Nurturing care: promoting early childhood development

Lessons learned from implementing the parenting Program P in Bolivia to prevent family violence

Parenting programs are an increasingly used strategy to prevent family violence and promote gender equality in the household. Yet, there is limited understanding of the processes and pathways to change through such programs, especially from the Global South. This paper presents key findings of a qualitative evaluation of the parenting 'Program P', which was implemented in El Alto, Bolivia. The study complements and aims to provide additional insights to an experimental evaluation of this program, which found limited impact on the intended objectives, including a reduction in violence against children and women and more gender equitable attitudes among parents. Thirty-six qualitative interviews and 6 focus groups were conducted with men and women that attended Program P, and facilitators of the program. Findings were analyzed thematically and organized around key successes and challenges of the program including motivations and ability to engage with the program, opportunities for supportive group-based processes, addressing hegemonic gender and social norms, and learning and applying skills as a platform to change behaviours. We use these findings to offer implications for more effective design and implementation of gender transformative, parenting programs in Bolivia and globally.

Neurodevelopment assessment of small for gestational age children in a community-based cohort from Pakistan

BACKGROUND

Children born small for gestational age (SGA) may experience more long-term neurodevelopmental issues than those born appropriate for gestational age (AGA). This study aimed to assess differences in the neurodevelopment of children born SGA or AGA within a periurban community in Pakistan.

METHODS

This was a prospective cohort study in which study participants were followed from the pilot Doppler cohort study conducted in 2018. This pilot study aimed to develop a pregnancy risk stratification model using machine learning on fetal Dopplers. This project identified 119 newborns who were born SGA (2.4±0.4 kg) based on International Fetal and Newborn Growth Consortium standards. We assessed 180 children (90 SGA and 90 AGA) between 2 and 4 years of age (76% of follow-up rate) using the Malawi Developmental Assessment Tool (MDAT).

FINDINGS

Multivariable linear regression analysis comparing the absolute scores of MDAT showed significantly lower fine motor scores (β: -0.98; 95% CI -1.90 to -0.06) among SGAs, whereas comparing the z-scores using multivariable logistic regression, SGA children had three times higher odds of overall z-scores ≤-2 (OR: 3.78; 95% CI 1.20 to 11.89) as compared with AGA children.

INTERPRETATION

SGA exposure is associated with poor performance on overall MDAT, mainly due to changes in the fine motor domain in young children. The scores on the other domains (gross motor, language and social) were also lower among SGAs; however, none of these reached statistical significance. There is a need to design follow-up studies to assess the impact of SGA on child's neurodevelopmental trajectory and school performance.

Valuing maternal, newborn, child and adolescent health for societal progress - Going beyond the economic orthodoxy of gross domestic product

AIM

In view of the long-standing recognition that gross domestic product (GDP) does not capture the unremunerated work largely conducted by women upon which societal well-being depends, to discuss the implications for GDP of maternal, newborn, child and adolescent health (MNCAH), and its influences on health, well-being and prosperity across the life course and across generations.

METHODS

A wide-ranging discussion of the informal think-tank The Venice Forum was held over two days, with inputs from invited experts in person and online.

RESULTS

There was consensus that a strong case could be made for inclusion of unremunerated work largely conducted by women as a positive contribution to GDP in view of its impact on future health and prosperity, and conversely exclusion from GDP of outputs from industries which harm health.

CONCLUSION

Taken with the current challenges from COVID, climate change and conflict, there is a compelling need to redefine economic progress through equitable models and metrics that incorporate short-/medium-/long-term societal value of activities that improve MNCAH.

Families' and professionals' perspectives of building and maintaining engagement in telepractice early intervention for young children with communication disability

PURPOSE

To explore and describe families' and professionals' perspectives about building and maintaining engagement in telepractice early intervention (EI).

METHODS

Individual semi-structured reflexive interviews were conducted with Australian families of young children with communication disability receiving telepractice EI and their treating professionals. These interviews were conducted within one day of a telepractice EI session and analysed using thematic analysis.

RESULTS

Thematic analysis of 72 interviews resulted in five themes that emphasised collaboration as an overarching enabler of engagement. The themes were: (1) the delivery of family-centred telepractice was essential for engaging children and families; (2) engagement in telepractice was variable and was affected by child, parent and professional factors; (3) engagement was an investment that required time, consistency and technology; (4) maximising communication interactions during telepractice sessions encouraged children and families to engage with professionals; and (5) joint planning and preparation facilitated child and family engagement in telepractice.

CONCLUSIONS

In the midst of the current COVID-19 pandemic, the present study shed light that in many ways, engagement in in-person and telepractice intervention is similar. However, the findings revealed the importance of families having an active role in telepractice EI sessions that occur in the family's social and communication environment.Implications for RehabilitationFamily engagement and high levels of parent participation are recommended in family-centred early intervention (EI).In EI delivered via telepractice, families and professionals invest in engagement-building and collaboration in a similar manner to in-person EI and in line with the principles of family-centred practice.The distinctiveness of telepractice engagement includes professionals being conscious of their communication style, taking advantage of the home environment, communicating inside and outside appointments, and jointly planning with parents/primary carers.EI professionals and students who work with young children with communication disability via telepractice can benefit by considering the engagement-building strategies described in the present study.

Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review

Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.

Digital tools to improve parenting behaviour in low-income settings: a mixed-methods feasibility study

INTRODUCTION

Digital parenting interventions could be potentially cost-effective means for providing early child development services in low-income settings. This 5-month mixed-methods pilot study evaluated the feasibility of using Afinidata, a comprehensive Facebook Messenger-based digital parenting intervention in a remote rural setting in Latin America and explored necessary adaptations to local context.

