1
|
Jiang Z, Song C, Shi M, Chen R, Hong Y, Zhang C, Zheng W, Hu B, Wang L, Zhang Y. Effect of Customized Nutritious Breakfast and Nutrition Education on Nutritional Status of Preschool Children in Economically Underdeveloped Multi-Ethnic Areas: A Cluster Randomized Clinical Trial in Linxia, China. Nutrients 2024; 16:2287. [PMID: 39064730 PMCID: PMC11280342 DOI: 10.3390/nu16142287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The nutritional status of preschool children in economically underdeveloped multi-ethnic areas is a global concern. This study aimed to examine the effect of a 2.2-year cluster randomized clinical trial that provided customized nutritious breakfast and nutrition education to preschool children in Linxia County, China. A total of 578 children aged 3 to 6 years were enrolled. After the intervention, the incidence of undernourishment was significantly lower in the intervention group compared to the control group (8.73% vs. 9.92%, OR = 0.01 [95%CI 0.00, 0.39], p = 0.014). Additionally, children with non-Muslim dietary habits had a lower incidence of undernourishment compared to those with Muslim dietary habits (OR = 0.05 [95%CI 0.00, 0.88]; p = 0.010). The intervention group also had a lower prevalence rate of wasting (OR = 0.02 [95%CI 0.00, 0.40]; p = 0.011) and a higher mean BMI-for-age Z-score (β = 1.05 [95%CI 0.32, 1.77]; p = 0.005) compared to the control group. These findings suggest that providing nutritious breakfast and nutrition education is an effective strategy to improve the nutrition and health of preschool children, particularly in economically disadvantaged regions and among children with Muslim dietary habits.
Collapse
Affiliation(s)
- Zhongquan Jiang
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| | - Chao Song
- Department of Developmental and Behavioral Pediatrics, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou 310051, China
| | - Mingxuan Shi
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| | - Runtong Chen
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| | - Ying Hong
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| | - Chong Zhang
- Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, China
| | - Wenhao Zheng
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA
| | - Binshuo Hu
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA
| | - Ying Zhang
- School of Public Health, Lanzhou University, 222 South Tianshui Road, Lanzhou 730000, China; (Z.J.)
| |
Collapse
|
2
|
Palmer T, Clare A, Fearon P, Head R, Hill Z, Kagone B, Kirkwood B, Manu A, Skordis J. Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso. BMJ Open 2024; 14:e080905. [PMID: 38626956 PMCID: PMC11029498 DOI: 10.1136/bmjopen-2023-080905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Approximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive, labour intensive and challenging to deliver at scale. Mass media may offer an alternative approach to ECD intervention. This protocol describes the planned economic evaluation of a cluster-randomised controlled trial of a radio campaign promoting responsive caregiving and opportunities for early learning during the first 3 years of life in rural Burkina Faso (SUNRISE trial). METHODS AND ANALYSIS The economic evaluation of the SUNRISE trial will be conducted as a within-trial analysis from the provider's perspective. Incremental costs and health outcomes of the radio campaign will be compared with standard broadcasting (ie, 'do nothing' comparator). All costs associated with creating and broadcasting the radio campaign during intervention start-up and implementation will be captured. The cost per child under 3 years old reached by the intervention will be calculated. Incremental cost-effectiveness ratios will be calculated for the trial's primary outcome (ie, incremental cost per SD of cognitive gain). A cost-consequence analysis will also be presented, whereby all relevant costs and outcomes are tabulated. Finally, an analysis will be conducted to assess the equity impact of the intervention. ETHICS AND DISSEMINATION The SUNRISE trial has ethical approval from the ethics committees of the Ministry of Health, Burkina Faso, University College London and the London School of Hygiene and Tropical Medicine. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference. TRIAL REGISTRATION NUMBER The SUNRISE trial was registered with ClinicalTrials.gov on 19 April 2019 (identifier: NCT05335395).
Collapse
Affiliation(s)
| | | | | | - Roy Head
- Development Media International, London, UK
| | | | | | | | - Alexander Manu
- London School of Hygiene and Tropical Medicine, London, UK, London, UK
| | | |
Collapse
|
3
|
Kakwangire P, Muhoozi G, Ngari M, Matovu N, Westerberg AC, Iversen PO, Atukunda P. 8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting. Pediatrics 2024; 153:e2023063352. [PMID: 38505933 DOI: 10.1542/peds.2023-063352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n = 263; control, n = 248), whereas in the current study, 361 (71%; intervention, n = 185; control, n = 176) pairs were available for analyses. RESULTS The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12-16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.
Collapse
Affiliation(s)
- Paul Kakwangire
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
| | - Grace Muhoozi
- Department of Nutritional Sciences and Dietetics, Kyambogo University, Kampala, Uganda
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya and Department of Public Health, School of Health & Human Sciences, Pwani University, Kilifi, Kenya
| | - Nicholas Matovu
- Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University, Belfast, UK
| | - Ane Cecilie Westerberg
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Per Ole Iversen
- Department of Nutrition, IMB, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Tygerberg, South Africa
| | - Prudence Atukunda
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
4
|
Bulgarelli C, Blasi A, McCann S, Milosavljevic B, Ghillia G, Mbye E, Touray E, Fadera T, Acolatse L, Moore SE, Lloyd-Fox S, Elwell CE, Eggebrecht AT. Growth in early infancy drives optimal brain functional connectivity which predicts cognitive flexibility in later childhood. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.02.573930. [PMID: 38260280 PMCID: PMC10802370 DOI: 10.1101/2024.01.02.573930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Functional brain network organization, measured by functional connectivity (FC), reflects key neurodevelopmental processes for healthy development. Early exposure to adversity, e.g. undernutrition, affects neurodevelopment, observable via disrupted FC, and leads to poorer outcomes from preschool age onward. We assessed longitudinally the impact of early growth trajectories on developmental FC in a rural Gambian population from age 5 to 24 months. To investigate how these early trajectories relate to later childhood outcomes, we assessed cognitive flexibility at 3-5 years. We observed that early physical growth before the fifth month of life drove optimal developmental trajectories of FC that in turn predicted cognitive flexibility at pre-school age. In contrast to previously studied developmental populations, this Gambian sample exhibited long-range interhemispheric FC that decreased with age. Our results highlight the measurable effects that poor growth in early infancy has on brain development and the subsequent impact on pre-school age cognitive development, underscoring the need for early life interventions throughout global settings of adversity.
Collapse
Affiliation(s)
- Chiara Bulgarelli
- Centre for Brain and Cognitive Development, Birkbeck, University of London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Anna Blasi
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Samantha McCann
- Department of Women and Children’s Health, King’s College London, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Bosiljka Milosavljevic
- Department of Psychology, University of Cambridge, UK
- School of Biological and Experimental Psychology, Queen Mary University of London, UK
| | - Giulia Ghillia
- Department of Women and Children’s Health, King’s College London, UK
| | - Ebrima Mbye
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Ebou Touray
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Tijan Fadera
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Lena Acolatse
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
- Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Ireland
| | - Sophie E. Moore
- Department of Women and Children’s Health, King’s College London, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | | | - Clare E. Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Adam T. Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, USA
| | - BRIGHT Study Team
- The BRIGHT team are (in alphabetic order): Muhammed Ceesay, Kassa Kora, Fabakary Njai, Andrew Prentice, Mariama Saidykhan
| |
Collapse
|
5
|
Smith JA, Powell CA, Chang SM, Ganga E, Tanyanyiwa H, Walker SP. A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe. Child Care Health Dev 2024; 50:e13189. [PMID: 37882173 DOI: 10.1111/cch.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.
Collapse
Affiliation(s)
- Joanne A Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Christine A Powell
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Susan M Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Emily Ganga
- Robert Mugabe School of Education and Culture, Great Zimbabwe University, Masvingo, Zimbabwe
| | | | - Susan P Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| |
Collapse
|
6
|
Hartinger Pena SM, Mäusezahl D, Jäggi L, Aguilar L, Alvarado Llatance M, Castellanos A, Huaylinos Bustamante ML, Hinckley K, Charles McCoy D, Zhang C, Fink G. Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50371. [PMID: 38096020 PMCID: PMC10755649 DOI: 10.2196/50371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. OBJECTIVE The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. METHODS This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. RESULTS Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. CONCLUSIONS This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. TRIAL REGISTRATION ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50371.
Collapse
Affiliation(s)
- Stella Maria Hartinger Pena
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Lena Jäggi
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Leonel Aguilar
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | | | | | | | - Kristen Hinckley
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Ce Zhang
- Institute for Computing Platforms, Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Gaidhane A, Khatib MN, Telrandhe S, Patil M, Kogade P, Gaidhane S, Choudhari SG, Holding PA, Saxena D, Syed ZQ. Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT. Front Public Health 2023; 11:1165728. [PMID: 38035279 PMCID: PMC10682778 DOI: 10.3389/fpubh.2023.1165728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
Background To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children. Methods Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months. Findings At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%. Interpretations The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program. Funding The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).
