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Urke HB, Contreras M, Matanda DJ. The Influence of Maternal and Household Resources, and Parental Psychosocial Child Stimulation on Early Childhood Development: A Cross-Sectional Study of Children 36⁻59 Months in Honduras. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050926. [PMID: 29735895 PMCID: PMC5981965 DOI: 10.3390/ijerph15050926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/10/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022]
Abstract
Optimal early childhood development (ECD) is currently jeopardized for more than 250 million children under five in low- and middle-income countries. The Sustainable Development Goals has called for a renewed emphasis on children’s wellbeing, encompassing a holistic approach that ensures nurturing care to facilitate optimal child development. In vulnerable contexts, the extent of a family’s available resources can influence a child’s potential of reaching its optimal development. Few studies have examined these relationships in low- and middle-income countries using nationally representative samples. The present paper explored the relationships between maternal and paternal psychosocial stimulation of the child as well as maternal and household resources and ECD among 2729 children 36⁻59 months old in Honduras. Data from the Demographic and Health Surveys conducted in 2011⁻2012 was used. Adjusted logistic regression analyses showed that maternal psychosocial stimulation was positively and significantly associated with ECD in the full, rural, and lowest wealth quintile samples. These findings underscore the importance of maternal engagement in facilitating ECD but also highlight the role of context when designing tailored interventions to improve ECD.
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Affiliation(s)
- Helga Bjørnøy Urke
- Department of Health Promotion and Development, University of Bergen, 5020 Bergen, Norway.
| | - Mariela Contreras
- GOAL Honduras, 11101 Tegucigalpa, Honduras.
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, 751 85 Uppsala, Sweden.
| | - Dennis Juma Matanda
- Population Council, Avenue 5, Rose Avenue, P.O. Box 17643-00500, Nairobi, Kenya.
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152
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Muhoozi GKM, Atukunda P, Diep LM, Mwadime R, Kaaya AN, Skaare AB, Willumsen T, Westerberg AC, Iversen PO. Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster-randomized trial. MATERNAL & CHILD NUTRITION 2018; 14:e12527. [PMID: 28925580 PMCID: PMC6866193 DOI: 10.1111/mcn.12527] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 01/22/2023]
Abstract
Stunting is associated with impaired cognitive and motor function. The effect of an education intervention including nutrition, stimulation, sanitation, and hygiene on child growth and cognitive/language/motor development, delivered to impoverished mothers in Uganda, was assessed. In a community-based, open cluster-randomized trial, 511 mother/children dyads aged 6-8 months were enrolled to an intervention (n = 263) or control (n = 248) group. The primary outcome was change in length-for-age z-score at age 20-24 months. Secondary outcomes included anthropometry and scores on the 2 developmental scales: Bayley Scales of Infant and Toddler Development-III and the Ages and Stages Questionnaire. There was no evidence of a difference in mean length-for-age z-score at 20-24 months between the 2 study groups: 0.10, 95% CI [-0.17, 0.36], p = .49. The intervention group had higher mean composite development scores than the controls on Bayley Scales of Infant and Toddler Development-III, the mean difference being 15.6, 95% CI [10.9, 20.2], p = .0001; 9.9, 95% CI [6.4, 13.2], p = .0001; and 14.6, 95% CI [10.9, 18.2], p = .0001, for cognitive, language, and motor composite scores, respectively. The mean difference in scores from the Ages and Stages Questionnaire were 7.0, 95% CI [2.9, 11.3], p = .001; 5.9, 95% CI [1.2, 10.3], p = .01; 4.2, 95% CI [1.7, 6.7], p = .001; 8.9, 95% CI [5.3, 12.3], p = .0001; and 4.4, 95% CI [0.0, 8.8], p = .05, for communication, gross motor, fine motor, problem solving, and personal-social development, respectively. The intervention education delivered to mothers promoted early development domains in cognitive, language, and motor development but not linear growth of small children in impoverished rural communities in Uganda. Our study showed that child development may be improved with a relatively low cost intervention strategy. This trial was registered at ClinicalTrials.gov as NCT02098031.
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Affiliation(s)
- Grace K. M. Muhoozi
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- Department of Human Nutrition and Home EconomicsKyambogo UniversityKampalaUganda
| | - Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
| | - Lien M. Diep
- Oslo Centre for Biostatistics and EpidemiologyOslo University HospitalOsloNorway
| | | | - Archileo N. Kaaya
- School of Food Technology, Nutrition and BioengineeringMakerere UniversityKampalaUganda
| | - Anne B. Skaare
- Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOsloNorway
| | - Tiril Willumsen
- Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOsloNorway
| | | | - Per O. Iversen
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- Department of HaematologyOslo University HospitalOsloNorway
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153
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Rockers PC, Zanolini A, Banda B, Chipili MM, Hughes RC, Hamer DH, Fink G. Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial. PLoS Med 2018; 15:e1002555. [PMID: 29689045 PMCID: PMC5915271 DOI: 10.1371/journal.pmed.1002555] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/19/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early childhood interventions have potential to offset the negative impact of early adversity. We evaluated the impact of a community-based parenting group intervention on child development in Zambia. METHODS AND FINDINGS We conducted a non-masked cluster-randomized controlled trial in Southern Province, Zambia. Thirty clusters of villages were matched based on population density and distance from the nearest health center, and randomly assigned to intervention (15 clusters, 268 caregiver-child dyads) or control (15 clusters, 258 caregiver-child dyads). Caregivers were eligible if they had a child 6 to 12 months old at baseline. In intervention clusters, caregivers were visited twice per month during the first year of the study by child development agents (CDAs) and were invited to attend fortnightly parenting group meetings. Parenting groups selected "head mothers" from their communities who were trained by CDAs to facilitate meetings and deliver a diverse parenting curriculum. The parenting group intervention, originally designed to run for 1 year, was extended, and households were visited for a follow-up assessment at the end of year 2. The control group did not receive any intervention. Intention-to-treat analysis was performed for primary outcomes measured at the year 2 follow-up: stunting and 5 domains of neurocognitive development measured using the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). In order to show Cohen's d estimates, BSID-III composite scores were converted to z-scores by standardizing within the study population. In all, 195/268 children (73%) in the intervention group and 182/258 children (71%) in the control group were assessed at endline after 2 years. The intervention significantly reduced stunting (56/195 versus 72/182; adjusted odds ratio 0.45, 95% CI 0.22 to 0.92; p = 0.028) and had a significant positive impact on language (β 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (β 0.11, 95% CI -0.06 to 0.29; p = 0.196), motor skills (β -0.01, 95% CI -0.25 to 0.24; p = 0.964), adaptive behavior (β 0.21, 95% CI -0.03 to 0.44; p = 0.088), or social-emotional development (β 0.20, 95% CI -0.04 to 0.44; p = 0.098). Observed impacts may have been due in part to home visits by CDAs during the first year of the intervention. CONCLUSIONS The results of this trial suggest that parenting groups hold promise for improving child development, particularly physical growth, in low-resource settings like Zambia. TRIAL REGISTRATION ClinicalTrials.gov NCT02234726.
