University of California, Berkeley, CA, USA
| | - Rose M. C. Kagawa
- School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | - Lia C. H. Fernald
- School of Public Health, University of California, Berkeley, CA, USA
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646
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Nilsson S, Johnson E, Adolfsson M. Professionals' Perceptions about the Need for Pain Management Interventions for Children with Cerebral Palsy in South African School Settings. Pain Manag Nurs 2016; 17:249-61. [PMID: 27349380 DOI: 10.1016/j.pmn.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/22/2016] [Accepted: 03/15/2016] [Indexed: 01/07/2023]
Abstract
Pain is common in children with cerebral palsy (CP) and may have negative consequences for children's success in their studies. Research has shown that pain in childhood negatively influences individuals' participation and quality of life in later years. This study investigated how professionals in South African school settings respond to children's need for pain management in an attempt to enable the children to be active participants in school activities, despite their pain. The study was descriptive and followed a qualitative design (i.e., focus group interviews with semistructured questions and a conventional content analysis). Five government schools for children with special education needs in South Africa's Gauteng province participated. Participants/Subjects: Thirty-eight professionals who represented eight professions. Professional statements on the topic were collected from five focus group sessions conducted during one week. Qualitative content analysis of the data was performed. Similar statements were combined, coded, and sorted into main categories and subcategories. The analysis identified three main categories for pain management: environmental, treatment, and support strategies. In addition, four groups of statements emerged on how contextual factors might affect pain in children with CP and their participation in school settings. It is important to train professionals in pain management and to implement structured models for pain prevention and management to ensure that best practices are adhered to for children with CP who suffer from acute or chronic pain.
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Affiliation(s)
- Stefan Nilsson
- CHILD, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Ensa Johnson
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Margareta Adolfsson
- CHILD, School of Education and Communication and the Swedish Institute of Disability Research, University of Jönköping, Jönköping, Sweden
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647
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Rubio-Codina M, Attanasio O, Grantham-McGregor S. Mediating pathways in the socio-economic gradient of child development: Evidence from children 6-42 months in Bogota. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016; 40:483-491. [PMID: 27885311 PMCID: PMC5102093 DOI: 10.1177/0165025415626515] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Research has previously shown a gap of near 0.5 of a standard deviation (SD) in cognition and language development between the top and bottom household wealth quartile in children aged 6–42 months in a large representative sample of low- and middle-income families in Bogota, using the Bayley Scales of Infant and Toddler Development. The gaps in fine motor and socio-emotional development were about half that size. Developmental deficits increased with age. The current study explored the associations amongst child development, household socio-economic status (SES), and a set of potential mediating variables—parental characteristics, child biomedical factors, and the quality of the home environment—in this sample. We ran mediation tests to quantify the contribution of these variables to the SES gap, and explored the role of age as a moderator. Parental education, particularly maternal education, and the quality of the home environment mediated the SES gap in all outcomes examined. Height-for-age mediated a small amount of the deficit in language scales only. More educated mothers provided better home stimulation than less educated mothers and the home environment partly mediated the effect of maternal education. These results suggested that in interventions aimed at promoting child development, those focusing on the quality of the home environment should be effective.
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Affiliation(s)
- Marta Rubio-Codina
- Institute for Fiscal Studies, London, UK; Inter-American Development Bank, Washington DC, USA
| | - Orazio Attanasio
- Institute for Fiscal Studies, London, UK; University College London, London, UK
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648
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Amos-Kroohs RM, Davenport LL, Gutierrez A, Hufgard JR, Vorhees CV, Williams MT. Developmental manganese exposure in combination with developmental stress and iron deficiency: Effects on behavior and monoamines. Neurotoxicol Teratol 2016; 56:55-67. [PMID: 27302314 DOI: 10.1016/j.ntt.2016.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
Abstract
Manganese (Mn) is an essential element but neurotoxic at higher exposures, however, Mn exposure seldom occurs in isolation. It often co-occurs in populations with inadequate dietary iron (Fe) and limited resources that result in stress. Subclinical FeD affects up to 15% of U.S. children and exacerbates Mn toxicity by increasing Mn bioavailability. Therefore, we investigated Mn overexposure (MnOE) in rats in combination with Fe deficiency (FeD) and developmental stress, for which we used barren cage rearing. For barren cage rearing (BAR), rats were housed in cages with a wire grid floor or standard bedding material (STD) from embryonic day (E)7 through postnatal day (P)28. For FeD, dams were fed a 90% Fe-deficient NIH-07 diet from E15 through P28. Within each litter, different offspring were treated with 100mg/kg Mn (MnOE) or vehicle (VEH) by gavage every other day from P4-28. Behavior was assessed at two ages and consisted of: open-field, anxiety tests, acoustic startle response (ASR) with prepulse inhibition (PPI), sociability, sucrose preference, tapered beam crossing, and the Porsolt's forced swim test. MnOE had main effects of decreasing activity, ASR, social preference, and social novelty. BAR and FeD transiently modified MnOE effects. BAR groups weighed less and showed decreased anxiety in the elevated zero maze, had increased ASR and decreased PPI, and exhibited reduced sucrose preference compared with the STD groups. FeD animals also weighed less and had increased slips on the tapered beam. Most of the monoamine effects were dopaminergic and occurred in the MnOE groups. The results showed that Mn is a pervasive developmental neurotoxin, the effects of which are modulated by FeD and/or BAR cage rearing.