METHODS

The study was conducted in three provinces in the Cajamarca region, Peru, from February to July 2021. 180 mothers with children aged between 2 and 24 months and regular access to a smartphone were enrolled. Mothers were interviewed three times in-person. Selected mothers also participated in focus groups or in-depth qualitative interviews.

RESULTS

Despite the rural and remote study site, 88% of local families with children between 0 and 24 months had access to internet and smartphones. Two months after baseline, 84% of mothers reported using the platform at least once, and of those, 87% rated it as useful to very useful. After 5 months, 42% of mothers were still active on the platform, with little variation between urban and rural settings. Modifications to the intervention focused on assisting mothers in navigating the platform independently and included adding a laminated booklet with general information on child development, sample activities and detailed instructions on how to self-enrol in case of lost phones.

CONCLUSIONS

We found high access to smartphones and the intervention was well received and used in very remote areas of Peru, suggesting that digital parenting interventions could be a promising path forward for supporting low-income families in remote parts of Latin America.

A Disruption, Not an Interruption: The Impact of COVID-19 on Child Care in Iowa

Background

In March 2020, when public health stay home orders began in order to halt the spread of COVID-19, child care as an industry was drastically and abruptly impacted. This public health emergency highlighted the weaknesses in the child care system in the United States.

Objective

This study investigated the changes in operations cost, child enrollment and attendance, and state and federal support that occurred during the first year of the COVID-19 pandemic among both center-based and home-based child care programs.

Methods

A total of 196 licensed centers and 283 home-based programs across Iowa participated in an online survey as a part of the 2020 Iowa Narrow Costs Analysis. This mixed method study utilizes qualitative analysis of response as well as descriptive statistics and pre- post comparison testing.

Results

Analysis of qualitative and quantitative data revealed that the COVID-19 pandemic had a marked impact on child care enrollment, the operational cost of child care, the availability of child care, and a variety of other areas including staff workload and mental health. In many instances, participants shared that state and federal COVID-19 relief funds were critical.

Conclusion

Although state and federal COVID-19 relief funds were critical for child care providers in Iowa during the pandemic, results suggest similar financial support will be necessary beyond the pandemic to sustain the workforce. Policy suggestions are made for how to continue to support the child care workforce in the future.

Development, Implementation, and Process Evaluation of Bukhali: An Intervention from Preconception to Early Childhood

The Healthy Life Trajectories Initiative, an international consortium developed in partnership with the World Health Organization, is addressing childhood obesity from a life-course perspective. It hypothesises that an integrated complex intervention from preconception, through pregnancy, infancy and early childhood, will reduce childhood adiposity and non-communicable disease risk, and improve child development. As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali randomised controlled trial is being conducted with 18–28-year-old women in Soweto, where young women face numerous challenges to their physical and mental health. The aims of this paper were to describe the intervention development process (including adaptations), intervention components, and process evaluation; and to highlight key lessons learned. Intervention materials have been developed according to the life-course stages: preconception (Bukhali), pregnancy (Bukhali Baby), infancy (Bukhali Nana; birth—2 years), and early childhood (Bukhali Mntwana, 2–5 years). The intervention is delivered by community health workers, and includes the provision of health literacy resources, multi-micronutrient supplementation, in-person health screening, services and referral, nutrition risk support, SMS-reminders and telephonic contacts to assist with behaviour change goals. A key adaption is the incorporation of principles of trauma-information care, given the mental health challenges faced by participants. The Bukhali process evaluation is focussing on context, implementation and mechanisms of impact, using a mixed methods approach. Although the completion of the trial is still a number of years away, the documentation of the intervention development process and process evaluation of the trial can provide lessons for the development, implementation, and evaluation of such complex life-course trials.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder

BACKGROUND

Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant.

AIMS

To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject.

METHODS & PROCEDURES

A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools.

MAIN CONTRIBUTION

The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive.

CONCLUSIONS & IMPLICATIONS

Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes.

WHAT THIS PAPER ADDS

What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

Feasibility of Developing Audiovisual Material for Training Needs in a Vietnam Orphanage: A Mixed-Method Design

Disabled children living in orphanages in low-income countries may not have access to the therapy they need. The COVID-19 pandemic has complicated the situation dramatically, making online training activities a possible innovative option to meet the real needs of local staff. This study aimed to detect the training needs of the local staff of an orphanage in Vietnam, as well as develop an audiovisual training material and measure its feasibility. Training needs were identified through a focus group carried out by the volunteers of Fisios Mundi, a nongovernmental organization. The audiovisual training material was developed to meet these specific needs. Lastly, its feasibility was evaluated, in terms of both content and format, through an ad hoc questionnaire. Nine volunteers participated in the project. Twenty-four videos were created and structured around five themes. This study expands the body of knowledge on how an international cooperation project can be developed in a pandemic situation. The audiovisual training material content and format created in this project was considered by the volunteers as very feasible and useful for training the staff of a Vietnamese orphanage.

Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean

INTRODUCTION

Reducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women's health and economic empowerment. To support investment decisions, we estimated the additional cost and expected health and economic benefits of achieving the United Nations targets of zero unmet need for modern contraceptive choices and 95% coverage of MH services by 2030 in select Small Island Developing States.

METHODS

Five Pacific (Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu) and four Caribbean (Barbados, Guyana, Jamaica and Saint Lucia) countries were considered based on population survey data availability. For each country, the Lives Saved Tool was used to model costs, health outcomes and economic benefits for two scenarios: business-as-usual (BAU) (coverage maintained) and coverage-targets-achieved, which scaled linearly from 2022 (following COVID-19 disruptions) coverage of evidence-based family planning and MH interventions to reach United Nations targets, including modern contraceptive methods and access to complete antenatal, delivery and emergency care. Unintended pregnancies, maternal deaths, stillbirths and newborn deaths averted by the coverage-targets-achieved scenario were converted to workforce, education and social economic benefits; and benefit-cost ratios were calculated.