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Affiliation(s)
- Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Bowen Banda
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | | | - Robert C Hughes
- UK Department for International Development, London, United Kingdom
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.,Zambia Center for Applied Health Research and Development, Lusaka, Zambia.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Jeong J, Pitchik HO, Yousafzai AK. Stimulation Interventions and Parenting in Low- and Middle-Income Countries: A Meta-analysis. Pediatrics 2018; 141:peds.2017-3510. [PMID: 29500293 DOI: 10.1542/peds.2017-3510] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early childhood stimulation interventions positively impact early child development (ECD) outcomes in low- and middle-income countries. However, trials have less comprehensively evaluated the effects of such parenting programs on caregivers' skills and capacities. OBJECTIVE We conducted a systematic review and meta-analysis to assess the effectiveness of stimulation interventions on improving parenting outcomes. DATA SOURCES Six electronic bibliographic databases. STUDY SELECTION Inclusion criteria included randomized controlled trials of stimulation interventions designed to improve ECD outcomes during the first 2 years of life that measured any maternal or parenting-related outcome after the start of the intervention. DATA EXTRACTION Two independent reviewers extracted data by using a structured form. RESULTS Fifteen studies representing 13 unique randomized controlled trials met the inclusion criteria. Pooled standardized mean differences (SMDs) based on random-effects models revealed medium-to-large benefits of stimulation interventions for improving the home caregiving environment (n = 10; SMD = 0.57; 95% confidence interval [CI], 0.37 to 0.77), mother-child interactions (n = 3; SMD = 0.44; 95% CI, 0.14 to 0.74), and maternal knowledge of ECD (n = 6; SMD = 0.91; 95% CI, 0.51 to 1.31). No significant difference was seen for maternal depressive symptoms (n = 9; SMD = -0.10; 95% CI, -0.23 to -0.03). LIMITATIONS Limitations include heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies. CONCLUSIONS Early childhood stimulation interventions improve several distinct aspects of maternal parenting. Improvements in parenting capacities may serve as key mechanisms by which these programs benefit ECD outcomes.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and
| | - Helen O Pitchik
- Department of Epidemiology, Berkeley School of Public Health, University of California Berkeley, Berkeley, California
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and
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155
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Stewart CP, Kariger P, Fernald L, Pickering AJ, Arnold CD, Arnold BF, Hubbard AE, Dentz HN, Lin A, Meerkerk TJ, Milner E, Swarthout J, Colford JM, Null C. Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:269-280. [PMID: 29616236 PMCID: PMC5859215 DOI: 10.1016/s2352-4642(18)30025-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Poor nutrition and infectious diseases can prevent children from reaching their developmental potential. We aimed to assess the effects of improvements in water, sanitation, handwashing, and nutrition on early child development in rural Kenya. Methods In this cluster-randomised controlled trial, we enrolled pregnant women in their second or third trimester from three counties (Kakamega, Bungoma, and Vihiga) in Kenya's western region, with an average of 12 households per cluster. Groups of nine geographically adjacent clusters were block-randomised, using a random number generator, into the six intervention groups (including monthly visits to promote target behaviours), a passive control group (no visits), or a double-sized active control group (monthly household visits to measure child mid-upper arm circumference). The six intervention groups were: chlorinated drinking water; improved sanitation; handwashing with soap; combined water, sanitation, and handwashing; improved nutrition through counselling and provision of lipid-based nutrient supplements; and combined water, sanitation, handwashing, and nutrition. Here we report on the prespecified secondary child development outcomes: gross motor milestone achievement assessed with the WHO module at year 1, and communication, gross motor, personal social, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at year 2. Masking of participants was not possible, but data assessors were masked. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105. Findings Between Nov 27, 2012, and May 21, 2014, 8246 women residing in 702 clusters were enrolled. No clusters were lost to follow-up, but 2212 households with 2279 children were lost to follow-up by year 2. 5791 (69%) children were measured at year 1 and 6107 (73%) at year 2. At year 1, compared with the active control group, the combined water, sanitation, handwashing, and nutrition group had greater rates of attaining the standing with assistance milestone (hazard ratio 1·23, 95% CI 1·09-1·40) and the walking with assistance milestone (1·32, 1·17-1·50), and the handwashing group had a greater rate of attaining the standing alone milestone (1·15, 1·01-1·31). There were no differences when comparing the other intervention groups with the active control group on any of the motor milestone measures at year 1. At year 2, there were no differences among groups for the communication, gross motor, personal social, or combined EASQ scores. Interpretation The handwashing and combined water, sanitation, handwashing, and nutrition interventions might have improved child motor development after 1 year, although after 2 years there were no other differences between groups. Future research should examine ways to make community health and nutrition programmes more effective at supporting child development. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Patricia Kariger
- School of Public Health, University of California, Davis, CA, USA
| | - Lia Fernald
- Community Health Sciences, University of California, Davis, CA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, CA, USA
| | | | - Alan E Hubbard
- Division of Biostatistics, University of California, Davis, CA, USA
| | - Holly N Dentz
- Department of Nutrition, University of California, Davis, CA, USA
| | - Audrie Lin
- Division of Epidemiology, University of California, Davis, CA, USA
| | - Theodora J Meerkerk
- Department of Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Erin Milner
- Environmental Health Sciences, University of California, Davis, CA, USA
| | | | - John M Colford
- Division of Epidemiology, University of California, Davis, CA, USA
| | - Clair Null
- Innovations for Poverty Action, New Haven, CT, USA; Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington DC, USA
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156
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Liu S, Wang Z, Zhao C, Huang X, Liang X, Wang X, Lu S, Scherpbier RW. Effects of early comprehensive interventions on child neurodevelopment in poor rural areas of China: a moderated mediation analysis. Public Health 2018; 159:116-122. [PMID: 29576227 DOI: 10.1016/j.puhe.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/21/2017] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine the effects of early comprehensive interventions on home environment and child neurodevelopment among children younger than 3 years in poor rural areas of China, as well as the underlying mediating and moderating mechanisms. STUDY DESIGN Non-randomized intervention study was conducted among 216 children aged 0-3 years in Shanxi province of China. Based on a 2 × 2 factor design, children in Lin and Fenxi County were assigned to an intervention group with duration less than 1 year (n = 26) or an intervention group with duration longer than 1 year (n = 82), while children in Fangshan County served as a control group with duration less than 1 year (n = 30) or a control group with duration longer than 1 year (n = 78). METHODS The control group received national public health services (NPHS), while the intervention group received NPHS plus comprehensive interventions covering health, nutrition, early psychosocial stimulation, and child protection. Home environment (Infant-Toddler Home Observation for Measurement of the Environment [HOME]) and child neurodevelopment (Ages and Stages Questionnaire [ASQ]) were measured by observation and interview with mothers after the intervention program. RESULTS The intervention group showed significantly higher overall HOME, organization, learning materials, and involvement than the control group, only for a duration longer than 1 year. Children in the intervention group performed better in overall ASQ, fine motor, problem-solving, and personal-social than children in the control group. Moderated mediation analyses indicated that there were significantly indirect effects of treatment on overall ASQ through overall HOME, organization, and involvement only when the duration was longer than 1 year. CONCLUSIONS Early comprehensive interventions longer than 1 year improve home environment and promote child neurodevelopment among children younger than 3 years in poor rural areas. What is more, effects of early comprehensive interventions longer than 1 year on child neurodevelopment were mediated by home environment.