Collapse
Affiliation(s)
- Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Manoj Patil
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Priti Kogade
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Sonali G. Choudhari
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Penny A. Holding
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Zahiruddin Quazi Syed
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- South Asia Infant Feeding Research Network (SAIFRN), School of Epidemiology and Public Health, Wardha, Maharashtra, India
| |
Collapse
|
8
|
Toh JY, Cai S, Lim SX, Pang WW, Godfrey KM, Shek LP, Tan KH, Yap F, Lee YS, Chong YS, Eriksson JG, Broekman BFP, Rifkin-Graboi A, Chong MFF. Nutrient trajectories during infancy and their associations with childhood neurodevelopment. Eur J Nutr 2023; 62:2429-2439. [PMID: 37118033 DOI: 10.1007/s00394-023-03164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study. METHODS One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression. RESULTS At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months. CONCLUSION Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.
Collapse
Affiliation(s)
- Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Centre and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, UK
| | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Birit F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Psychiatry, OLVG and Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Anne Rifkin-Graboi
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
| |
Collapse
|
9
|
Anago R, Forzy T, Guei S, Pelras C, Ramde S, Tevenart C, Vera Rueda J, Macours K. Piloting, testing and scaling parental training: a multi-partnership approach in Côte d'Ivoire. Front Public Health 2023; 11:1106565. [PMID: 37655283 PMCID: PMC10466389 DOI: 10.3389/fpubh.2023.1106565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Background and objectives Early Childhood Development is high on the policy agenda in Côte d'Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how "MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale," one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of "How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)? Methods Five training approaches to improve caregivers' knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD. Results The evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation. Conclusion The iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis.
Collapse
Affiliation(s)
- Romuald Anago
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Sosthene Guei
- Transformer L’éducation Dans Les Communautés de Cacao, Abidjan, Côte d'Ivoire
| | | | - Samuel Ramde
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | | | - Karen Macours
- Paris School of Economics, Paris, France
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), Paris, France
| |
Collapse
|
10
|
Coore-Hall J, Smith J, Kelly M, Baker-Henningham H, Chang S, Walker S. Using lessons learnt from key stakeholders to increase support for scaling the Reach Up Early Childhood Parenting program. Front Public Health 2023; 11:1151826. [PMID: 37614447 PMCID: PMC10442950 DOI: 10.3389/fpubh.2023.1151826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Sustainable implementation of early childhood programs requires resources, materials and methods that are adaptable, scalable and feasible for delivery through multiple sectors. Additional or modified program resources may be required to meet emerging needs, as programs go to scale. An active and effective monitoring, evaluation and learning (MEL) process may enable programs to be responsive to demands. The Reach Up: Early Childhood Parenting program, is designed primarily for disadvantaged children under 4 years of age in low- and middle-income countries (LMICs) to promote their development through playful caregiver interactions. The curriculum, training manuals and other materials and resources support implementers in the adaptation of the intervention, implementation, workforce training, monitoring and evaluation. This paper reports on how data collected from key informants drove modifications to program processes, materials and resources. Methods We conducted in-depth interviews with 14 key informants (including program managers, lead trainers, academics, consultants and workforce personnel) on their experiences with Reach Up across 15 LMICs where the program has been implemented. We also reviewed written records generated from (i) structured small group discussions at a Knowledge Exchange meeting of 31 Reach Up partners and (ii) notes from working groups formed at the meeting and tasked to continue working post-meeting to find solutions to support ongoing implementation. The transcripts from the in-depth interviews and the meeting records were analysed using thematic analysis with a mixture of pre-defined categories and data-driven sub-themes. Results The main findings indicated that there was a need to: (i) develop advocacy and communication resources and materials to aid prospective implementers and other stakeholders, to make decisions for implementation, (ii) revise and/or add to the content and format of the curriculum and add content in the training and other supporting manuals and (iii) enhance the training process. Conclusion The feedback from the key global partners informed the development of new knowledge materials, resources and processes and modifications to existing program materials and resources. These will help to support advocacy, ongoing implementations, and the process of transitioning the Reach Up early childhood intervention to scale.
Collapse
Affiliation(s)
- Jacqueline Coore-Hall
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Joanne Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | - Helen Baker-Henningham
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
| | - Susan Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
11
|
Hossain SJ, Tofail F, Mehrin SF, Hamadani JD. Six-Year Follow-up of Childhood Stimulation on Development of Children With and Without Anemia. Pediatrics 2023; 151:191217. [PMID: 37125884 DOI: 10.1542/peds.2023-060221e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previously, in 30 Bangladeshi villages, 2 groups of children with iron-deficiency anemia (IDA) and nonanemic (NA) iron sufficiency aged 6 to 24 months participated in 2 parallel cluster randomized controlled trials of the effect of psychosocial stimulation on neurodevelopment. The intervention was composed of weekly play sessions at home for 9 months. All children with anemia received iron treatment of 6 months. The intervention improved the mental development of NA but not IDA groups. Six years after end line when the children were aged 8 to 9 years, we aimed to determine if benefits were sustained in the NA group or late-onset benefits emerged in the IDA group. METHODS We relocated 372 (90%) of the initial 412 children from all the clusters (villages), and assessed their IQ with the Wechsler Abbreviated Scale of Intelligence-II, motor development, and school achievement including math, spelling, and reading. Analyses were by intention-to-treat, adjusting for clustering. RESULTS There was a significant interaction between anemia groups (IDA/NA) and intervention on IQ. The intervention benefitted the NA group's Full-Scale IQ (effect size, 0.43 [95% confidence interval, 0.08-0.79]) and Perceptual Reasoning Index (effect size, 0.48 [95% confidence interval, 0.08-0.89]) but did not affect the IDA group's outcomes. No other outcomes were significant. CONCLUSIONS The benefits from early childhood psychosocial stimulation on the NA group's IQ, 6 years after intervention ended, adds to the limited evidence on the sustainability of benefits in low- and middle-income countries. Reasons for lack of effect in children with anemia are unknown.
Collapse
Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fahmida Tofail
- Nutrition and Clinical Science Division, icddr,b, Dhaka, Bangladesh
| | | | | |
Collapse
|
12
|
Jervis P, Coore-Hall J, Pitchik HO, Arnold CD, Grantham-McGregor S, Rubio-Codina M, Baker-Henningham H, Fernald LCH, Hamadani J, Smith JA, Trias J, Walker SP. The Reach Up Parenting Program, Child Development, and Maternal Depression: A Meta-analysis. Pediatrics 2023; 151:191225. [PMID: 37125892 DOI: 10.1542/peds.2023-060221d] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence is needed on effective approaches to build parents' ability to promote child development feasible in low- and middle-income countries. Our objective was to synthesize impact of the Reach Up early childhood parenting program in several low- and middle-income countries and examine moderation by family and implementation characteristics. METHODS Systematic search using PubMed and Academic Search Elite/EBSCO Host. Randomized controlled trials of the Reach Up program from 1985 to February 2022 were selected. Data were extracted by 2 independent researchers. Primary outcomes were child cognitive, language, and motor development. Secondary outcomes were home stimulation and maternal depressive symptoms. We synthesized pooled effect sizes using random effect inverse-variance weighting and effect modification by testing pooled subgroup effect estimates using the χ2 test for heterogeneity. RESULTS Average effect size across 18 studies ranged from 0.49 (95% confidence interval [CI] 0.32 to 0.66) for cognition, 0.38 (CI 0.24 to 0.51) for language, 0.27 (CI 0.13 to 0.40) for motor development, 0.37 (CI 0.21 to 0.54) for home stimulation, and -0.09 (CI -0.19 to 0.01) for maternal depressive symptoms. Impacts were larger in studies targeted to undernourished children, with mean enrollment older than age 12 months and intervention duration 6 to 12 months. Quality of evidence assessed with the Cochrane Assessment of Risk of Bias and GRADE system was moderate. Instruments used to assess child development varied. In moderator analyses, some subgroups included few studies. CONCLUSIONS Reach Up benefits child development and home stimulation and is adaptable across cultures and delivery methods. Child and implementation characteristics modified the effects, with implications for scaling.