RESULTS

The coverage-targets-achieved scenario required an additional US$12.6M (US$10.8M-US$15.9M) over 2020-2030 for the five Pacific countries (15% more than US$82.4M to maintain BAU). This additional investment was estimated to avert 126 000 (40%) unintended pregnancies, 2200 (28%) stillbirths and 121 (29%) maternal deaths and lead to a 15-fold economic benefit of US$190.6M (US$67.0M-US$304.5M) by 2050. For the four Caribbean countries, an additional US$17.8M (US$15.3M-US$22.4M) was needed to reach the targets (4% more than US$405.4M to maintain BAU). This was estimated to avert 127 000 (23%) unintended pregnancies, 3600 (23%) stillbirths and 221 (25%) maternal deaths and lead to a 24-fold economic benefit of US$426.2M (US$138.6M-US$745.7M) by 2050.

CONCLUSION

Achieving full coverage of contraceptive and MH services in the Pacific and Caribbean is likely to have a high return on investment.

Prelinguistic intersubjective and socio-communicative skills in infants with neurodevelopmental disabilities aged 0-36 months: A new assessment and parent support tool

Background

Although children with neurodevelopmental disability (NDD) present with several deficits, they partially share developmental impairments in prelinguistic intersubjective and socio-communicative skills, which are not easily assessed by conventional tests during the first years of life.

Aim

The current paper presents a new procedure to assess the prelinguistic intersubjective and socio-communicative skills of NDD children aged 0-36 months. A specific observation form template, called the Observation of Prelinguistic Intersubjective and Socio-Communicative Skills (OPISCoS) form, has been designed to systematically detect infant skills during daily routines (e.g., mealtime, playtime, desk activities). The OPISCoS form helps speech therapists to provide parents support to better perceive and understand early communicative signals from their children, avoiding the risk of excessive or reduced social stimulation.

Methods

The OPISCoS form is composed of three sections, namely, "Pragmatics and Communication," "Decoding," and "Expression," which are useful to delineate the communication abilities of children with NDD and are not tapped by traditional batteries. Vignettes from clinical practice illustrate and provide exemplifications for using the OPISCoS form with NDD infants and their parents.

Results

The OPISCoS form was reported for two children and showed potential in detecting disrupted communicative behaviors and planning specific early interventions. Further, we observed an improvement not only in children's communicative abilities improve but also in their interactions with parents. From a clinical point of view, the OPISCoS form (1) offers an observational perspective of prelinguistic intersubjective and socio-communicative skills in infants with NDD and (2) may be useful to practitioners to enhance parents' sensitivity to their infants' communicative behavior.

Conclusion

The OPISCoS form was developed in clinical practice and is based on a very preliminary description of a new observational procedure as integration for the assessment of NDD children. The OPISCoS form appears to be a useful tool for the clinical assessment of prelinguistic intersubjective and socio-communicative skills in NDD infants as well as for promoting the quality of early parenting.

Shared reading: Parental attitudes, practices and barriers in Turkey

AIM

Understanding the nature of parent-child shared reading (SR) practices is important to reach children's developmental potential and subsequent achievement. We evaluated the parental attitudes and practices, associated variables and barriers related to SR.

METHODS

This prospective study enrolled 624 parents of children aged 1-72 months who presented to a tertiary hospital for well-child care or acute minor illness. Face-to-face interviews were conducted using a questionnaire.

RESULTS

The median age for starting SR was 12 (0-72) months. Daily SR activities were provided by 29.5% of the parents. Owning >10 children's books, higher socioeconomic status, attending pre-school/kindergarten and being a single child were associated with daily reading (P < 0.001). In total, 36.5% of the parents reported that they had not yet started SR and planned to start SR when their children reached a median age of 20.5 (2-72) months. The most commonly reported barriers were time constraints and the perception that their child was too young. Almost 10% of the parents had received an SR recommendation. Parents who had received a recommendation and those who had a habit of self-reading multiple times a week were more likely to begin SR at younger child age and to read daily (P < 0.001).

CONCLUSIONS

This study demonstrated low rates of parent-child SR activities in early childhood, particularly in the first years of life, in Turkey. Our findings emphasise the need for a national strategy integrated into the healthcare system to promote SR.

Training packages for the use of child development tools in low/middle-income countries: a review

BACKGROUND

We are now moving beyond the focus of 'child survival' to an era which promotes children thriving and developing rather than simply 'surviving'. In doing so, we are becoming more aware of the large variation of child development screening tools available globally, but in particular, those in low/middle-income countries (LMICs).

METHODS

This narrative review identifies 24 child development tools used in LMICs. We aimed to identify information on training accessibility and training design, assessment methods and cost of training. For those tools with no training information identified or for any tools identified as providing online training, the tool author was contacted individually to obtain information on the features of the tool's training package.

RESULTS

Information on training features was identified for 18 tools. All of the tools are identified as screening tools with some also identified as surveillance or assessment tools. The training material for the majority of the tools was not readily accessible and most training packages were proprietary and only available with a face-to-face training design. Other training options included a user manual, training videos or training through an online platform.

CONCLUSIONS

Training is a key factor when selecting a child development screening or surveillance tool particularly in a low-income or middle-income setting where funds may be limited. The accessibility of training can have a key impact on the implementation and utilisation of tools desperately needed for use in LMICs.