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Affiliation(s)
- S Liu
- Beijing Key Laboratory of Learning and Cognition, Research Center for Child Development, School of Psychology, Capital Normal University, Beijing, China
| | - Z Wang
- Beijing Key Laboratory of Learning and Cognition, Research Center for Child Development, School of Psychology, Capital Normal University, Beijing, China
| | - C Zhao
- UNICEF China Office, Beijing, China
| | - X Huang
- UNICEF China Office, Beijing, China
| | - X Liang
- Beijing Key Laboratory of Learning and Cognition, Research Center for Child Development, School of Psychology, Capital Normal University, Beijing, China
| | - X Wang
- Department of Child, Adolescent and Women's Health, School of Public Health, Peking University Health Science Center, China
| | - S Lu
- Beijing Key Laboratory of Learning and Cognition, Research Center for Child Development, School of Psychology, Capital Normal University, Beijing, China.
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Worku BN, Abessa TG, Wondafrash M, Lemmens J, Valy J, Bruckers L, Kolsteren P, Granitzer M. Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty: a randomized single-blind controlled trial. BMC Pediatr 2018; 18:29. [PMID: 29402258 PMCID: PMC5800292 DOI: 10.1186/s12887-018-1023-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children living with foster families in a resource-limited setting such as Ethiopia are at risk of developmental problems. It is not yet clear whether intensive home-based developmental stimulation assisted by play can reduce these problems. The main objective of this study was to examine the effects of play-assisted intervention integrated into basic services on the developmental performance of children living with foster families in extreme poverty. METHODS A randomized single-blind (investigator) controlled trial design was used. The study was conducted in Jimma, South West Ethiopia. Using computer-generated codes, eligible children of 3-59 months in age were randomly allocated to intervention (n = 39) and control (n = 39) groups at a 1:1 ratio. Children in the intervention group received home-based play-assisted stimulation in addition to the basic services provided to children in both groups. The intervention consisted of an hour of play stimulation conducted during a weekly home visit over the course of six months. Personal-social, language, fine and gross motor outcomes were assessed using Denver II-Jimma, and social-emotional outcome was obtained using an adapted Ages and Stages Questionnaire: Social-Emotional (ASQ: SE). Information about sociodemographic characteristics was collected using a structured questionnaire. Anthropometric methods were used to determine nutritional status. The effects of the intervention on the abovementioned outcomes over the study period and group differences in change over time were examined using Generalized Estimating Equations (GEE). RESULTS Statistically significant intervention effects were found for language (P = 0.0014), personal-social (P = 0.0087) and social-emotional (P < 0.0001) performances. At the midline of the study, language (effect size = 0.34) and social-emotional (effect size = - 0.603) benefits from the play-assisted stimulation had already been observed for the children in the intervention group. For language, the intervention effect depended on the child's sex (P = 0.0100) and for personal-social performance, on family income (P = 0.0300). CONCLUSIONS Intensive home-based play-assisted stimulation reduced the developmental problems of children in foster families in the context of extreme poverty. Longer follow-up may reveal further improvements in the developmental performance of the children. TRIAL REGISTRATION The study was retrospectively registered on ClinicalTrials.gov on 17 November 2016, Study Identifier: NCT02988180 .
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Affiliation(s)
- Berhanu Nigussie Worku
- Department of Psychology, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
| | - Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
| | - Mekitie Wondafrash
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Johan Lemmens
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | - Jan Valy
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | - Liesbeth Bruckers
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
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159
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Ahun MN, Aboud FE, Aryeetey R, Colecraft E, Marquis GS. Child development in rural Ghana: Associations between cognitive/language milestones and indicators of nutrition and stimulation of children under two years of age. Canadian Journal of Public Health 2018; 108:e578-e585. [PMID: 29356667 DOI: 10.17269/cjph.108.5875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/03/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Two studies aimed to assess the provision of nutrition and psychosocial stimulation in the home and to examine associations between mental development and nutrition and stimulation using a validated measure of development milestones. METHODS The first study consisted of secondary analyses on health and nutrition data from 1081 mother-child pairs (the children aged 0-12 months) and their households in Ghana's Eastern Region. For the second study, the Ghana Milestones Measure, consisting of items assessing cognitive and language development, was used to assess child development in a subsample (N = 330) of Study 1 participants one year later (children 10-24 months of age). This measure was mother-reported and had been validated in a separate community in Ghana. Correlation and linear regression analyses were used to analyze the data. RESULTS Family assets and maternal education were identified as key factors of the family context. Both variables were positively associated with preventive health practices (r = 0.08 to 0.13, p < 0.0001 to 0.01), and dietary diversity (r = 0.15, p = 0.0001 to 0.0006), and negatively associated with maternal depressive symptoms (r = -0.19 to -0.12, p < 0.0001). Taller children had higher receptive (standardized beta = 0.16; p = 0.04) and expressive (0.21; 0.003) language, but not cognitive (0.15; 0.07) milestone scores, and psychosocial stimulation was positively associated with all three milestones (receptive = 0.13, p = 0.01; expressive = 0.21, p < 0.0001; and cognitive = 0.24, p < 0.0001). CONCLUSION Our study provides the first validated measure of children's language and cognitive development in Ghana, finding associations with nutrition and stimulation. The Ghana Milestones Measure can be used to assess and help promote children's mental development.
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Affiliation(s)
- Marilyn N Ahun
- Department of Psychology, McGill University, Montreal, QC (at time of study; currently a PhD candidate, Department of Social and Preventive Medicine, University of Montreal, Montreal, QC).