Collapse
Affiliation(s)
- Pamela Jervis
- Universidad de Chile, Santiago, Chile
- Institute for Fiscal Studies, London, United Kingdom
| | - Jacqueline Coore-Hall
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, California
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, California
| | | | | | - Helen Baker-Henningham
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- School of Human and Behavioural Sciences, Bangor University, Bangor, Wales
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, California
| | - Jena Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Joanne A Smith
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
13
|
Fisher J, Tran T, Tran H, Luchters S, Hipgrave DB, Nguyen H, Tran T, Hanieh S, Simpson JA, Biggs BA, Tran T. Structured, multicomponent, community-based programme for women's health and infant health and development in rural Vietnam: a parallel-group cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:311-325. [PMID: 37011652 DOI: 10.1016/s2352-4642(23)00032-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Interventions to improve early childhood development have previously addressed only one or a few risk factors. Learning Clubs is a structured, facilitated, multicomponent programme designed to address eight potentially modifiable risk factors, and offered from mid-pregnancy to 12 months post partum; we aimed to establish whether this programme could improve the cognitive development of children at 2 years of age. METHODS For this parallel-group cluster-randomised controlled trial, 84 of 116 communes (the clustering unit) in HaNam Province in rural Vietnam were randomly selected and randomly assigned to receive the Learning Clubs intervention (n=42) or usual care (n=42). Women aged at least 18 years who were pregnant (gestational age <20 weeks) were eligible for inclusion. Data sources were standardised, and study-specific questionnaires assessing risks and outcomes were completed in interviews in mid-pregnancy (baseline), late pregnancy (after 32 weeks of gestation), at 6-12 months post partum, and at the end of the study period when children were 2 years of age. Mixed-effects models were used to estimate trial effects, adjusting for clustering. The primary outcome was the cognitive development of children at 2 years of age, assessed by the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) cognitive score. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000442303). FINDINGS Between April 28, 2018, and May 30, 2018, 1380 women were screened and 1245 were randomly assigned (669 to the intervention group and 576 to the control group). Data collection was completed on Jan 17, 2021. Data at the end of the study period were contributed by 616 (92%) of 669 women and their children in the intervention group, and by 544 (94%) of 576 women and their children in the control group. Children aged 2 years in the intervention group had significantly higher mean Bayley-III cognitive scores than those in the control group (99·6 [SD 9·7] vs 95·6 [9·4]; mean difference 4·00 [95% CI 2·56-5·43]; p<0·0001). At 2 years of age, 19 (3%) children in the intervention group had Bayley-III scores less than 1 SD, compared with 32 (6%) children in the control group, but this difference was not significant (odds ratio 0·55 [95% CI 0·26-1·17]; p=0·12). There were no significant differences between groups in maternal, fetal, newborn, or child deaths. INTERPRETATION A facilitated, structured, community-based, multicomponent group programme improved early childhood development to the standardised mean in rural Vietnam and could be implemented in other similarly resource-constrained settings. FUNDING Australian National Health and Medical Research Council and Grand Challenges Canada Saving Brains Initiative. TRANSLATION For the Vietnamese translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Jane Fisher
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Thach Tran
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ha Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
| | - Stanley Luchters
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David B Hipgrave
- UNICEF, New York, NY, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Hau Nguyen
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thuy Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
| | - Sarah Hanieh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Julie Anne Simpson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Beverley-Ann Biggs
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine and Victorian Infectious Diseases Service at the Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Tuan Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
| |
Collapse
|
14
|
Black MM, Walker SP, Attanasio O, Rubio-Codina M, Meghir C, Hamadani JD, Fernald LCH, Kowalski A, Grantham-McGregor S. Promoting Childhood Development Globally Through Caregiving Interventions. Pediatrics 2023; 151:191213. [PMID: 37125880 DOI: 10.1542/peds.2023-060221b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Maureen M Black
- University of Maryland School of Medicine, Baltimore, Maryland
- RTI International, Research Triangle Park, North Carolina
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | | | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Alysse Kowalski
- University of Maryland School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
15
|
Brou AM, Djalega FA, Tokpa V, Seri ECG, Anoua ALF, Robinson JA. Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire. Front Public Health 2023; 10:1035488. [PMID: 36699902 PMCID: PMC9868242 DOI: 10.3389/fpubh.2022.1035488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
Background Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school. Method Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI). Results A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness. Conclusion Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.
Collapse
Affiliation(s)
- Abenin Mathieu Brou
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire,*Correspondence: Abenin Mathieu Brou ✉
| | - Franck Adjé Djalega
- Laboratory of Nutrition and Food Security of the Department of Food Science and Technology, University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Venance Tokpa
- Department of Language Sciences, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Edy Constant Gbala Seri
- Ivorian Center for Studies and Research in Applied Psychology, University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Apie Léa Fabienne Anoua
- Institute of Anthropological Development Sciences (ISAD), University of Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Julie Ann Robinson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
16
|
Nutritional status and psychosocial stimulation associated with cognitive development in preschool children: A cross-sectional study at Western Terai, Nepal. PLoS One 2023; 18:e0280032. [PMID: 36913321 PMCID: PMC10010513 DOI: 10.1371/journal.pone.0280032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/20/2022] [Indexed: 03/14/2023] Open
Abstract
Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p<0.0001), psychological stimulation from caregivers (β = 0.184; p<0.0001), and advantageous castes/ethnicity (β = 0.190; p<0.0001), but negatively associated with the child's age (β = - 0.145; p = 0.002) and family type (β = -0.157; p = 0.001). Nutritional status and psychosocial stimulation appear to be major factors affecting cognitive development of preschoolers. Nutritional promotion strategies, as well as techniques for optimal psychosocial stimulation behavior, may play an important role in enhancing preschoolers' cognitive development.
Collapse
|
17
|
Thomas MSC, Coecke S. Associations between Socioeconomic Status, Cognition, and Brain Structure: Evaluating Potential Causal Pathways Through Mechanistic Models of Development. Cogn Sci 2023; 47:e13217. [PMID: 36607218 DOI: 10.1111/cogs.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/07/2023]
Abstract
Differences in socioeconomic status (SES) correlate both with differences in cognitive development and in brain structure. Associations between SES and brain measures such as cortical surface area and cortical thickness mediate differences in cognitive skills such as executive function and language. However, causal accounts that link SES, brain, and behavior are challenging because SES is a multidimensional construct: correlated environmental factors, such as family income and parental education, are only distal markers for proximal causal pathways. Moreover, the causal accounts themselves must span multiple levels of description, employ a developmental perspective, and integrate genetic effects on individual differences. Nevertheless, causal accounts have the potential to inform policy and guide interventions to reduce gaps in developmental outcomes. In this article, we review the range of empirical data to be integrated in causal accounts of developmental effects on the brain and cognition associated with variation in SES. We take the specific example of language development and evaluate the potential of a multiscale computational model of development, based on an artificial neural network, to support the construction of causal accounts. We show how, with bridging assumptions that link properties of network structure to magnetic resonance imaging (MRI) measures of brain structure, different sets of empirical data on SES effects can be connected. We use the model to contrast two possible causal pathways for environmental influences that are associated with SES: differences in prenatal brain development and differences in postnatal cognitive stimulation. We then use the model to explore the implications of each pathway for the potential to intervene to reduce gaps in developmental outcomes. The model points to the cumulative effects of social disadvantage on multiple pathways as the source of the poorest response to interventions. Overall, we highlight the importance of implemented models to test competing accounts of environmental influences on individual differences.
Collapse
Affiliation(s)
- Michael S C Thomas
- Developmental Neurocognition Laboratory, Department of Psychological Sciences, Birkbeck, University of London, 3 Quantinuum, UK.,Centre for Educational Neuroscience, Birkbeck, University of London
| | | |
Collapse
|
18
|
Stein AD, Adair LS, Donati G, Wray C, Richter LM, Norris SA, Stein A, Martorell R, Ramirez-Zea M, Menezes AMB, Murray J, Victora C, Lee N, Bas I. Early-life stature, preschool cognitive development, schooling attainment, and cognitive functioning in adulthood: a prospective study in four birth cohorts. Lancet Glob Health 2023; 11:e95-e104. [PMID: 36521958 PMCID: PMC9764453 DOI: 10.1016/s2214-109x(22)00448-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nutrition is important for growth and brain development and therefore cognitive ability. Growth faltering in early childhood, an important indicator of early adversity, is associated with poorer developmental outcomes, some into adulthood, but this association probably reflects early-life deprivation. We aimed to investigate the associations between early-life stature, child IQ, and adult IQ. METHODS In this cohort study, we used prospective longitudinal data collected in four birth cohorts from Brazil (born in 1993), Guatemala (born in 1969-77), the Philippines (born in 1983-84), and South Africa (born in 1990). Using multivariable linear models, we estimated the relative contributions of early-life stature, child IQ, and schooling (highest school year completed) to adult IQ, including interaction effects among the early-childhood measures and schooling. FINDINGS We included 2614 individuals in the analysis. Early-life stature was associated with adult IQ (range across eight site-by-sex groups -0·14 to 3·17 IQ points) and schooling (-0·05 to 0·77 years) per height-for-age Z-score. These associations were attenuated when controlling for child IQ (-0·86 to 1·72 for adult IQ and -0·5 to 0·60 for schooling). The association of early-life stature with adult IQ was further attenuated when controlling for schooling (-1·86 to 1·21). Child IQ was associated with adult IQ (range 3·91 to 10·02 points) and schooling (0·25 to 1·30 years) per SD of child IQ in all groups; these associations were unattenuated by the addition of early-life stature to the models. The interaction between schooling and child IQ, but not that between schooling and early-life stature, was positively associated with adult IQ across groups. INTERPRETATION The observed associations of early-life stature with adult IQ and schooling varied across cohorts and sexes and explained little variance in adult IQ beyond that explained by child IQ. These findings suggest that interventions targeted at growth for health and early development are important. Our results are consistent with the inference that improving long-term cognitive outcomes might require interventions that more specifically target early cognitive ability. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Charlotte Wray
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Global Health Research Institute, School of Human Development and Health & NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Nanette Lee
- USC-Office of Population Studies Foundation, University of San Carlos, Talamban, Cebu City, Cebu, Philippines
| | - Isabelita Bas
- USC-Office of Population Studies Foundation, University of San Carlos, Talamban, Cebu City, Cebu, Philippines
| | | |
Collapse
|
19
|
Eekhout I, van Buuren S. Child development with the D-score: tuning instruments to unity. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13223.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The chapter familiarises the reader with an intuitive yet powerful methodology to tune instruments to a common unit, presenting a fresh approach that expresses measurements made by different instruments on the D-score scale. As a result, the reader may compare D-scores between ages, children or cohorts. It shows how to exploit common developmental milestones to bridge instruments and cohorts; presents an analysis to obtain D-scores from 16 cohorts and 14 instruments; compares D-score age-distribution across populations from four continents; suggests an indicator for the United Nations Sustainable Development Goals; and defines developmentally-on-track.