Family-level factors of early childhood development: Evidence from rural China

Family-level factors that characterize the home environment are critical inputs to early language and cognitive development, and potential mechanisms for improving developmental outcomes in vulnerable populations. Many studies conducted in high-income and Western settings highlight stimulating parenting, the home language environment, and parental self-efficacy as possible mechanisms of early development, though less is known about how these family-level factors impact child development in low- or middle-income settings. Even less is known about these family-level factors and early childhood development in rural China, where rates of cognitive and language delay in children aged 0-3 years are as high as 45% and 46%, respectively. Using data collected from 77 rural households with children aged 18-24 months in Southwestern China, this study examines the associations between stimulating parenting, the home language environment, and parental self-efficacy, and early cognitive and language development. The results indicate that stimulating parenting was significantly associated with cognitive, language, and overall development; the home language environment was only significantly associated with language development; and parental self-efficacy was not significantly associated with any developmental outcomes. The implications of such findings reveal mechanisms for supporting healthy child development in rural China.

Cognitive Development

Cognitive development in children begins with brain development. Early life exposures may both positively and negatively influence cognitive development in children. Infants, toddlers, and children learn best in secure, nurturing environments and when attachment to a consistent caregiver is present. Pediatricians can screen for both social determinants of health and developmental milestones at office visits to address barriers to care and promote positive cognitive and learning outcomes. Pediatricians may model developmental stimulation during office visits to talk with an infant/child, asking questions of a child, singing and pointing to pictures in books, and modeling responsive listening. Pediatricians may support caregivers to talk with their children, read to their children, and avoid/reduce screen time. Pediatricians can help point caregivers to resources for parent training, Head Start, and quality preschool programs. School readiness has both pre-academic and socioemotional components and can have long-term effects on a child's school success, health, and quality of life. School readiness depends on both the child and the caregiver being ready for school, taking into account caregiver and child health and mental health and child cognitive development.

Prevalence of malnutrition among Samoan children aged 5 to 11 years in 2019-2020

BACKGROUND

Globally, rapid economic development, urbanisation, and nutrition transitions have led to rising levels of malnutrition in all forms.

AIM

The study objective was to document the prevalence of overweight/obesity, underweight, stunting, and anaemia among Samoan children in 2019-2020.

SUBJECTS AND METHODS

Children from the Ola Tuputupua'e "Growing Up" in Samoa study at ages 5-11 years with complete physical assessments were included. Overweight/obesity, underweight, and stunting were classified using World Health Organisation Z-scores for body mass index-for-age (BMIZ> +1), weight-for-age (WAZ< -2SD), and height-for-age (HAZ< -2SD), respectively. Anaemia was defined as haemoglobin concentration <11.5 g/dL. Prevalence was compared by child age, sex, and census region of residence (representing urbanicity and exposure to nutrition transition) using Wilcoxon two-sample, Chi-square, or Fisher's exact tests.

RESULTS

The prevalence of overweight/obesity, underweight, stunting, and anaemia was 36.2%, 0.5%, 1.6%, and 31.6%, respectively. Overweight/obesity in children was positively associated with age and highly prevalent in periurban and urban regions. While children living in the rural region with the lowest exposure to nutrition transition had the highest prevalence of mild-to-moderate stunting, anaemia prevalence was lower compared to those in the urban region. No sex differences in malnutrition were observed.

CONCLUSION

Moderate-to-high levels of overweight/obesity and anaemia call for comprehensive intervention strategies.

Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review

Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.

Parenting Stress and Parenting Efficacy of Parents Having Children with Disabilities in China: The Role of Social Support

Raising children with disabilities is challenging for parents, who experience high parenting stress. The study aimed to understand the status quo of parenting efficacy of parents having children with disabilities and to analyze the association between parent efficacy, parenting stress, and social support in China. We surveyed 373 parents having children with disabilities enrolled in special education schools or rehabilitation institutions from 14 provinces in China. The online questionnaire including Parental Stress Index-Short Form, the Child Adjustment and Parent Efficacy Scale-Developmental Disability (CAPES-DD), and Social Support Scale was applied in the study. The results suggested that parenting efficacy of parents having children with disabilities in China was at the medium level. Parenting stress, social support, and parenting efficacy were significantly related with each other, and social support played a mediating role between parenting stress and parenting efficacy. The findings indicated that reducing parenting stress and improving social support might improve parenting efficacy. We also discussed the implications of providing intervention strategies or social support to improve parenting efficacy for parents with disabled children in China.

Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial

INTRODUCTION

Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme.

METHODS AND ANALYSIS

We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes.

ETHICS AND DISSEMINATION

Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

ISRCTN16800789.

Profiles of Quality in Three Distinct Early Childhood Programs Using the Brief Early Childhood Quality Inventory (BEQI)

Quality early childhood care and education (ECCE) is important for young children's holistic healthy development. As ECCE scales, contextually relevant and feasible measurement is needed to inform policy and programs on strengths and areas for improvement. However, few measures have been designed for use across diverse contexts. Drawing on principles of mixed methods design, this study reports on a new approach to ECCE quality measurement: the Brief Early Childhood Quality Inventory. Using data from the USA, Liberia, and Colombia, results indicate variation in the items perceived as highly relevant to each setting and in the characteristics of classrooms including the degree of child autonomy, the types of activities, and in child/educator interactions and dialogue. However, despite this variation, a small set of items indicate potential functionality as cross-country anchor items. Findings lend support to the idea that quality measures can have some common elements with room for adaptation within and across settings. Future work in this area should address the possibility that the significance of these practices for child development also varies across settings.