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Nelson AK, Miller AC, Munoz M, Rumaldo N, Kammerer B, Vibbert M, Lundy S, Soplapuco G, Lecca L, Condeso A, Valdivia Y, Atwood SA, Shin SS. CASITA: a controlled pilot study of community-based family coaching to stimulate early child development in Lima, Peru. BMJ Paediatr Open 2018; 2:e000268. [PMID: 29862331 PMCID: PMC5976100 DOI: 10.1136/bmjpo-2018-000268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether the 3-month, community-based early stimulation coaching and social support intervention 'CASITA', delivered by community health workers, could improve early child development and caregiver-child interaction in a resource-limited district in Lima, Peru. DESIGN A controlled two-arm proof-of-concept study. SETTING Six neighbourhood health posts in Carabayllo, a mixed rural/urban district in Lima. Sessions were held in homes and community centres. PARTICIPANTS Children aged 6-24 months who screened positive for risk of neurodevelopmental delay (using validated developmental delay tool) and poverty (using progress out of poverty tool) were enrolled with their caregivers. Dyads with children born >21 days early were excluded. INTERVENTION 12-week parenting/support intervention plus nutritional support (n=41) or nutrition alone (n=19). OUTCOME MEASURES Development and home environment differences and mean changes from baseline to 3 months postintervention were evaluated using age-adjusted z-scores on the Extended Ages and Stages Questionnaire (EASQ) and the Home Observation Measurement of the Environment (HOME) scores, respectively. RESULTS Development in CASITA improved significantly in all EASQ domains, whereas the control group's z-scores did not improve significantly in any domain. The mean adjusted difference (MAD) in change in EASQ age-adjusted z-scores between the two study arms was 1.39 (95% CI 0.55 to 2.22); Cohen's d effect size of 0.87 (95% CI 0.23 to 1.50). Likewise, intervention significantly improved global HOME scores versus control group (MAD change of 6.33 (95% CI 2.12 to 10.55); Cohen's d of 0.85 (95% CI 0.28 to 1.41)). CONCLUSIONS An evidence-based early intervention delivered weekly during 3 months by a community health worker significantly improved children's communication, motor and personal/social development in this proof-of-concept study.
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Affiliation(s)
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Betsy Kammerer
- Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Martha Vibbert
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,SPARK Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Shannon Lundy
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,UCSF Benioff Children's Hospital, San Francisco, California, USA
| | | | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Socios En Salud Sucursal, Lima, Peru
| | | | | | - Sidney A Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Ramaiya MK, Fiorillo D, Regmi U, Robins CJ, Kohrt BA. A Cultural Adaptation of Dialectical Behavior Therapy in Nepal. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:428-444. [PMID: 29056846 PMCID: PMC5645023 DOI: 10.1016/j.cbpra.2016.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growing evidence exists on the potential for adapting evidence-based interventions for low- and-middle-income countries (LMIC). One opportunity that has received limited attention is the adaptation of psychotherapies developed in high-income countries (HIC) based on principles from LMIC cultural groups. Dialectical behavior therapy (DBT) is one such treatment with significant potential for acceptability in South Asian settings with high suicide rates. We describe a tri-phasic approach to adapt DBT in Nepal that consists of qualitative interviews with major Nepali mental health stakeholders (Study 1), an adaptation workshop with 15 Nepali counselors (Study 2), and a small-scale treatment pilot with eligible clients in one rural district (Study 3). Due to low literacy levels, distinct conceptualizations of mind and body, and program adherence barriers, numerous adaptations were required. DBT concepts attributable to Asian belief systems were least comprehensible to clients. However, the 82% program completion rate suggests utility of a structured, skills-based treatment. This adaptation process informs future research regarding the effectiveness of culturally adapted DBT in South Asia.
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Affiliation(s)
- Megan K. Ramaiya
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Department of Psychology, University of Washington, Box 351525, Seattle, WA
| | - Devika Fiorillo
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Dr. NE, Atlanta, GA
| | - Upasana Regmi
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
| | - Clive J. Robins
- Department of Psychology & Neuroscience, Duke University, Box 90086, 417 Chapel Drive, Durham, NC
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
| | - Brandon A. Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, Nepal
- Department of Psychiatry and Behavioral Sciences, Duke University, Box 90519 Durham, NC
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162
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Goettems ML, Poletto-Neto V, Shqair AQ, Pinheiro RT, Demarco FF. Influence of maternal psychological traits on sleep bruxism in children. Int J Paediatr Dent 2017; 27:469-475. [PMID: 28117919 DOI: 10.1111/ipd.12285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sleep bruxism (SB) is a sleep disorder with high incidence in toddlers and may perpetuate to adulthood. The multifactorial etiology of bruxism includes pathophysiologic and psychological factors. AIM To investigate the relationship between depression, stressful events, and the presence of symptoms of anxiety and depression with SB in children of adolescent mothers. DESIGN This cross-sectional study nested in a cohort evaluated a sample of 536 mothers and their children aged 24-36 months. Interviews were conducted with mothers. Maternal report of SB was collected. Mother's major depressive disorder was assessed using the Mini International Neuropsychiatric Interview (MINI Plus); Life Events Scale assessed the stressful events; Beck Depression Inventory and Beck Anxiety Inventory investigated the symptoms of depression and anxiety. Poisson regression analysis was applied to assess the association of maternal psychological disorders and stressful events with SB on children. RESULTS Prevalence of SB was 25.93% (95% CI 22.2-29.7). After adjustments, maternal major depression disorder [PR 1.43 (95% CI 1.06-1.92)] and the presence of stressful events mainly environmental changes [PR 1.47 (95% CI 1.08-2.00)] showed significant association with bruxism in children. CONCLUSION This study showed a positive association between mother's psychological traits and SB development in their toddlers.
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Affiliation(s)
- Marilia Leão Goettems
- Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Victorio Poletto-Neto
- Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ayah Qassem Shqair
- Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ricardo Tavares Pinheiro
- Post Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Flavio Fernando Demarco
- Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil.,Post Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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163
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Randomized controlled trial of caregiver training for HIV-infected child neurodevelopment and caregiver well being. AIDS 2017; 31:1877-1883. [PMID: 28609401 DOI: 10.1097/qad.0000000000001563] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES HIV infection places children at neurodevelopmental risk; for young children in poverty, risk is compounded by compromised caregiving quality. The mediational intervention for sensitizing caregivers (MISC) program trained caregivers on fostering daily interactions with young children. We hypothesized that MISC could enhance neurodevelopment of rural Ugandan HIV-infected children and improve mental health outcomes of their caregivers, which might mediate improved caregiving quality. DESIGN A randomized trial of HIV-infected young children (ages 2-5 years) and their female caregivers; cluster randomization was to MISC or a nutrition curriculum. SETTING A total of 18 geographic clusters in rural Uganda. STUDY PARTICIPANTS Children and caregivers were evaluated at baseline, 6 months, 1 year, and 1-year post-training. MAIN OUTCOME MEASURES Mullen Scales of Early Learning, the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function for the children. Caregivers completed measures of depression and anxiety symptoms and daily functioning. RESULTS MISC had a significant impact on postintervention receptive language (adjusted mean difference = 3.13, 95% confidence interval 0.08, 6.18) that persisted at 1-year follow-up. MISC caregivers reported significantly less functional impairment postprogram (adjusted mean difference = -0.15, 95% confidence interval -0.28, -0.01). Other outcomes were NS. CONCLUSION Both intervention conditions resulted in improvements in the study children over time. MISC showed additional impacts on child language and caregiver well-being. Future directions that include assessing the extent enhanced language development resulting from improved caregiving may better prepare impoverished children for school.