Collapse
|
20
|
Santos IS, Munhoz TN, Barcelos RS, Blumenberg C, Bortolotto CC, Matijasevich A, Salum C, Santos Júnior HGD, Marques L, Correia L, Souza MRD, Lira PICD, Pereira V, Victora CG. Evaluation of the Happy Child Program: a randomized study in 30 Brazilian municipalities. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222712.13472022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract The Happy Child Program (Programa Criança Feliz - PCF, in Portuguese) reaches 1.4 million Brazilian children under three years of age with home visits aimed at promoting neuropsychomotor development. Based on a conceptual model, PCF implementation and impact were evaluated in a randomized study in 30 municipalities. A total of 3,242 children were allocated to the intervention (IG) or control (CG) group, 80.0% of whom were prospectively followed up from late 2018 to late 2021. Development was assessed by the Ages and Stages Questionnaire (ASQ3). During the three-year study period, visits were replaced by virtual contacts for an average of 12 months due to COVID-19. At the endline survey, intent-to-treat analyses showed mean scores of 203.3 in the IG and 201.3 in the CG. Additional analyses using instrumental variables and propensity scores matching also showed no effect, since the number of contacts with the program was not associated with ASQ3 scores. No impact was observed on stimulation, responsive interactions or psychological attributes of children. The implementation study revealed low coverage in the IG, contamination of the CG, deficiencies in management and low quality of visits in many municipalities. The study did not demonstrate an impact of PCF implemented under routine conditions, but provides elements for its improvement.
Collapse
|
21
|
Santos IS, Munhoz TN, Barcelos RS, Blumenberg C, Bortolotto CC, Matijasevich A, Salum C, Santos Júnior HGD, Marques L, Correia L, Souza MRD, Lira PICD, Pereira V, Victora CG. Avaliação do Programa Criança Feliz: um estudo randomizado em 30 municípios brasileiros. CIENCIA & SAUDE COLETIVA 2022; 27:4341-4363. [DOI: 10.1590/1413-812320222712.13472022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/23/2022] Open
Abstract
Resumo O Programa Criança Feliz (PCF) atinge 1,4 milhão de crianças brasileiras menores de três anos com visitas domiciliares visando o desenvolvimento neuropsicomotor. Com base em modelo conceitual, avaliou-se implementação e impacto do PCF em estudo randomizado, em 30 municípios. Ao todo 3.242 crianças foram alocadas para o grupo intervenção (GI) ou controle (GC), sendo 80,0% acompanhadas prospectivamente durante três anos. O desenvolvimento foi avaliado pelo Ages and Stages Questionnaire (ASQ3). Análises por intenção de tratar mostraram escores médios de 203,3 no GI e 201,3 no GC. Análises adicionais com variáveis instrumentais e emparelhamento por escores de propensão tampouco mostraram efeito, uma vez que o número de contatos recebidos não esteve associado aos escores ASQ3. Tampouco foi observado impacto sobre estimulação, interações responsivas ou atributos psicológicos das crianças. As visitas foram interrompidas durante 12 meses devido à COVID-19, sendo substituídas por contatos virtuais. O estudo de implementação revelou baixa cobertura no GI, contaminação do GC, deficiências na gestão e baixa qualidade das visitas em muitos municípios. O estudo não demonstrou impacto do PCF implementado sob condições de rotina e fornece elementos para seu aprimoramento.
Collapse
|
22
|
Soysal Cimen H, Karaaslan BT. Expectant mothers and fathers' knowledge of nurturing care in a developing country. Front Pediatr 2022; 10:1024593. [PMID: 36483466 PMCID: PMC9722760 DOI: 10.3389/fped.2022.1024593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Nurturing Care Framework (NCF), which has been emphasized by the World Health Organization (WHO) in recent years and is among the United Nations Sustainable Development Goals (SDGs), expresses the conditions created to promote early childhood development (ECD). These conditions aim to provide opportunities for children in the Good Health, Adequate Nutrition, Responsive Caregiving, Security and Safety, and Opportunities for Early Learning (5 Components) by caregivers, primarily from low and middle-income countries (LMICs). The aim of this study is to examine the knowledge and awareness of expectant mothers and fathers in Turkey, about the NCF. Methods In this study, a cross-sectional, analytical research design was used. Nurturing Care (NC) knowledge and awareness levels of expectant mothers and fathers in the 2nd and 3rd trimesters of pregnancy were determined via the online form of "The Knowledge of Nurturing Care Inventory (KNCI)" prepared by the researchers. This form consists of 60 questions describing the 5 components mentioned above. The sample contains a total of 103 people, 91 (88.3%) women, and 12 (11.7%) men. Results Among the findings, the highest mean of knowledge level (13.76 ± 1.22) was found in Responsive Caregiving, and the lowest mean of knowledge level (4.35 ± 1.83) was found in Opportunities for Early Learning. The general level of knowledge on NC was found to vary statistically significantly depending on gender in favor of the women [t(101) = 3.27, p < .05], depending on educational status in favor of those with university and graduate education [F(2, 100) = 3.481, p < .05], depending on participation in pregnancy school training in favor of those who attended [t(101) = 2.349, p < .05], and depending on knowledge on how to support development in favor of those who know how to support [t(101) = 2.370, p < .05]. Conclusions As a result, expectant parents need information and support about the period when children can acquire the basic developmental milestones and about the developmental risk indicators. More research is needed to implement the NCF starting from the preconception period, especially in LMICs, so that the opportunities in early childhood (which is the time period when the brain architecture is shaped, and development is the fastest) are not missed.
Collapse
Affiliation(s)
- Hafize Soysal Cimen
- Child Development Master's Program, Institute of Health Sciences, Üsküdar University, Istanbul, Turkey
| | - Bedriye Tugba Karaaslan
- Department of Child Development, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
23
|
Jiwani Z, Drylewski G, Sharma S, Ahun M, Thapa S, Steele M. Adverse childhood experiences and maternal self-efficacy: Examining the mediating role of intimate partner violence and the moderating role of caste membership in rural India. Infant Ment Health J 2022; 43:546-557. [PMID: 35665944 DOI: 10.1002/imhj.21997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/15/2022] [Indexed: 11/09/2022]
Abstract
Maternal self-efficacy (MSE) is associated with healthy functioning in mothers and children globally. Maternal exposure to adverse childhood experiences (ACEs) and intimate partner violence (IPV) is known to negatively impact MSE in high-income countries; however, the association has not been examined in low-and-middle-income countries, such as India, which face socioeconomic risks including poverty, illiteracy, and discrimination based on caste membership. The present study examines the mediating role of IPV in the association between ACEs (specifically-emotional, physical, and sexual abuse, neglect, household dysfunction, and discrimination) and MSE and tests caste membership as a moderator. A community-based, cross-sectional survey was performed with 316 mothers with at least one child between 0 and 24 months in a rural area in the North Indian state of Uttar Pradesh. A structural equation framework was used to test the moderated-mediation model. Results from the moderated-mediation model indicate that greater ACEs exposure was associated with lower MSE and this association was mediated by IPV exposure for low-caste but not high-caste mothers, even after controlling for wealth and literacy. These findings add to existing evidence on ACEs exposure as a significant burden for rural Indian mothers, negatively impacting parenting outcomes such as MSE. The critical role of caste membership is also highlighted, providing implications for future research.
Collapse
Affiliation(s)
- Zishan Jiwani
- Department of psychology, New School for Social Research, New York City, New York, USA.,University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Grace Drylewski
- Department of psychology, New School for Social Research, New York City, New York, USA
| | | | - Marilyn Ahun
- University of Montreal, Montreal, Quebec, Canada
| | - Shobhali Thapa
- Department of psychology, New School for Social Research, New York City, New York, USA
| | - Miriam Steele
- Department of psychology, New School for Social Research, New York City, New York, USA
| |
Collapse
|
24
|
Walker SP, Chang SM, Wright AS, Pinto R, Heckman JJ, Grantham‐McGregor SM. Cognitive, psychosocial, and behaviour gains at age 31 years from the Jamaica early childhood stimulation trial. J Child Psychol Psychiatry 2022; 63:626-635. [PMID: 34403137 PMCID: PMC8850528 DOI: 10.1111/jcpp.13499] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is little evidence on adult benefits from early childhood interventions in low and middle-income countries. We assessed adult cognition, psychosocial skills and behaviour from a stimulation trial conducted in Jamaica. METHODS Children with stunted growth (height-for age <-2SD of references) aged 9-24 months were enrolled in a two-year randomised-controlled trial of nutritional supplementation and/or stimulation. At mean age 31.79 (SD 0.40) years, 95 of 127 participants (74.8%; 53.7% male) were assessed. Children without stunted growth were also followed as a comparison group (64 of 84 participants, 76.2%). Measurements included IQ, executive function, mental health, psychosocial skills, personality traits and risk behaviours. A block permutation test, valid for small sample sizes, was used. Analyses accounted for the randomisation protocol, multiple hypothesis testing and attrition. RESULTS Treatment group participants (stimulation intervention with or without supplementation, n = 48) had significantly greater IQ (Hedges g effect size 0. 57; 95%CI 0.20, 0.95) and cognitive flexibility (0.61; 0.25, 0.98) compared with no-treatment (no-intervention and supplementation only, n = 47). They also had reduced depressive symptoms (0.61; 0.28, 1.00), increased grit (0.53; 0.16, 0.92) and conscientiousness (0.66; 0.31, 1.07), lower substance use (rank mean score, 0.45; 0.08, 0.81) and risk taking related to health and work (0.64; 0.27, 1.00). There were 18 significant outcomes of 33 assessed. Comparison participants had higher IQ than no-treatment (1.17; 0.81, 1.54) and treatment groups (0.62; 0.18, 1.07); and better executive function, lower social inhibition and risk taking than the no-treatment group. CONCLUSIONS The wide-ranging benefits at 31 years from the stimulation intervention supports investment in larger scale programmes to promote early childhood development in disadvantaged children. The lower IQ in the treatment group compared with comparison participants, emphasises the need for continued efforts to prevent early childhood growth retardation.