App-based support for parental self-efficacy in the first 1,000 days: A randomized control trial

Parental self-efficacy is key for guiding parents' interactions with their child and is an important target for early intervention. This study reports a pilot randomized control trial (RCT) of a parenting application (app) with 79 parents of children aged 0-6 months in the United Kingdom. The app includes 1,026 daily age-appropriate activities across eight areas of child development, using resources accessible at home. While controlling for pre-test scores, parents who used the parenting app (Treatment Group) had significantly higher parental self-efficacy, after the 4-week intervention period, compared to the Active Control Group. Partial correlation analyses indicated that higher frequency of self-reported use of the parenting app was associated with greater parental self-efficacy outcomes. This evidence establishes proof of concept that parenting apps can have significant benefits on parental self-efficacy in early childhood. Limitations to the interpretation and generalization of the findings, as well as directions for future research are discussed.

Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire

Background

Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school.

Method

Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI).

Results

A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness.

Conclusion

Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.

Community-based intervention via WeChat official account to improve parental health literacy among primary caregivers of children aged 0 to 3 years: Protocol for a cluster randomized controlled trial

Background

Parental health literacy is an important determinant of children's health, especially during the critical window of early development in the first 3 years. As the information communication technology develops, health education via social media is widely used to deliver health information. However, few studies have explored the effect of intervention via social media on parental health literacy.

Objective

This study aims to determine whether a WeChat official account-based health intervention can improve parental health literacy of primary caregivers of children aged 0 to 3 years in Minhang District, Shanghai, China.

Methods

The cluster randomized controlled trial includes all 13 community health centers (CHCs) in Minhang District, Shanghai. We take each CHCs as a cluster in the randomization. The CHCs are randomly allocated to the intervention or the control group through random sequence generation. Ninety primary caregivers of children aged 0 to 2 years will be recruited from each CHC, 1170 in total. Caregivers in the intervention group will be provided with a series of video clips and online reading material links on scientific parenting via a WeChat account. Caregivers in the control group will receive printed educational materials with similar contents to the intervention group. All the participants will access routine child health care and be followed up for 9 months. Online assessment of health literacy will be conducted for both groups before and after the intervention. The primary outcome is the change in the total scores of parental health literacy using a validated instrument. The data of secondary outcomes, such as exclusive breastfeeding in the first 6 months, anthropometric measurements, and disease conditions, will be extracted from routine health care records. Generalized linear mixed model (GLMM) will be used for data analyses.

Discussion

Compared with traditional health education, health intervention via WeChat official account could be a feasible and effective solution to improve parental health literacy.

Trial registration

This trial is registered with the Chinese Clinical Trial Registry (ChiCTR): (#ChiCTR2000031711) on April 07, 2020.

Effectiveness of an integrated multilevel early child development intervention on caregiver knowledge and behavior: a quasi-experimental evaluation of the Malezi program in Tanzania

BACKGROUND

The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.

METHODS

This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0-24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF's Care for Child Development package, used ECD videos in home- and facility-based sessions with caregivers. We used McNemar's testing (pre-post pairs) within intervention group to describe how the intervention was associated with change in five outcomes: ECD knowledge, early stimulation, father engagement, responsive care, and environment safety. Logistic regression was used to describe the relative benefits of the combined intervention package (RMV-ECD) compared to radio messaging (RM).

RESULTS

In the RMV-ECD arm, all outcomes at endline except environment safety significantly improved after the intervention with the largest change seen in ECD knowledge (35.8% increase, p < .0001) and the smallest in father engagement (6.7%, p = .015). In the RM arm, ECD knowledge (5.7%, p = .031) and environment safety (18.1%, p = <.0001) improved. High measures of parenting stress were associated with lower likelihood of having good ECD knowledge (AOR 0.50, 95%CI: 0.35, 0.71), father engagement (AOR 0.72, 95%CI: 0.52, 0.99) and responsive care (AOR 0.31, 95%CI: 0.18, 0.54).

CONCLUSIONS

An intervention that includes mass media, educational video content and CHWs who counsel caregivers in their homes and health facilities was associated with significant improvements in ECD parenting knowledge and behaviors but a relationship with responsive care could not be established. The less costly mass media-only intervention was associated with improved parenting knowledge and household environment safety. Parenting interventions targeting young children could be improved by incorporating more messaging and caregiver coaching in managing parental stress.

TRIAL REGISTRATION

NCT05244161 (17/02/2022); retrospectively registered with the US National Institutes of Health ClinicalTrials.gov.

Does money matter for child nutrition? Exploration of a preschool nutrition program in rural South-Central China

OBJECTIVES

The aim of this study was to examine the relationship between poverty and children's nutritional outcomes.

METHODS

Drawing on a 2018 survey of the preschool nutrition program conducted in the Xiangxi Autonomous Prefecture, Hunan Province, China, we applied propensity score matching to estimate the average treatment effects on the treated children.

RESULTS

The most striking result was that although poverty is often used as predictive of poor childhood nutrition, this effect was only significant for weight-for-age z-score and height-for-age z-score, but not for other nutritional indicators, cognition, or social emotional indexes. The results varied using different measures of poverty. The weak linkage between poverty and children's nutritional outcomes was confirmed by a series of robustness checks by changing the covariates for matching, adopting other matching methods, using bootstrapping standard errors, and building on machine learning tools.

CONCLUSIONS

A single tool of small money transfer would have limited effects, but considerable income increases that lift the poor out of poverty are important for the poor. Additionally, a mixed tool of financial support and nutritional knowledge may lead to better outcomes, especially for those living above the poverty line.

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

Introduction

In the last decade, there has been increased global policy and program momentum to promote early childhood development. The Care for Child Development (CCD) package, developed by UNICEF and the WHO, is a key tool responding to the global demand. The CCD package comprises two age-specific evidence-based recommendations for caregivers to 1) play and communicate and 2) responsively interact with their children (0-5 years) and was designed to be integrated within existing services to strengthen nurturing care for child development. The aim of this report was to provide an up-to-date global review of the implementation and evaluation of the CCD package.