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Affiliation(s)
- Robyn M Amos-Kroohs
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Laurie L Davenport
- Department of Environmental Health, University of Cincinnati, 3223 Eden Ave., Cincinnati, OH 45220, United States
| | - Arnold Gutierrez
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Jillian R Hufgard
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Charles V Vorhees
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Michael T Williams
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
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649
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Fernald LCH, Galasso E, Qamruddin J, Ranaivoson C, Ratsifandrihamanana L, Stewart CP, Weber AM. A cluster-randomized, controlled trial of nutritional supplementation and promotion of responsive parenting in Madagascar: the MAHAY study design and rationale. BMC Public Health 2016; 16:466. [PMID: 27255923 PMCID: PMC4891833 DOI: 10.1186/s12889-016-3097-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 04/29/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Over half of the world's children suffer from poor nutrition, and as a consequence they experience delays in physical and mental health, and cognitive development. There is little data evaluating the effects of delivery of lipid-based, nutrition supplementation on growth and development during pregnancy and early childhood within the context of a scaled-up program. Furthermore, there is limited evidence on effects of scaled-up, home-visiting programs that focus on the promotion of child development within the context of an existing, national nutrition program. METHODS/DESIGN The MAHAY ("smart" in Malagasy) study uses a multi-arm randomized-controlled trial (RCT) to test the effects and cost-effectiveness of combined interventions to address chronic malnutrition and poor child development. The arms of the trial are: (T0) existing program with monthly growth monitoring and nutritional/hygiene education; (T1) is T0 + home visits for intensive nutrition counseling within a behavior change framework; (T2) is T1 + lipid-based supplementation (LNS) for children 6-18 months old; (T3) is T2 + LNS supplementation of pregnant/lactating women; and (T4) is T1 + intensive home visiting program to support child development. There are anticipated to be n = 25 communities in each arm (n = 1250 pregnant women, n = 1250 children 0-6 months old, and n = 1250 children 6-18 months old). Primary outcomes include growth (length/height-for-age z-scores) and child development (mental, motor and social development). Secondary outcomes include care-giver reported child morbidity, household food security and diet diversity, micro-nutrient status, maternal knowledge of child care and feeding practices, and home stimulation practices. We will estimate unadjusted and adjusted intention-to-treat effects. Study protocols have been reviewed and approved by the Malagasy Ethics Committee at the Ministry of Health in Madagascar and by the institutional review board at the University of California, Davis. This study is funded by the Strategic Impact Evaluation Fund (SIEF), the World Bank Innovation Grant, the Early Learning Partnership Grant, the Japan Scaling-up for Nutrition Trustfund, and Grand Challenges Canada. The implementation of the study is financed by Madagascar's National Nutrition Office. TRIAL REGISTRATION Current Controlled Trials ISRCTN14393738 . Registered June 23, 2015.
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Affiliation(s)
- Lia C H Fernald
- School of Public Health, University of California, Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720-7360, USA.
| | - Emanuela Galasso
- Development Research Group, The World Bank, Washington D.C., USA
| | - Jumana Qamruddin
- Health, Nutrition and Population Global Practice, The World Bank, Washington D.C., USA
| | | | | | - Christine P Stewart
- Program in International and Community Nutrition, University of California, Davis, Davis, CA, USA
| | - Ann M Weber
- School of Medicine, Stanford University, Stanford, CA, USA
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650
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McCoy DC, Peet ED, Ezzati M, Danaei G, Black MM, Sudfeld CR, Fawzi W, Fink G. Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling. PLoS Med 2016; 13:e1002034. [PMID: 27270467 PMCID: PMC4896459 DOI: 10.1371/journal.pmed.1002034] [Citation(s) in RCA: 241] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. METHODS AND FINDINGS The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of children ages 3 and 4 y), followed by South Asia (27.7 million; 37.7%) and the East Asia and Pacific region (15.1 million; 25.9%). Positive associations were found between low development scores and stunting, poverty, male sex, rural residence, and lack of cognitive stimulation. Additional research using more detailed developmental assessments across a larger number of LMICs is needed to address the limitations of the present study. CONCLUSIONS The number of children globally failing to reach their developmental potential remains large. Additional research is needed to identify the specific causes of poor developmental outcomes in diverse settings, as well as potential context-specific interventions that might promote children's early cognitive and socioemotional well-being.
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Affiliation(s)
- Dana Charles McCoy
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Graduate School of Education, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Evan D. Peet
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Goodarz Danaei
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Maureen M. Black
- School of Medicine, University of Maryland, Baltimore, Baltimore, Maryland, United States of America
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Christopher R. Sudfeld
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Wafaie Fawzi
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Günther Fink
- Department of Global Health and Population, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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