Collapse
Affiliation(s)
- Susan P. Walker
- Caribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaica
| | - Susan M. Chang
- Caribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaica
| | - Amika S. Wright
- Caribbean Institute for Health ResearchThe University of the West IndiesKingstonJamaica
| | - Rodrigo Pinto
- Department of EconomicsThe University of California at Los AngelesLos AngelesCAUSA
| | - James J. Heckman
- Centre for for the Economics of Human DevelopmentUniversity of ChicagoChicagoILUSA,American Bar FoundationChicagoILUSA
| | | |
Collapse
|
25
|
These experiments could lift millions out of dire poverty. Nature 2022; 606:640-642. [PMID: 35732770 DOI: 10.1038/d41586-022-01679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Rocha HAL, Correia LL, Leite ÁJM, Rocha SGMO, Machado MMT, Campos JS, Cunha AJLA, E Silva AC, Sudfeld CR. Undernutrition and short duration of breastfeeding association with child development: a population-based study. J Pediatr (Rio J) 2022; 98:316-322. [PMID: 34508663 PMCID: PMC9432002 DOI: 10.1016/j.jped.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. METHODS The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazil (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. RESULTS A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR 2,08 (1,38-3,12)) was also associated. CONCLUSIONS The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.
Collapse
Affiliation(s)
- Hermano A L Rocha
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, United States; Universidade Federal do Ceará, Departamento de Saúde Materno-Infantil, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil.
| | - Luciano L Correia
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil
| | - Álvaro J M Leite
- Universidade Federal do Ceará, Departamento de Saúde Materno-Infantil, Fortaleza, CE, Brazil
| | - Sabrina G M O Rocha
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil; ISEC, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Márcia M T Machado
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil
| | | | - Antonio J L A Cunha
- Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | | | - Christopher R Sudfeld
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, United States
| |
Collapse
|
27
|
Sokolovic N, Schneider A, Perlman M, Sousa R, Jenkins JM. Teaching home-visitors to support responsive caregiving: A cluster randomized controlled trial of an online professional development program in Brazil. J Glob Health 2022; 12:04007. [PMID: 35136598 PMCID: PMC8818297 DOI: 10.7189/jogh.12.04007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Home-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries. The World Health Organization and UNICEF have identified responsive caregiving as one key component of the nurturing care children need to survive and thrive. Nonetheless, the importance of responsive caregiving and how to coach it is often overlooked in trainings for staff in home-visiting programs. Methods To determine whether it is possible to enhance home-visitors’ understanding of responsive caregiving and how to coach it, we conducted a cluster randomized controlled trial with 181 staff working in Brazil’s national home-visiting program. We used a computerized random number generator to randomly assign half of participants to take an online professional development course about responsive caregiving immediately and the other half to a waitlist. Individuals assessing outcome data were blind to group assignment. Results Compared to those in the control group (N = 90, both randomized and analyzed), participants assigned to take the course (N = 91, both randomized and analyzed) were more knowledgeable about responsivity (Cohen’s d = 0.64, 95% Confidence Interval (CI) = 0.34, 0.94) and its importance for children’s socioemotional (odds ratio (OR) = 1.88, 95% CI = 1.00, 3.50) and cognitive (OR = 2.57, 95% CI = 1.15, 5.71) development, better able to identify responsive parental behaviors in videotaped interactions (d = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity (d = 0.51, 95% CI = 0.21, 0.80) and tracking goal implementation (OR = 3.20, 95% CI = 1.28, 7.99). There were no significant changes in participants’ tendency to encourage goal setting and reflection, or their perspective-taking skills. Participants were very satisfied with the course content and mode of delivery and there was no drop-out from the program. Conclusions A short, online professional development program created moderate to large improvements in home-visitors’ knowledge and intended coaching practices. This suggests that such programs are feasible, even in low-income and rural areas, and provide a low-cost, scalable option for possibly maximizing the impact of home-visiting programs – particularly with regard to parental responsivity, and in turn, child outcomes.
Collapse
Affiliation(s)
- Nina Sokolovic
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Alessandra Schneider
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Michal Perlman
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Rosângela Sousa
- State Department of Social Assistance, Labour, and Human Rights, Piauí, Brazil
| | - Jennifer M Jenkins
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Sylvia S, Luo R, Zhong J, Dill SE, Medina A, Rozelle S. Passive versus active service delivery: Comparing the effects of two parenting interventions on early cognitive development in rural China. WORLD DEVELOPMENT 2022; 149:105686. [PMID: 34980940 PMCID: PMC8566276 DOI: 10.1016/j.worlddev.2021.105686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.
Collapse
Affiliation(s)
- Sean Sylvia
- Gillings School of Global Public Health and Carolina Population Center, 1101-D McGavran-Greenberg Bldg., University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Science, 409 Wangkezhen Bldg., Peking University, No. 5 Yiheyuan, Haidian District, Beijing, China
| | - Jingdong Zhong
- School of Economics, Peking University, No. 5 Yiheyuan, Haidian District, Beijing, China
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
| |
Collapse
|
29
|
Hossain SJ, Roy BR, Sujon HM, Tran T, Fisher J, Tofail F, El Arifeen S, Hamadani JD. Effects of integrated psychosocial stimulation (PS) and unconditional cash transfer (UCT) on children's development in rural Bangladesh: A cluster randomized controlled trial. Soc Sci Med 2021; 293:114657. [PMID: 34942577 DOI: 10.1016/j.socscimed.2021.114657] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is evidence on benefits of psychosocial stimulation (PS) and cash transfer programmes in low- and middle-income countries on children's development. We integrated PS into an unconditional cash transfer (UCT) programme for poor Bangladeshi mothers to examine the effects on children's development. METHODS This cluster randomized controlled trial was conducted in rural Bangladesh from July 2017 to December 2018 in 33 clusters, with 11 clusters randomly assigned to each of the three arms, namely i) PS + UCT ii) UCT-only and iii) Comparison. We enrolled poor mothers and child (6-16 months) dyads eligible to receive maternity allowance by the Government of Bangladesh. Trained local women imparted training to mothers to provide psychosocial stimulation to their children for one year. Children's cognitive, language and motor development were measured with Bayley-III, behaviour with Wolke's ratings and maternal self-esteem with Rosenberg self-esteem scale. The analysis was intention-to-treat. RESULTS Of the 594 mother-child dyads, 40 (6·8%) were lost to follow-up. Compared to UCT-only, children in the PS + UCT had significant improvement in cognitive (B = 2.96, 95% CI: 0.46-5.47, Effect Size [ES] 0.24SD) and language (2.73, 0.39-5.00, ES 0.21SD) scores and were more responsive to examiner (0.30, 0.06-0.52, ES 0.27SD), while compared to comparison group, they had significantly higher cognitive (3.37, 1.27-6.19, ES 0.32SD), language (2.82, 0.53-5.10, ES 0.24SD) and motor (2.65, 0.24-5.06, ES 0.22SD) scores and were more responsive to examiner (0.30, 0.08-0.52, ES 0.26 SD). The mothers' self-esteem was significantly higher in PS + UCT (2.46, 0.94-3.98, ES 0.48 SD) and UCT-only (1.67, 0.02-3.20, ES 0.32 SD) compared to the comparison group. CONCLUSION PS integrated into an UCT programme benefited children's neurodevelopment and UCT improved mother's self-esteem. UCT programme may be an important platform for child stimulation programmes for rural poor populations.