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164
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Designing and Implementing an Early Childhood Health and Development Program in Rural, Southwest Guatemala: Lessons Learned and Future Directions. Adv Pediatr 2017; 64:381-401. [PMID: 28688599 DOI: 10.1016/j.yapd.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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165
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Abstract
Improving maternal and child nutrition is central to global development goals and reducing the noncommunicable disease burden. Although the process of becoming malnourished starts in utero, the consequences of poor nutrition extend across the life cycle and into future generations. The global nutrition targets for 2025 include reducing infant and young child growth faltering, halting the increase of overweight children, improving breastfeeding practices, and reducing maternal anemia. In this review, we address nutritional assessment, discuss nonnutritive factors that affect growth, and endorse the evidence-based interventions that should be scaled up to improve maternal and child nutrition.
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166
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Vaivada T, Gaffey MF, Bhutta ZA. Promoting Early Child Development With Interventions in Health and Nutrition: A Systematic Review. Pediatrics 2017; 140:peds.2016-4308. [PMID: 28771408 DOI: 10.1542/peds.2016-4308] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although effective health and nutrition interventions for reducing child mortality and morbidity exist, direct evidence of effects on cognitive, motor, and psychosocial development is lacking. OBJECTIVE To review existing evidence for health and nutrition interventions affecting direct measures of (and pathways to) early child development. DATA SOURCES Reviews and recent overviews of interventions across the continuum of care and component studies. STUDY SELECTION We selected systematic reviews detailing the effectiveness of health or nutrition interventions that have plausible links to child development and/or contain direct measures of cognitive, motor, and psychosocial development. DATA EXTRACTION A team of reviewers independently extracted data and assessed their quality. RESULTS Sixty systematic reviews contained the outcomes of interest. Various interventions reduced morbidity and improved child growth, but few had direct measures of child development. Of particular benefit were food and micronutrient supplementation for mothers to reduce the risk of small for gestational age and iodine deficiency, strategies to reduce iron deficiency anemia in infancy, and early neonatal care (appropriate resuscitation, delayed cord clamping, and Kangaroo Mother Care). Neuroprotective interventions for imminent preterm birth showed the largest effect sizes (antenatal corticosteroids for developmental delay: risk ratio 0.49, 95% confidence interval 0.24 to 1.00; magnesium sulfate for gross motor dysfunction: risk ratio 0.61, 95% confidence interval 0.44 to 0.85). LIMITATIONS Given the focus on high-quality studies captured in leading systematic reviews, only effects reported within studies included in systematic reviews were captured. CONCLUSIONS These findings should guide the prioritization and scale-up of interventions within critical periods of early infancy and childhood, and encourage research into their implementation at scale.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; and .,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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167
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Emerson JA, Tol W, Caulfield LE, Doocy S. Maternal Psychological Distress and Perceived Impact on Child Feeding Practices in South Kivu, DR Congo. Food Nutr Bull 2017. [PMID: 28627261 DOI: 10.1177/0379572117714385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maternal mental health problems are associated with poor child growth and suboptimal child feeding practices, yet little qualitative research has been conducted to understand mothers' perceptions about how maternal mental ill health and child nutrition are related. OBJECTIVE The objective of the study was to understand maternal perceptions on sources of psychological distress, and how distress impacts functioning, especially related to childcare and feeding practices among mothers of young children in South Kivu, DR Congo. METHODS Mothers of young children who were participating in a larger study were eligible. Using purposive sampling, participants were selected if they had high or low levels of psychological distress, based on their mean item score on measures of symptoms of depression, anxiety, and post-traumatic stress. Twenty in-depth interviews and 2 focus group discussions were conducted, with a total of 35 mothers. Key informant interviews were conducted with 5 local health workers. Audio recordings were transcribed and coded, and the analysis was guided by Grounded Theory methodology. RESULTS Major themes to emerge were that women's husbands were a significant source of distress, with husbands' infidelity, abandonment, and lack of financial support mentioned by participants. Psychological distress resulted in appetite and weight loss, and poor nutritional status made it difficult to breastfeed. Participants perceived psychological distress caused milk insufficiency and difficulty breastfeeding. CONCLUSION Mothers experiencing psychological distress may need greater support for maternal nutrition and breastfeeding, and engaging fathers through responsible parenting interventions may reduce psychological distress and have a positive impact on child health.
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Affiliation(s)
- Jillian A Emerson
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Peter C. Alderman Foundation, New York, NY, USA
| | - Laura E Caulfield
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shannon Doocy
- 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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168
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Abstract
This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.
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Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC 20006;
| | - Lia Fernald
- Community Health Sciences, School of Public Health, University of California, Berkeley, California 94720;
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169
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Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annu Rev Clin Psychol 2017; 13:149-181. [PMID: 28482687 PMCID: PMC5506549 DOI: 10.1146/annurev-clinpsy-032816-045217] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2-3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36-0.62), favoring intervention conditions. Our review demonstrates that psychological treatments-comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource-have moderate to strong effects in reducing the burden of common mental disorders.
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Affiliation(s)
- Daisy R Singla
- Sinai Health Network, Toronto, Ontario, Canada M5G 1X5
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada M5T 1R8;
| | - Brandon A Kohrt
- Duke Global Health Institute, Department of Psychiatry, Duke University, Durham, North Carolina 27710;
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205;
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California 90095;
| | - Vikram Patel
- Sangath, Goa, India 403501;
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115;
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon India 122022
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170
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Boothby N, Mugumya F, Ritterbusch AE, Wanican J, Bangirana CA, Pizatella AD, Busi S, Meyer S. Ugandan households: A Study of parenting practices in three districts. CHILD ABUSE & NEGLECT 2017; 67:157-173. [PMID: 28273491 DOI: 10.1016/j.chiabu.2017.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/19/2017] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
Ugandan households play a central role in child care and protection, and household-level practices influence the ways in which children are protected from adversities. This study was designed to identify community perceptions of protective and harmful parenting practices in three districts in Uganda. It employed free-listing interviews to determine priorities and practices deemed to be important in providing care and protection to children. Findings suggest that parenting practices can be grouped into seven basic themes, which are: Investing in children's future, Protection, Care, Enterprising, Relationship with neighbors, Intimate partner relationship, and Child Rearing. Investing in children's future, including educating children, was cited most often as a hallmark of positive parenting; while failure to care for children was most often cited as a hallmark of negative parenting. Concrete behaviors, such as walking a daughter to school; sewing a son's torn pants before going to church; and structuring study time at home were identified as concrete actions Ugandan parents undertake daily to promote their children's well-being. Conversely, specific contextual aspects of neglect and abuse were identified as central components of negative parenting, including lack of investment in children's education and not serving as a good role model. Building on community strengths is recommended as a principal means of enhancing household resilience and reducing childhood risk.