Methods

In addition to a systematic review of 55 reports, we interviewed 23 key informants (including UNICEF and WHO personnel) to better understand the implementation of CCD.

Results

The CCD package has been or is being implemented in 54 low- and middle-income countries and territories, and it has been integrated into government services across the health, social, and education sectors in 26 countries. Across these contexts, CCD has been adapted in three primary ways: 1) translations of CCD materials (mostly counseling cards) into local language(s), 2) adaptations of CCD materials for the local context, vulnerable children, or a humanitarian/emergency setting (e.g., including local play activities, using activities that are better suited to children with visual impairments), and 3) substantive modifications to the content of CCD materials (e.g., expansion of play and communication activities, addition of new themes, creation of a structured curriculum). While there is promising evidence and examples of good implementation practice, there has been mixed experience about implementation of CCD with respect to adaptation, training, supervision, integration into existing services, and monitoring implementation fidelity and quality. For example, many users of CCD found difficulties with training the workforce, garnering buy-in from governments, and ensuring benefits for families, among others.

Discussion

Additional knowledge on how to improve the effectiveness, implementation fidelity and quality, and acceptance of CCD is needed. Based on the findings of the review we make recommendations for future efforts to implement CCD at-scale.

Exploring the feasibility of integrating health, nutrition and stimulation interventions for children under three years in Nepal's health system: A qualitative study

Community-based primary care settings are a potential entry point for delivering Early Childhood Development (ECD) interventions in Nepal. Past studies have suggested that integrating stimulation with nutrition interventions is an effective way to deliver multiple benefits for children, but there is limited knowledge of how to do this in Nepal. We conducted a qualitative study in Nepal's Dhanusha district to explore how stimulation interventions for early learning could be integrated into existing health and nutrition programmes within the public health system. Between March and April 2021, we completed semi-structured interviews with caregivers (n = 18), health service providers (n = 4), district (n = 1) and national stakeholders (n = 4), as well as policymakers (n = 3). We also carried out focus group discussions with Female Community Health Volunteers (FCHVs) (n = 2) and health facility operation and management committee members (n = 2). We analysed data using the framework method. Respondents were positive about introducing stimulation interventions into maternal and child health and nutrition services. They thought that using health system structures would help in the implementation of integrated interventions. Respondents also highlighted that local governments play a lead role in decision-making but must be supported by provincial and national governments and external agencies. Key factors impeding the integration of stimulation into national programmes included a lack of intersectoral collaboration, poor health worker competency, increased workload for FCHVs, financial constraints, a lack of prioritisation of ECD and inadequate capacity in local governments. Key barriers influencing the uptake of intervention by community members included lack of knowledge about stimulation, caregivers' limited time, lack of paternal engagement, poverty, religious or caste discrimination, and social restrictions for newlywed women and young mothers. There is an urgent need for an effective coordination mechanism between ministries and within all three tiers of government to support the integration and implementation of scalable ECD interventions in rural Nepal.

The predictive validity of Bayley Scales of Infant and Toddler Development-III at 2 years for later general abilities: Findings from a rural, disadvantaged cohort in Pakistan

Using data from a rural cohort in Pakistan (N = 1298), the study examined the predictive validity of the Bayley Scales of Infant and Toddler Development (BSID) 3rd edition on later tests of general abilities. The BSID III subscales (cognitive, language and motor) were administered at 2 years; general ability was assessed using the Verbal, Performance and Full-Scale score from the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) III at 4 years, and the Fluid Reasoning Index (FRI) from the Wechsler Intelligence Scale for Children (WISC) V at 8 years. The combined BSID subscales explained 15% of the variation of the WPPSI III full scale, 16% of the Verbal scale, 7% of the Performance scale and 1% of the FRI. BSID III scores at 24 months should be used with caution to predict future intellectual abilities.

Environmental opportunities facilitating cognitive development in preschoolers: development of a multicriteria index

Access to environmental opportunities can favor children's learning and cognitive development. The objectives is to construct an index that synthesizes environmental learning opportunities for preschoolers considering the home environment and verify whether the index can predict preschoolers' cognitive development. A quantitative, cross-sectional, exploratory study was conducted with 51 preschoolers using a multi-attribute utility theory (MAUT). The criteria used for drawing up the index were supported by the literature and subdivided in Group A "Resources from the house" extracted from HOME Inventory including: (1) to have three or more puzzles; (2) have at least ten children's books; (3) be encouraged to learn the alphabet; (4) take the family out at least every 2 weeks. Group B "Screens" (5) caution with using television; (6) total screen time in day/minutes. Group C "Parental Schooling" (7) maternal and paternal education. Pearson correlation analyses and univariate linear regression were performed to verify the relationship between the established index with cognitive test results. The index correlated with the total score of the mini-mental state exam (MMC) and verbal fluency test (VF) in the category of total word production and word production without errors. Multicriteria index explained 18% of the VF (total word production), 19% of the VF (total production of words without errors) and 17% of the MMC. The present multicriteria index has potential application as it synthesizes the preschooler's environmental learning opportunities and predicts domains of child cognitive development.

The BEM Program: An innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil

Objective

To describe the BEM Program, an innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil.

Methods

The Template for Intervention Description and Replication checklist was used to describe the BEM Program in detail.

Results

The BEM Program (an acronym for Brincar Ensina Mudar in Portuguese, "Play Teaches Change" in English) refers to the change in adult, child, and dyad outcomes that can be observed through incorporating playful interactions between the caregiver and their child into their daily household chores. Content consisting of 8 videos and 40 text and audio messages was sent entirely online through WhatsApp®. Thus, the Program could be accessed wherever caregivers wanted, if they had their smartphone and Internet access.