Collapse
Affiliation(s)
- Sheikh Jamal Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh; Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Bharati Rani Roy
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Hasan Mahmud Sujon
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Thach Tran
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Jena Derakshani Hamadani
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| |
Collapse
|
30
|
Gupta SS, Raut AV, Kothekar P, Maliye CH, Kalantri A, Bahulekar PV, Anshu, Garg BS. Nurturing Care Interventions for Realizing the Development Potential of Every Child: From Pilot to Scale Up in Maharashtra. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
31
|
Daniel AI, Bwanali M, Ohuma EO, Bourdon C, Gladstone M, Potani I, Mbale E, Voskuijl W, van den Heuvel M, Bandsma RHJ. Pathways between caregiver body mass index, the home environment, child nutritional status, and development in children with severe acute malnutrition in Malawi. PLoS One 2021; 16:e0255967. [PMID: 34424919 PMCID: PMC8382172 DOI: 10.1371/journal.pone.0255967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022] Open
Abstract
Children with severe acute malnutrition (SAM) remain vulnerable after treatment at nutritional rehabilitation units (NRUs). The objective was to assess the concurrent pathways in a hypothesized model between caregiver body mass index (BMI), the home environment, and child nutritional status, and development (gross motor, fine motor, language, and social domains) in children with SAM following discharge from inpatient treatment. Structural equation modelling (SEM) was performed with data from a cluster-randomized controlled trial at the Moyo Nutritional Rehabilitation and Research Unit in Blantyre, Malawi. This approach was undertaken to explore simultaneous relationships between caregiver BMI, the home environment (Home Observation for Measurement of the Environment Inventory scores), child nutritional status (anthropometric indicators including weight-for-age z-scores [WAZ]), and child development (Malawi Developmental Assessment Tool (MDAT) z-scores as a latent variable) in children with SAM. These data were collected at participants' homes six months after discharge from NRU treatment. This analysis included 85 children aged 6-59 months with SAM and their caregivers recruited to the trial at the NRU and followed up successfully six months after discharge. The model with WAZ as the nutritional indicator fit the data according to model fit indices (χ2 = 28.92, p = 0.42). Caregiver BMI was predictive of better home environment scores (β = 0.23, p = 0.03) and child WAZ (β = 0.30, p = 0.005). The home environment scores were positively correlated with MDAT z-scores (β = 0.32, p = 0.001). Child nutritional status based on WAZ was also correlated with MDAT z-scores (β = 0.37, p<0.001). This study demonstrates that caregiver BMI could ultimately relate to child development in children with SAM, through its links to the home environment and child nutritional status.
Collapse
Affiliation(s)
- Allison I. Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mike Bwanali
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Eric O. Ohuma
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Celine Bourdon
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Melissa Gladstone
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Isabel Potani
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
| | - Emmie Mbale
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Wieger Voskuijl
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Global Child Health Group, Emma Children’s Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Meta van den Heuvel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert H. J. Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Blantyre, Malawi
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|
32
|
Dulal S, Prost A, Karki S, Saville N, Merom D. Characteristics and effects of integrated nutrition and stimulation interventions to improve the nutritional status and development of children under 5 years of age: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2020-003872. [PMID: 34321232 PMCID: PMC8319976 DOI: 10.1136/bmjgh-2020-003872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Around 250 million children in low-income and middle-income countries are at risk of not fulfilling their developmental potential. There is a need to update syntheses investigating the effects of combined nutrition and stimulation interventions on children’s growth and development and identify intervention characteristics associated with positive effects. Methods We did a systematic review to: (1) understand the effects of integrated nutrition and stimulation interventions versus (i) usual care and (ii) standalone nutrition or stimulation interventions, on the growth and development of children under five; (2) explore intervention characteristics (delivery strategies, behaviour change techniques, intensity and personnel) associated with positive effects. We searched eight databases for studies published from inception to 16 November 2020. Eligible studies were randomised and non-randomised controlled trials of integrated nutrition and stimulation interventions examining growth and developmental outcomes. We performed meta-analyses for length-for-age/height-for-age, weight-for-age and weight-for-length/weight-for-height Z scores and cognitive, motor and language development scores, and subgroup analyses by intervention characteristics. We conducted random-effects metaregression to assess potential subgroup differences in outcomes by intervention characteristics. Results Twenty trials were included in the meta-analysis. Pooled effect sizes showed significant benefits of integrated interventions on developmental outcomes compared with usual care and standalone nutrition interventions (I2 >75%) but not on growth outcomes. Moreover, integrated interventions have non-significant effects on developmental outcomes compared with standalone stimulation interventions. Integrated interventions showed greater effects on cognitive (p=0.039) and language (p=0.040) outcomes for undernourished children compared with adequately nourished children. The effects of integrated interventions on developmental outcomes did not differ by intervention characteristics. Conclusion Integrated interventions have greater benefits for children’s development than usual care or standalone nutrition interventions, especially in settings with high levels of undernutrition. Future studies should use standardised reporting of implementation processes to identify intervention characteristics linked to positive effects.
Collapse
Affiliation(s)
- Sophiya Dulal
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - Surendra Karki
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.,Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Naomi Saville
- Institute for Global Health, University College London, London, UK
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Penrith South, New South Wales, Australia
| |
Collapse
|
33
|
Brentani A, Walker S, Chang-Lopez S, Grisi S, Powell C, Fink G. A home visit-based early childhood stimulation programme in Brazil-a randomized controlled trial. Health Policy Plan 2021; 36:288-297. [PMID: 33496330 DOI: 10.1093/heapol/czaa195] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/11/2020] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
Home visiting programmes are increasingly recognized as one of the most effective interventions to improve child health and development in low-income settings. However, the best platforms to deliver such programmes remain unclear. We conducted a randomized controlled trial to test the relative effectiveness of child development agents (CDAs) and community health workers (CHWs) as two possible delivery platforms for early childhood development (ECD) focused home visiting intervention in São Paulo, Brazil. A total of 900 children aged 9-15 months were screened for potential study inclusion between January and March 2015. Children who did not attend crèches at enrolment were included in the trial. Children were randomly assigned to control or to receive biweekly home visits either through a CHW in the areas covered by the Brazilian Family Health Strategy (FHS) or by a newly hired cadre of CDAs in the areas not covered by the FHS. The primary study outcome was children's development (cognition, motor, language and social emotional skills) assessed after 12 months of intervention with the PRIDI and Caregiver-Reported Early Development Instruments tools. A total of 826 mother-child dyads were enrolled in the trial. In intention-to-treat analysis, neither intervention arm improved study outcomes. In per-protocol (PP) analysis, the CDA programme resulted in a 0.22 standard deviation increase in children's development (95% confidence interval [0.01-0.43]). The results presented in this study suggest that home visiting programmes have the potential to improve child development among poor urban families in Brazil. However, delivering home visiting interventions through already active CHWs may not be feasible in the Brazilian context and coordination across sectors is essential to effective ECD policies.
Collapse
Affiliation(s)
- Alexandra Brentani
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas de Carvalho Aguiar, 647, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil
| | - Susan Walker
- Caribbean Institute for Health Research, University of West Indies (TMRI), Mona, Kingston 7, Jamaica
| | - Susan Chang-Lopez
- Caribbean Institute for Health Research, University of West Indies (TMRI), Mona, Kingston 7, Jamaica
| | - Sandra Grisi
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Eneas de Carvalho Aguiar, 647, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil
| | - Christine Powell
- Caribbean Institute for Health Research, University of West Indies (TMRI), Mona, Kingston 7, Jamaica
| | - Günther Fink
- Swiss TPH and University of Basel, socinstrasse 59, CH-4051 Basel, Switzerland
| |
Collapse
|
34
|
Weber AM, Diop Y, Gillespie D, Ratsifandrihamanana L, Darmstadt GL. Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries. BMJ Glob Health 2021; 6:e006218. [PMID: 34266849 PMCID: PMC8286753 DOI: 10.1136/bmjgh-2021-006218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/29/2021] [Indexed: 01/11/2023] Open
Abstract
The Nurturing Care Framework for Early Childhood Development urges stakeholders to implement strategies that help children worldwide achieve their developmental potential. Related programmes range from the WHO's and UNICEF's Care for Child Development intervention, implemented in 19 countries, to locally developed programmes, such as non-governmental organisation Tostan's Reinforcement of Parental Practices in Senegal. However, some researchers argue that these programmes are unethical as they impose caregiving practices and values from high-income countries (HICs) on low-income communities, failing to consider local culture, communities' goals for their children and generalisability of scientific findings from HICs. We explore these criticisms within a public health framework, applying principles of beneficence, autonomy and justice to the arguments. To facilitate the change communities themselves desire for their children, we recommend that practitioners codevelop programmes and cooperate with communities in implementation to harness local beliefs and customs and promote evidence-based and locally adapted practices.
Collapse
Affiliation(s)
- Ann M Weber
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Yatma Diop
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Diane Gillespie
- Emeritus, Community Psychology, University of Washington, Bothell, Washington, USA
| | | | - Gary L Darmstadt
- Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
35
|
Eekhout I, van Buuren S. Child development with the D-score: tuning instruments to unity. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13223.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The chapter familiarises the reader with an intuitive yet powerful methodology to tune instruments to a common unit, presenting a fresh approach that expresses measurements made by different instruments on the D-score scale. As a result, the reader may compare D-scores between ages, children or cohorts. It shows how to exploit common developmental milestones to bridge instruments and cohorts; presents an analysis to obtain D-scores from 16 cohorts and 14 instruments; compares D-score age-distribution across populations from four continents; suggests an indicator for the United Nations Sustainable Development Goals; and defines developmentally-on-track.