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Affiliation(s)
- Neil Boothby
- Mailman School of Public Health, Columbia University, 60 Haven Ave B-4, New York, NY 10032, USA.
| | - Firminus Mugumya
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-7823-51444, Uganda.
| | - Amy E Ritterbusch
- School of Government, Universidad de los Andes, Cra. 1 No. 19-27, EdificioAulas, Bogotá 57-3138783502, Colombia.
| | - Joyce Wanican
- Centre for the Study of the African Child, College of Humanities and Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-0792-666610, Uganda.
| | - Clare Ahabwe Bangirana
- AfriChild Centre for the Study of the African Child, College of Humanities and Social Sciences, Makerere University, P.O. Box 7062, Kampala 256-0792-666610, Uganda.
| | - Adrienne D Pizatella
- Program on Forced Migration and Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue B-4, New York, NY 10032 304-657-9500, USA.
| | - Sophie Busi
- AfriChild Centre for the Study of the African Child, P.O. Box 21378, Kampala 256-7516-00618, Uganda.
| | - Sarah Meyer
- Mailman School of Public Health, Columbia University, 60 Haven Ave B-4, New York, NY 10032, USA.
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171
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Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017; 389:951-963. [PMID: 28271846 PMCID: PMC5491333 DOI: 10.1016/s0140-6736(17)30402-6] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Abstract
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.
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Affiliation(s)
- Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA.
| | - Brandon A Kohrt
- Department of Psychiatry, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Foundation, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
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172
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Liu Y, Kaaya S, Chai J, McCoy DC, Surkan PJ, Black MM, Sutter-Dallay AL, Verdoux H, Smith-Fawzi MC. Maternal depressive symptoms and early childhood cognitive development: a meta-analysis. Psychol Med 2017; 47:680-689. [PMID: 27834159 DOI: 10.1017/s003329171600283x] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis. METHOD Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted. RESULTS The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = -0.25, 95% CI -0.39 to -0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6-8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = -4.17, 95% CI -8.01 to -0.32). CONCLUSIONS The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.
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Affiliation(s)
- Y Liu
- Department of Global Health and Social Medicine,Harvard Medical School,Boston MA,USA
| | - S Kaaya
- School of Medicine, Muhimbili University of Health and Allied Sciences,Dar es Salaam,Tanzania
| | - J Chai
- Department of Global Health and Population,Harvard T. H. Chan School of Public Health,Boston MA,USA
| | - D C McCoy
- Graduate School of Education, Harvard University,Cambridge MA,USA
| | - P J Surkan
- Department of International Health,Johns Hopkins Bloomberg School of Public Health,Baltimore MD,USA
| | - M M Black
- Department of Pediatrics,University of Maryland School of Medicine,Baltimore MD,USA
| | | | - H Verdoux
- INSERM,U1219, F-33000 Bordeaux,France
| | - M C Smith-Fawzi
- Department of Global Health and Social Medicine,Harvard Medical School,Boston MA,USA
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173
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Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, Devercelli AE, Wodon QT, Vargas-Barón E, Grantham-McGregor S. Early childhood development coming of age: science through the life course. Lancet 2017; 389:77-90. [PMID: 27717614 PMCID: PMC5884058 DOI: 10.1016/s0140-6736(16)31389-7] [Citation(s) in RCA: 1174] [Impact Index Per Article: 167.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 12/19/2022]
Abstract
Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Park, NC, USA.
| | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Chunling Lu
- Division of Global Health Equity, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Boston, MA, USA
| | - Günther Fink
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yusra R Shawar
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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174
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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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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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176
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Black RE, Levin C, Walker N, Chou D, Liu L, Temmerman M. Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition. Lancet 2016; 388:2811-2824. [PMID: 27072119 DOI: 10.1016/s0140-6736(16)00738-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention). Scaling up all interventions in these packages from coverage in 2015 to hypothetically immediately achieve 90% coverage would avert 149 000 maternal deaths, 849 000 stillbirths, 1 498 000 neonatal deaths, and 1 515 000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of a Reproductive Health package, meeting 90% of the unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at 2015 rates of fertility and mortality. Thus, 67 000 maternal deaths, 440 000 neonatal deaths, 473 000 child deaths, and 564 000 stillbirths could be averted from avoided pregnancies. Particularly effective interventions in the Maternal and Newborn Health and Child Health packages would be management of labour and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centres, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be US$6·2 billion in low-income countries, $12·4 billion in lower-middle-income countries, and $8·0 billion in upper-middle-income countries. With the additional funding, greater focus on high-effect integrated interventions and innovations in service delivery, such as task shifting to other groups of health workers and supply and demand incentives, can help rectify major gaps in accessibility and quality of care. In recent decades, reduction of avoidable maternal and child deaths has been a global priority. With continued priority and expansion of essential reproductive, maternal, newborn, and child health interventions to high coverage, equity, and quality, as well as interventions to address underlying problems such as women's low status in society and violence against women, these deaths and substantial morbidity can be largely eliminated in another generation.
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Affiliation(s)
- Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Li Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marleen Temmerman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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177
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dos Santos Pinto G, de Ávila Quevedo L, Britto Correa M, Sousa Azevedo M, Leão Goettems M, Tavares Pinheiro R, Demarco FF. Maternal Depression Increases Childhood Dental Caries: A Cohort Study in Brazil. Caries Res 2016; 51:17-25. [DOI: 10.1159/000449040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/09/2016] [Indexed: 11/19/2022] Open
Abstract
Aim: To investigate the relationship between maternal depression and childhood caries in a cohort of adolescent mothers. Methods: This cross-sectional study nested in a cohort evaluated a sample of 538 mother/child dyads. When the children were 24-36 months of age, data regarding oral health from children and mothers were collected by clinical dental examination. A mother's major depressive disorder was assessed by using the Mini International Neuropsychiatric Interview (MINI [Plus]), at the current moment. Independent variables were obtained by using questionnaires. The outcome on dental caries experience was dichotomized by using 2 cut points: dmfs ≥1 and dmfs ≥3. Poisson regression analysis, using a hierarchical approach, was applied to assess the association between major depressive disorder in mothers with and those without caries experience and the outcome. Results: The prevalence of dental caries in children was 15.1% (n = 82). The mean dmfs index was 1.12 (SD = 3.72). The prevalence of major depressive disorder was 32.6% (n = 168). An interaction between caries status and depressive disorder was found, and after adjusted analysis, children from mothers with major depressive disorder with negative caries experience presented a higher caries prevalence (prevalence ratio 4.00, 95% confidence interval 1.29-12.41). Conclusion: Our findings suggest that maternal psychiatric disorders could have a negative impact on children's oral health.