Conclusions

The detailed description of an innovative online parenting program focused on caregiver-child interaction and child development contributes to the scarce evidence on this type of programs. Adherence to the program continues to represent one of the main challenges to overcome.

A conceptual framework for selecting appropriate populations for public health interventions

This article suggests a conceptual framework for choice of target populations for public health interventions. In short, who should benefit? Taking the seminal work of Geoffrey Rose on "individuals at risk" versus the "whole population approach" as a point of departure, we explore later contributions. Frohlich and Potvin introduced the notion of "vulnerable populations" applying relevant social determinants as the defining selection criterion. Other interventions focus on a "physical space" (spatial demarcations) such as a neighborhood as a means to define intervention populations. As an addition to these criteria, we suggest that the life-course perspective entails an alternative means of selecting target populations based on a "temporal" perspective. A focus on the various age phases ranging from fetal life and infancy to old age may guide selection of population segments for targeted public health interventions. Each of the selection criteria has advantages and disadvantages when used for primary, secondary, or tertiary prevention. Thus, the conceptual framework may guide informed decisions in public health planning and research regarding precision prevention versus various approaches to complex community-based interventions.

Associations between Socioeconomic Status, Cognition, and Brain Structure: Evaluating Potential Causal Pathways Through Mechanistic Models of Development

Differences in socioeconomic status (SES) correlate both with differences in cognitive development and in brain structure. Associations between SES and brain measures such as cortical surface area and cortical thickness mediate differences in cognitive skills such as executive function and language. However, causal accounts that link SES, brain, and behavior are challenging because SES is a multidimensional construct: correlated environmental factors, such as family income and parental education, are only distal markers for proximal causal pathways. Moreover, the causal accounts themselves must span multiple levels of description, employ a developmental perspective, and integrate genetic effects on individual differences. Nevertheless, causal accounts have the potential to inform policy and guide interventions to reduce gaps in developmental outcomes. In this article, we review the range of empirical data to be integrated in causal accounts of developmental effects on the brain and cognition associated with variation in SES. We take the specific example of language development and evaluate the potential of a multiscale computational model of development, based on an artificial neural network, to support the construction of causal accounts. We show how, with bridging assumptions that link properties of network structure to magnetic resonance imaging (MRI) measures of brain structure, different sets of empirical data on SES effects can be connected. We use the model to contrast two possible causal pathways for environmental influences that are associated with SES: differences in prenatal brain development and differences in postnatal cognitive stimulation. We then use the model to explore the implications of each pathway for the potential to intervene to reduce gaps in developmental outcomes. The model points to the cumulative effects of social disadvantage on multiple pathways as the source of the poorest response to interventions. Overall, we highlight the importance of implemented models to test competing accounts of environmental influences on individual differences.

Using WhatsApp support groups to promote responsive caregiving, caregiver mental health and child development in the COVID-19 era: A randomised controlled trial of a fully digital parenting intervention

Objective

Digital interventions hold important potential for supporting parents when face-to-face interventions are unavailable. We assessed the feasibility and effectiveness of a digital parenting intervention in Zambia and Tanzania.

Methods

Using a randomised controlled trial, we evaluated the Sharing Stories digital parenting intervention for caregivers of children aged 9-32 months with access to a smartphone in their household. Caregivers were stratified based on child age and randomly assigned to the intervention or waitlist control arm. The intervention was delivered via facilitated WhatsApp groups over 6 weeks to promote caregiver wellbeing and responsive caregiving through shared reading activities. Primary outcomes were caregiver-reported responsive caregiving, child language and socio-emotional development. Secondary outcomes were caregiver mental health and parental stress. Masked assessors conducted assessments at baseline and immediate follow-up.

Results

Between October 2020 and March 2021, we randomly assigned 494 caregiver-child dyads to the intervention (n = 248) or waitlist control (n = 246) arm. Caregivers in the intervention group reported more responsive caregiving (OR = 2.55, 95% CI: 1.15-5.66, p = 0.02), time reading or looking at books (β = 0.45, p = 0.04) and telling stories (β = 0.72, p = 0.002). Intervention caregivers reported significantly lower symptoms of depression (β = -0.64, p = 0.05) and anxiety (β = -0.65, p = 0.02). Child development and parental stress did not differ significantly between groups.

Conclusions

Digital parenting interventions using WhatsApp can effectively promote responsive caregiving and caregiver mental health in low-resource settings, with great potential for scalability.

Trial registration

ISRCTN database, ISRCTN77689525.

[Analysis of the influence of the timing of enrollment in daycares on child development]

This study aimed to analyze the relationship between the age of enrollment into early childhood education (ECE) programs and child development. This is a cross-sectional study using data from the Birth Cohort of the Western Region of São Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of São Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child development was measured by the Engle Scale of the Regional Project on Child Development Indicators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample consisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [β = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for confounding variables in the regression models, it was observed that being enrolled in a private institution, total time of breastfeeding, time spent by the main caregiver working outside home, and inhibitory control were determinants in explaining the infant development at 36 months in the sample. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.

Child development with the D-score: tuning instruments to unity

The chapter familiarises the reader with an intuitive yet powerful methodology to tune instruments to a common unit, presenting a fresh approach that expresses measurements made by different instruments on the D-score scale. As a result, the reader may compare D-scores between ages, children or cohorts. It shows how to exploit common developmental milestones to bridge instruments and cohorts; presents an analysis to obtain D-scores from 16 cohorts and 14 instruments; compares D-score age-distribution across populations from four continents; suggests an indicator for the United Nations Sustainable Development Goals; and defines developmentally-on-track.