Collapse
|
36
|
Smith JA, Chang SM, Lopez Boo F, Ferro MDLP, Walker SP. Are Benefits From a Parenting Intervention Delivered Through the Health Services Sustainable? Follow-Up of a Randomized Evaluation in Jamaica. Acad Pediatr 2021; 21:638-645. [PMID: 33434700 DOI: 10.1016/j.acap.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE An innovative low-cost parenting intervention, implemented through health services in Jamaica showed benefits to children's cognitive development at 18 months and parent's attitudes concerning childcare. We assessed the impact of the intervention on child and parent outcomes at 6 years of age. METHODS A cluster randomized trial of 2 parenting interventions was conducted through 20 health centers in Jamaica. Interventions were implemented from age 3 to 18 months and each intervention benefited cognitive development at 18 months (effect size 0.34-0.38 standard deviation). Children were reassessed at 6 years (n = 262, 80.1% of those assessed at 18 months) to determine any benefits to cognition, behavior, and parenting behavior. Loss to follow-up was not significantly different by treatment. Inverse probability weighting and Lee bounds were used to adjust for loss to follow-up, and multilevel regression analyses conducted with random effects at the health center level. RESULTS There were no significant benefits to any child outcomes at age 6 years or to parenting behavior. Results are robust using the wild cluster bootstrap procedure and using Lee bounds for attrition. The initial trial benefits were reproduced with the current sample and methods. CONCLUSION Lack of sustained benefits may be related to the initial effect size and low intensity of the intervention that ended very young at age 18 months. It may also be related to lack of initial impact on home environment and fade-out of effects in a country with near universal preschool. The findings have implications for intervention design and targeting.
Collapse
Affiliation(s)
- Joanne A Smith
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica.
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
| | - Florencia Lopez Boo
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Maria de la Paz Ferro
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
| |
Collapse
|
37
|
Jeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med 2021; 18:e1003602. [PMID: 33970913 PMCID: PMC8109838 DOI: 10.1371/journal.pmed.1003602] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily E. Franchett
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Clariana V. Ramos de Oliveira
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karima Rehmani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
38
|
Ramírez-Luzuriaga MJ, DiGirolamo AM, Martorell R, Ramírez-Zea M, Waford R, Stein AD. Influence of enhanced nutrition and psychosocial stimulation in early childhood on cognitive functioning and psychological well-being in Guatemalan adults. Soc Sci Med 2021; 275:113810. [PMID: 33713924 PMCID: PMC8024786 DOI: 10.1016/j.socscimed.2021.113810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/06/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022]
Abstract
Rationale Early-life nutrition interventions in low and middle-income countries have demonstrated long-term benefits on cognitive skills, however, their influence on socioemotional outcomes has not been fully explored. Moreover, the mediating processes through which nutrition intervention effects operate and are maintained over time are understudied. Methods We followed-up a cohort of Guatemalan adults who participated as children in a community randomized food-supplementation trial. We examined associations of exposure to nutritional supplementation from conception to age 2 years with executive function (measured using three sub-tests of the NIH Toolbox Cognition Battery) and psychological well-being (measured using two sub-scales of the NIH Toolbox Emotion Battery) at ages 40–57 years (n = 1268). We used structural equation modeling to investigate the mediating role of psychosocial stimulation (measured in childhood using parent reports and ratings of home environments), cognitive ability (measured at ages 26–42 years using standardized tests), and executive function on the association of early-life exposure to nutritional supplementation with adult psychological well-being (n = 1640). Results We found positive but inconsistent associations of nutritional supplementation in childhood with executive function and psychological well-being in adulthood. Psychosocial stimulation, cognitive ability, and executive function did not mediate the association of early-life nutritional supplementation with adult psychological well-being. We found strong and positive associations of psychosocial stimulation in childhood with cognitive ability, executive function, and psychological well-being in adulthood. Moreover, we observed no interaction of exposure to nutritional supplementation and psychosocial stimulation in childhood with cognitive and psychological well-being outcomes in adulthood. Conclusion Our findings suggest that childhood nutrition interventions have long-lasting effects on cognitive ability and psychological well-being outcomes. We assess the influence of early-life nutrition on neurodevelopmental outcomes. We use a theoretical approach to examine mediators of the association. We found no mediators of the association of early-life nutrition with adult psychological well-being. Psychosocial stimulation is strongly associated with neurodevelopmental outcomes. Improved child nutrition is positively associated with adult psychological well-being.
Collapse
Affiliation(s)
- María J Ramírez-Luzuriaga
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Ann M DiGirolamo
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Eighth Floor, Park Pl NE, Atlanta, GA, 30303, USA
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala
| | - Rachel Waford
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Aryeh D Stein
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA.
| |
Collapse
|
39
|
Jeong J, Pitchik HO, Fink G. Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:e004067. [PMID: 33674266 PMCID: PMC7938974 DOI: 10.1136/bmjgh-2020-004067] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Parenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time. METHODS We conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1-3 years after programme completion), medium-term (4-9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children's cognitive and behavioral development by these subgroups of follow-up rounds. RESULTS We identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children's outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time. CONCLUSIONS There have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.
Collapse
Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
40
|
Luoto JE, Lopez Garcia I, Aboud FE, Singla DR, Fernald LCH, Pitchik HO, Saya UY, Otieno R, Alu E. Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial. LANCET GLOBAL HEALTH 2020; 9:e309-e319. [PMID: 33341153 PMCID: PMC8054650 DOI: 10.1016/s2214-109x(20)30469-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 01/24/2023]
Abstract
Background Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya’s network of community health volunteers. Methods We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558. Findings Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Interpretation Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability.
Collapse
Affiliation(s)
| | | | - Frances E Aboud
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Daisy R Singla
- Department of Psychiatry, Sinai Health and University of Toronto, Toronto, ON, Canada
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Edith Alu
- Safe Water and AIDS Project, Kisumu, Kenya
| |
Collapse
|
41
|
Clark DC, Cifelli CJ, Pikosky MA. Growth and Development of Preschool Children (12-60 Months): A Review of the Effect of Dairy Intake. Nutrients 2020; 12:E3556. [PMID: 33233555 PMCID: PMC7699766 DOI: 10.3390/nu12113556] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Undernutrition in young children is a global health issue. The ability to meet energy and nutrient needs during this critical stage of development is necessary, not only to achieve physical and mental potential but also socio-economic achievement later in life. Given ongoing discussions regarding optimization of dietary patterns to support achievement of the Sustainable Development Goals established by the United Nations, it is important to identify foods/food groups that have shown efficacy in reducing the negative impacts of undernutrition in young children. This narrative review addresses the impact of dairy intake, with a focus on linear growth, cognitive development and weight gain in early childhood (12-60 months). The impact of country economic status is also examined, to help elucidate regional specific recommendations and/or future research needs. Overall, the body of research addressing this age group is somewhat limited. Based on the data available, there is a positive association between dairy intake and linear growth. The impact of milk or dairy products on cognitive development is less clear due to a lack of evidence and is a gap in the literature that should be addressed. Regarding the impact on body weight, the majority of evidence suggests there is either no association or an inverse association between milk intake by preschool children on overweight and obesity later in life. This evidence is exclusively in high income countries, however, so additional work in lower income countries may be warranted.
Collapse
Affiliation(s)
- David C. Clark
- Bovina Mountain Consulting LLC, Englewood, FL 34223, USA;
| | | | | |
Collapse
|
42
|
Jetelina KK, Oke O, Rodriguez P, Weerakoon SM, Barlow SE. Implementation of a telehealth-enhanced home visiting programme for families of young children. J Telemed Telecare 2020; 28:266-279. [PMID: 32772762 DOI: 10.1177/1357633x20938282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Health systems are applying innovative solutions, such as telehealth and home visiting, to reduce unnecessary healthcare utilization, including emergency department (ED) visits. A large paediatric healthcare system implemented a telehealth-enhanced home visiting programme as an extension of primary care services. The purpose of this paper is three-fold: (1) Examine the process of implementation and the intermediate clinical outcomes; (2) Evaluate patient experiences and acceptability of the programme post-implementation; (3) Identify system, clinic and patient factors influencing implementation of the home visiting programme. METHODS Implementation of the telehealth-enhanced home visiting programme occurred from July 2018 to March 2019. Longitudinal electronic health records (EHR) and surveys were triangulated with qualitative data to evaluate the preliminary effectiveness, feasibility, and acceptability of the programme. RESULTS Of the 948 eligible families, clinical care staff referred 38% of families to the home visiting programme and 49 families (5%) completed the 12-week home visiting programme. Necessary ED utilization significantly increased post-implementation compared with pre-implementation. Families were overall highly satisfied with the programme and its content. Several factors influenced implementation including outer setting (i.e. patient needs and external policy), inner setting (e.g. poor leadership engagement, fully integrated network, and high tension for change), and individual characteristics (e.g. high self-efficacy). CONCLUSIONS Once families were enrolled, the programme was fairly successful in addressing patient outcomes. The programme and visit process was highly regarded by families and the unlicensed healthcare professionals. Future programme recommendations, such as small programmatic changes and major improvements in the clinic, should be implemented before widespread dissemination.