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178
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Rockers PC, Fink G, Zanolini A, Banda B, Biemba G, Sullivan C, Mutembo S, Silavwe V, Hamer DH. Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Glob Health 2016; 1:e000104. [PMID: 28588962 PMCID: PMC5321359 DOI: 10.1136/bmjgh-2016-000104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Community-based programmes are a critical platform for improving child health and development. We tested the impact of a community-based early childhood intervention package in rural Zambia. METHODS We conducted a non-blinded cluster randomised controlled trial in Southern Province, Zambia. 30 clusters of villages were matched based on population density and distance from the nearest health centre, and randomly assigned to intervention (15 clusters and 268 caregiver-child dyads) or control (15 clusters and 258 caregiver-child dyads). Caregivers were eligible if they had a child aged 6-12 months at baseline. In intervention clusters, health workers screened children for infections and malnutrition, and invited caregivers to attend fortnightly group meetings covering a nutrition and child development curriculum. 220 intervention and 215 control dyads were evaluated after 1 year. The primary outcomes were stunting and INTERGROWTH-21st neurodevelopmental assessment (NDA) scores. Weight-for-age and height-for-age z-scores based on WHO growth standards were also analysed. Secondary outcomes were child illness symptoms, dietary intake and caregiver-child interactions based on self-report. Impact was estimated using intention-to-treat analysis. RESULTS The intervention package was associated with a 0.12 SD increase in weight-for-age (95% CI -0.14 to 0.38), a 0.15 SD increase in height-for-age (95% CI -0.18 to 0.48) and a reduction in stunting (OR 0.68; 95% CI 0.36 to 1.28), whereas there was no measurable impact on NDA score. Children receiving the intervention package had fewer symptoms, a more diverse diet and more caregiver interactions. CONCLUSIONS In settings like Zambia, community-based early childhood programmes appear to be feasible and appreciated by caregivers, as evidenced by high rates of uptake. The intervention package improved parenting behaviours and had a small positive, though statistically insignificant, impact on child development. Given the short time frame of the project, larger developmental impact is likely if differential parenting behaviours persist. TRIAL REGISTRATION NUMBER NCT02234726; Results.
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Affiliation(s)
- Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Günther Fink
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Arianna Zanolini
- American Institutes for Research, Washington, District of Columbia, USA
| | - Bowen Banda
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Godfrey Biemba
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Cierra Sullivan
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Colorado, USA
| | | | | | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
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179
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Hua J, Zhu L, Du W, Du L, Luo T, Wu Z. Infant's sex, birth control policy and postpartum well-being: a prospective cohort study in Shanghai, China. BMJ Open 2016; 6:e012207. [PMID: 27855096 PMCID: PMC5073912 DOI: 10.1136/bmjopen-2016-012207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The majority of Chinese families were under either one-child or two-child birth control policy status from 2001 to 2015. We explore the association between an infant's sex and the mother's postpartum well-being, which may be moderated by birth control policy status in China. SETTING AND PARTICIPANTS We conducted a prospective cohort study in Shanghai City, one of the largest cities in China. A total number of 1730 childbearing women from eight obstetric hospitals across Shanghai were included in the study at baseline, with 1503 women completing the survey 7 days postpartum in 2013. MEASURES The General Well-Being Schedule (GWBS) was used to assess maternal well-being at baseline and follow-up investigation in the study. The women's demographic, clinical characteristics, and well-being were measured at baseline. Maternal satisfaction and postpartum well-being were assessed in the follow-up survey. RESULTS Multivariable linear regression analyses showed that women who gave birth to male infants were positively associated with the total score of maternal well-being, when the participating hospitals, maternal well-being at baseline, sociodemographic characteristics, and maternal and infant health outcomes were added to the adjustments (β=1.462, p<0.05). The association disappeared when the two-child policy status was added to the adjustments (p>0.05). The results of a multiple logistic regression model showed that having a male infant was a risk factor of 'severe distress' (OR=1.607, p<0.05), which was moderated by the two-child policy status (p>0.05). CONCLUSIONS Our results emphasise the importance of conducting interventions to increase maternal general well-being, especially for those with a female infant in a society such as China where preference is for a son, and enhance the necessity of sustainability of a newly relaxed two-child policy which allows more couples to have a second child in China.
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Affiliation(s)
- Jing Hua
- Department of Shanghai First Maternity and Infant Hospital, The Women and Children's Health Care, Tongji University School of Medicine, Shanghai, China
| | - Liping Zhu
- The Research Office of Shanghai Maternity and Child Health Care Center, Shanghai, China
| | - Wenchong Du
- Psychology Division, Nottingham Trent University, Nottingham, UK
| | - Li Du
- The Research Office of Shanghai Maternity and Child Health Care Center, Shanghai, China
| | - Ting Luo
- Department of Public health School, Health Statistics and Social Medicine, Fudan University, Shanghai, China
| | - Zhuochun Wu
- Department of Public health School, Health Statistics and Social Medicine, Fudan University, Shanghai, China
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180
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Herba CM, Glover V, Ramchandani PG, Rondon MB. Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries. Lancet Psychiatry 2016; 3:983-992. [PMID: 27650772 DOI: 10.1016/s2215-0366(16)30148-1] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
Studies examining mechanisms underlying associations between maternal depression and adverse child outcomes (including behaviour, socioemotional adjustment, and emotion regulation) indicate that during pregnancy, maternal depression could affect child outcomes through altered placental function, epigenetic changes in the child, and stress reactivity. Infection and dietary deficiencies in the mother and the child, together with the child's genetic vulnerability, might also affect outcome. Postnatally, associations between maternal depression and child outcome are influenced by altered mother-child interactions, sociodemographic or environmental influences, and social support. Knowledge is scarce on mechanisms in low-income and middle-income countries where maternal depression is highly prevalent, and stressful factors that influence the development of perinatal maternal depression and adverse child outcome (eg, food insecurity, perinatal infections, crowded or rural living conditions, and interpersonal violence) are both more intense and more common than in high-income countries. We reviewed evidence and use the biopsychosocial model to illustrate risk factors, mediators and moderators underlying associations between maternal depression and child outcomes in low-income and middle-income countries.