Child development with the D-score: turning milestones into measurement

The chapter equips the reader with a basic understanding of robust psychometric methods that are needed to turn developmental milestones into measurements, introducing the fundamental issues in defining a unit for child development and demonstrates the relevant quantitative methodology. It reviews quantitative approaches to measuring child development;introduces the Rasch model in a non-technical way;shows how to estimate model parameters from real data;puts forth a set of principles for model evaluation and assessment of scale quality;analyses the relation between early D-scores and later intelligence;and compares the D-scores from three studies that all use the same instrument.

Effect of parenting intervention through "Care for Child Development Guideline" on early child development and behaviors: a randomized controlled trial

BACKGROUND

Several studies showed that parenting intervention programs play a core component in early child development. Considering the limited healthcare resources in developing countries, group-session intervention based on care for child development (CCD) guideline might be cost-effective.

METHODS

This randomized controlled trial was conducted at an outpatient public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women aged 18-45 years in their third trimester and followed their children for 18 months. The intervention group underwent 5 educational group sessions, each lasting for almost 45 minutes. The main outcomes were the children's development and socio-emotional behavior problems based on Bayley Scales of Infant and Toddler Development-III (BSID-III) at 12 months and the Children Behavior Checklist (CBCL) at 18 months.

RESULTS

Overall, data of 181 children were included in the current study, including 80 in the intervention group and 101 controls. The adjusted median/mean differences between intervention and control groups using median/linear regression were not significant for all BSID-III domains except for median differences for cognitive score based on BSID-III (β (SE): - 4.98(2.31), p:0.032) and mean differences for anxiety/depression score based on CBCL (β (SE): - 2.54(1.27), p:0.046).

CONCLUSION

In this study, parenting interventions through CCD group sessions were significantly effective on just one subscale of children's socio-emotional behavior domains based on CBCL and one domain of children's development based on BSID-III. There might be a ceiling or floor effects for the BSID-III and CBCL assessment, respectively, leaving little room for improvement as almost all children have achieved their full developmental potential in our study.

TRIAL REGISTRATION

IRCT20190128042533N2, Date of registration: 16/01/2020, www.irct.ir.

Influência de determinantes socioeconômicos no desenvolvimento motor de lactentes acompanhados por programa de follow-up em Manaus, Amazonas

RESUMO O desenvolvimento infantil é um processo gradual e contínuo dividido em estágios para fins teóricos. Os fatores intrínsecos e extrínsecos podem influenciar de modo positivo ou negativo na evolução do lactente. O objetivo foi avaliar a influência do ensino superior materno e da renda familiar no Desenvolvimento Motor (DM) de lactentes. Estudo transversal, que avaliou 106 crianças, oriundas do programa de follow-up de uma maternidade de referência no Amazonas. Foram aplicados dois questionários (roteiro de anamnese e perfil socioeconômico); e, em seguida, Escala Motora Infantil de Alberta para avaliar o DM desses lactentes. Para a análise estatística, foram utilizados dados descritivos e teste Qui-quadrado e Exato de Fischer, com p ≤ 0,05. O maior grau de escolaridade materna estava relacionada com a tipicidade do DM (71,4%, com p = 0,04), em contrapartida, uma menor renda familiar, apesar de ter apresentado maior percentual em crianças atípicas (51,9%), não demonstrou uma relação significativa com a atipicidade do DM. Foi observado que, na amostra, a escolaridade materna possuiu maior impacto para o adequado DM quando comparado à renda familiar. Tal fato parece estar relacionado com o maior grau de instrução materna, o qual implica o melhor assistencialismo infantil ante cuidados gerais e estimulações.

Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities

Abstract The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.

Rethinking water, sanitation, and hygiene for human growth and development

Life history theory emphasises plasticity in developmental and biological programming where conditions in early life, lead to long-term consequences for health and wellbeing. Studies linking water, sanitation, and hygiene, nutrition, and child growth and development have emphasised the optimisation of linear growth as a key metric for the evaluation of intervention efficacy. Life history characteristics pertaining to human growth and phenotypic plasticity, suggest that different developmental outcomes in early childhood may be responsive to different stimuli at different ages. Energy utilisation by the human brain, from birth through childhood, accounts for a disproportionate percentage of the resting metabolic rate. Undernutrition in early life, and its relative resultant energy deficiency, may trigger adaptive physiological mechanisms prioritising brain growth at the expense of body growth. Emphasis placed on linear growth may have impeded the significance of WASH due to excluding aspects of child development beyond height/weight. We propose that incorporating evolutionary public health and life history theory perspectives, allows for the identification of age-appropriate biological outcomes and WASH indicators, while anticipating the timing and life-course suitability of the interventions being operationalised. Finally, integrating reflections regarding context allows for the development of transformative WASH interventions.

Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting

OBJECTIVE

Supporting Early Childhood Development (ECD) is an Australian national priority. Aboriginal children in Western Australia's Kimberley region have much higher rates of developmental concerns at school entry than non-Aboriginal children. We aimed to describe ECD practices in the participating service; document follow-up of identified developmental concerns; and identify barriers and enablers to incorporating ECD practices into clinic activity.

DESIGN

Mixed-method design incorporating clinical audit and staff interviews.

SETTING

An Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region.

PARTICIPANTS

A total of 176 children receiving primary health care through the participating ACCHS; interviews with five ACCHS staff members.

MAIN OUTCOME MEASURES

Frequency of developmental enquiry by age and domain; follow-up of identified developmental concerns; and barriers and enablers to ECD practices.

RESULTS

Developmental enquiry was documented for 114 of 176 eligible children (65%), including in 80% of ACCHS child health assessments. Standardised ECD assessments were less common. Staff were aware of the importance of developmental enquiry, however, barriers to increasing ECD practices included a lack of resources and structured staff education, time pressures and a lack of role clarity between the ACCHS and government community health clinic.

CONCLUSIONS

This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.