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Affiliation(s)
- Catherine M Herba
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada; CHU Sainte-Justine Research Center, Montréal, QC, Canada.
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | - Marta B Rondon
- Mental Health and Psychiatry Unit, Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
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181
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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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182
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Muhoozi GKM, Atukunda P, Mwadime R, Iversen PO, Westerberg AC. Nutritional and developmental status among 6- to 8-month-old children in southwestern Uganda: a cross-sectional study. Food Nutr Res 2016; 60:30270. [PMID: 27238555 PMCID: PMC4884678 DOI: 10.3402/fnr.v60.30270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Undernutrition continues to pose challenges to Uganda's children, but there is limited knowledge on its association with physical and intellectual development. OBJECTIVE In this cross-sectional study, we assessed the nutritional status and milestone development of 6- to 8-month-old children and associated factors in two districts of southwestern Uganda. DESIGN Five hundred and twelve households with mother-infant (6-8 months) pairs were randomly sampled. Data about background variables (e.g. household characteristics, poverty likelihood, and child dietary diversity scores (CDDS)) were collected using questionnaires. Bayley Scales of Infant and Toddler Development (BSID III) and Ages and Stages questionnaires (ASQ) were used to collect data on child development. Anthropometric measures were used to determine z-scores for weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), head circumference (HCZ), and mid-upper arm circumference. Chi-square tests, correlation coefficients, and linear regression analyses were used to relate background variables, nutritional status indicators, and infant development. RESULTS The prevalence of underweight, stunting, and wasting was 12.1, 24.6, and 4.7%, respectively. Household head education, gender, sanitation, household size, maternal age and education, birth order, poverty likelihood, and CDDS were associated (p<0.05) with WAZ, LAZ, and WLZ. Regression analysis showed that gender, sanitation, CDDS, and likelihood to be below the poverty line were predictors (p<0.05) of undernutrition. BSID III indicated development delay of 1.3% in cognitive and language, and 1.6% in motor development. The ASQ indicated delayed development of 24, 9.1, 25.2, 12.2, and 15.1% in communication, fine motor, gross motor, problem solving, and personal social ability, respectively. All nutritional status indicators except HCZ were positively and significantly associated with development domains. WAZ was the main predictor for all development domains. CONCLUSION Undernutrition among infants living in impoverished rural Uganda was associated with household sanitation, poverty, and low dietary diversity. Development domains were positively and significantly associated with nutritional status. Nutritional interventions might add value to improvement of child growth and development.
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Affiliation(s)
- Grace K M Muhoozi
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Human Nutrition and Home Economics, Kyambogo University, Kampala, Uganda;
| | - Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Robert Mwadime
- School of Food Technology, Nutrition and Bioengineering, Makerere University, Kampala, Uganda
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Oslo, Norway
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183
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Tinajero AR, Cohen NJ, Ametorwo S. No data, no problem, no action: parenting programs in low-income countries. Making the social-emotional outcomes more visible. Child Care Health Dev 2016; 42:117-24. [PMID: 26547387 DOI: 10.1111/cch.12301] [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: 03/19/2015] [Revised: 08/23/2015] [Accepted: 09/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parenting programs are delivered in many low income countries in an effort to address the effects of insufficient cognitive stimulation, major social-emotional risk factors related to inadequate caregiver sensitivity and responsiveness, maternal depression, violence and biological risk factors. However, the outcomes of these programs are often untested because of methodological limitations in the existing evaluation tools available for cross-cultural research, and especially those related to social-emotional development and functioning. METHOD This study takes an approach that involves organizing data from focus groups collected following caregiver participation in a parenting program, Learning Through Play (LTP) delivered in 11 low income countries. The LTP program has as its aim to increase parent knowledge and influence parental practice regarding the essential components of early development of children aged birth to 6 years. The purpose of systematically organizing focus group data was to illustrate a means by which program developers worldwide can discuss outcomes of program participation, particularly in social-emotional domains that have been overlooked in past studies on parenting programs. RESULTS AND CONCLUSION The findings from this study suggest that qualitative outcome data can be organized to make the social-emotional outcomes of participation in parenting programs more visible.
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Affiliation(s)
- A R Tinajero
- The Hincks-Dellcrest Centre and the Hincks Dellcrest Institute, Toronto, Canada
| | - N J Cohen
- The Hincks-Dellcrest Centre and the Hincks Dellcrest Institute, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - S Ametorwo
- The Hincks-Dellcrest Centre and the Hincks Dellcrest Institute, Toronto, Canada
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Singla DR, Kumbakumba E. The development and implementation of a theory-informed, integrated mother-child intervention in rural Uganda. Soc Sci Med 2015; 147:242-51. [PMID: 26605968 DOI: 10.1016/j.socscimed.2015.10.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/22/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
RATIONALE A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12-36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up. OBJECTIVES The objectives of this study were to describe and critically examine (a) perceived barriers and facilitators related to implementation processes of intervention content, training and supervision and delivery from the perspectives of delivery agents and supervisors; (b) perceived barriers and facilitators related to enactment of practices from the perspective of intervention mothers participating in the parenting program; and c) whether the program was implemented as intended. METHODS Semi-structured interviews were conducted at midline with peer delivery agents (n = 12) and intervention mothers (n = 31) and at endline with supervisors (n = 4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators of intervention content, training and supervision, delivery and enactment. Additionally, mothers' recall and enactment of practices were coded and analyzed statistically. Monitoring of group sessions and home visits were examined to reveal whether the program was implemented as intended. RESULTS Among the program's five key messages, 'love and respect' targeting maternal psychological well-being was the most practiced by mothers, easiest to implement by delivery agents, and mothers reported the most internal facilitators for this message. A detailed manual and structured monitoring forms were perceived to facilitate training, intervention delivery, and supervision. Interactive and active strategies based on social-cognitive learning theory were reported as facilitators to intervention delivery. Only program attendance, but not barriers, facilitators or message recall, was significantly positively related to message enactment. Monitoring of group sessions and home visits showed that the program was largely implemented as intended. CONCLUSIONS This implementation assessment revealed a number of important barriers and facilitators from the perspectives of delivery agents, supervisors and program participants. The methods and results are useful to examining and informing the content, delivery, and scaling up of the current program as well as future mother-child interventions in LMIC settings.
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Affiliation(s)
- Daisy R Singla
- Department of Psychology, McGill University, 1205 Avenue Docteur Penfield, Montreal, Quebec H3A-1B1, Canada.
| | - Elias Kumbakumba
- Department of Paediatric & Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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185
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Black MM, Surkan PJ. Child development and maternal wellbeing: family perspectives for low-income and middle-income countries. LANCET GLOBAL HEALTH 2015; 3:e426-e427. [PMID: 26144388 DOI: 10.1016/s2214-109x(15)00084-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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