Collapse
Affiliation(s)
- Katelyn K Jetelina
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center School of Public Health, Dallas, TX, USA
| | | | | | - Sitara M Weerakoon
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
43
|
An Integrated Infant and Young Child Feeding and Small-Quantity Lipid-based Nutrient Supplementation Program Is Associated with Improved Gross Motor and Communication Scores of Children 6-18 Months in the Democratic Republic of Congo. J Pediatr 2020; 222:154-163. [PMID: 32122634 PMCID: PMC9396473 DOI: 10.1016/j.jpeds.2020.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/05/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of an infant, young child feeding practices-small-quantity lipid nutrient supplements (SQ-LNS) intervention on child development scores in children aged 6-18 months in the Katanga Province, Democratic Republic of Congo (DRC). STUDY DESIGN We analyzed data of 2595 children from 2 health zones in a quasi-experimental design with preimplementation and postimplementation surveys to evaluate program impact on child development scores. Standard care was received in the comparison health zone and the intervention health zone received standard care plus enhanced infant, young child feeding practices with a monthly supply of 28 SQ-LNS sachets for up to 1 year. Program exposure and communication and motor domains of the Ages and Stages questionnaire were collected to assess changes in child development scores. A quasi-intent-to-treat and adjusted difference-in-difference analyses were used to quantify impact of the enhanced compared with the standard package. RESULTS In adjusted models contrasting endline with baseline, there was a greater relative increase in proportion of children with normal communication (difference-in-difference, +13.7% [95%CI, 7.9-19.6; P < .001] and gross motor scores, +7.4% [95% CI: 1.3-13.5; P < .001]) in the intervention vs comparison health zones. Further, in separate analyses among children of intervention health zone at endline, each additional SQ-LNS distribution was associated with +0.09 (95% CI, 0.03-0.16) z-score unit increase in gross motor scores (P < .01). CONCLUSIONS The integrated infant, young child feeding practice-SQ-LNS intervention was positively associated with larger relative improvements in measures of child communication and motor development in the Katanga province of DRC.
Collapse
|
44
|
Andrew A, Attanasio O, Augsburg B, Day M, Grantham‐McGregor S, Meghir C, Mehrin F, Pahwa S, Rubio‐Codina M. Effects of a scalable home-visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial. J Child Psychol Psychiatry 2020; 61:644-652. [PMID: 31797385 PMCID: PMC7242140 DOI: 10.1111/jcpp.13171] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND An estimated 63.4 million Indian children under 5 years are at risk of poor development. Home visits that use a structured curriculum to help caregivers enhance the quality of the home stimulation environment improve developmental outcomes. However, achieving effectiveness in poor urban contexts through scalable models remains challenging. METHODS Using a cluster randomised controlled trial, we evaluated a psychosocial stimulation intervention, comprising weekly home visits for 18 months, in urban slums of Cuttack, Odisha, India. The intervention is complementary to existing early childhood services in India and was run and managed through a local branch of a national NGO. The study ran from August 2013 to July 2015. We enrolled 421 children aged 10-20 months from 54 slums. Slums were randomised to intervention or control. Primary outcomes were children's cognitive, receptive language, expressive language and fine motor development assessed using the Bayley-III. Prespecified intent-to-treat analysis investigated impacts and heterogeneity by gender. TRIAL REGISTRATIONS ISRCTN89476603, AEARCTR-0000169. RESULTS Endline data for 378 (89.8%) children were analysed. Attrition was balanced between groups. We found improvements of 0.349 of a standard deviation (SD; p = .005, stepdown p = .017) to cognition while impacts on receptive language, expressive language and fine motor development were, respectively, 0.224 SD (p = .099, stepdown p = .184), 0.192 SD (p = .085, stepdown p = .184) and 0.111 (p = .385, stepdown p = .385). A child development factor improved by 0.301 SD (p = .032). Benefits were larger for boys. The quality of the home stimulation environment also improved. CONCLUSIONS This study shows that a potentially scalable home-visiting intervention is effective in poor urban areas.
Collapse
Affiliation(s)
- Alison Andrew
- Institute for Fiscal StudiesLondonUK,Department of EconomicsUniversity College LondonLondonUK
| | - Orazio Attanasio
- Institute for Fiscal StudiesLondonUK,Department of EconomicsUniversity College LondonLondonUK
| | | | - Monimalika Day
- Center for Early Childhood Education and DevelopmentAmbedkar UniversityDelhiIndia
| | | | - Costas Meghir
- Institute for Fiscal StudiesLondonUK,Department of EconomicsYale UniversityNew HavenCTUSA
| | - Fardina Mehrin
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
| | | | | |
Collapse
|
45
|
Henwood T, Channon S, Penny H, Robling M, Waters CS. Do home visiting programmes improve children's language development? A systematic review. Int J Nurs Stud 2020; 109:103610. [PMID: 32585448 DOI: 10.1016/j.ijnurstu.2020.103610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 02/26/2020] [Accepted: 04/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development. DATA SOURCES A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies. REVIEW METHOD Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template. RESULTS Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development. CONCLUSION Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.
Collapse
Affiliation(s)
- Tom Henwood
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, United Kingdom
| | - Sue Channon
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, United Kingdom
| | - Helen Penny
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, United Kingdom
| | - Mike Robling
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, United Kingdom
| | - Cerith S Waters
- Cardiff University, Tower Building, 70 Park Place, Cardiff CF10 3AT, United Kingdom.
| |
Collapse
|
46
|
Brentani A, Ferrer APS, Bessa L, Chang S, Walker S, Powell C, Hamadani J, Grisi S, Fink G. Survive and Thrive in Brazil: The Boa Vista Early Childhood Program: study protocol of a stepped-wedge, randomized controlled trial. Trials 2020; 21:390. [PMID: 32381097 PMCID: PMC7206708 DOI: 10.1186/s13063-020-4217-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence suggests that early life health and developmental outcomes can be improved through parental support programs. The objective of this project was to test the feasibility, impact, and relative cost-effectiveness of an adapted "Reach Up and Learn" program delivered through home-visiting programs as well as through center-based parenting groups on child health and development in the municipality of Boa Vista, Brazil. METHODS A randomized, stepped-wedge design was used to roll out and evaluate the two parenting platforms in Boa Vista municipality. A total of 39 neighborhoods with a high Neighborhood Vulnerability Index were selected for the study. For the first phase of the program, nine neighborhoods were randomly selected for home visits, and two were randomly selected for the center-based parenting groups. In the second phase of the program, 10 neighborhoods were added to the home-visiting program, and eight were added to the center-based program. In the final phase of the program, the remaining 10 control areas will also be assigned to treatment. Study eligibility will be assessed through a baseline survey completed by all pregnant women in the 39 study areas. Pregnant women will be eligible to participate in the study if they are either classified as poor, were under age 20 years when they became pregnant, or if they indicate to have been exposed to domestic or sexual violence. To assess program impact, an endline survey will be conducted when children reach age 2 years. The primary study outcome is child development at age 2 years as measured by the PRIDI instrument. Secondary outcome will be infant mortality, which will be assessed linking municipal vital registration systems to the program rollout. DISCUSSION This trial will assess the feasibility and impact of parenting programs rolled out at medium scale. The results from the trial should create evidence urgently needed for guiding Brazil's national Criança Feliz program as well as similar efforts in other countries. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03386747. Registered on 13 December 2017. All items of the World Health Organization Trial Registration Data Set are available in this record.
Collapse
Affiliation(s)
- Alexandra Brentani
- Department of Pediatrics, University of São Paulo Medical School, Av. Dr. Emeas de Carvalho Aguiar, 467, São Paulo, Brazil
| | - Ana Paula Scolezze Ferrer
- Department of Pediatrics, University of São Paulo Medical School, Av. Dr. Emeas de Carvalho Aguiar, 467, São Paulo, Brazil
| | - Luana Bessa
- Department of Pediatrics, University of São Paulo Medical School, Av. Dr. Emeas de Carvalho Aguiar, 467, São Paulo, Brazil
| | - Susan Chang
- Caribbean Institute of Health Research, University of the West Indies, Kingston, 7 WI Jamaica
| | - Susan Walker
- Caribbean Institute of Health Research, University of the West Indies, Kingston, 7 WI Jamaica
| | - Christine Powell
- Caribbean Institute of Health Research, University of the West Indies, Kingston, 7 WI Jamaica
| | - Jena Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani Mohakhali, Dhaka, 1212 Bangladesh
| | - Sandra Grisi
- Department of Pediatrics, University of São Paulo Medical School, Av. Dr. Emeas de Carvalho Aguiar, 467, São Paulo, Brazil
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss TPH and University of Basel, Socintrasse 57, 4002 Basel, Switzerland
| |
Collapse
|
47
|
Does use of solid fuels for cooking contribute to childhood stunting? A longitudinal data analysis from low- and middle-income countries. J Biosoc Sci 2020; 53:121-136. [DOI: 10.1017/s0021932020000097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractUsing longitudinal data from the first and second waves of the Young Lives Study (YLS) in Ethiopia, India (Andhra Pradesh), Peru and Vietnam, conducted in 2002 and 2006–07, and a repeated measures mixed model, this study examined the effect of the use of solid fuels for cooking on childhood stunting among children aged 5–76 months. The analysis showed that in all four populations, the average height-for-age z-score (HAZ score) was much lower among children living in households using solid fuels than among children in households using cleaner fuels for cooking. The average HAZ score was lower among children living in households that used solid fuels in both waves of the YLS compared with those whose households used solid fuels in only one of the two waves. A significant reduction was noted in the average HAZ score between the two waves in all countries except Ethiopia. The results of the repeated measures mixed model suggest that household use of solid fuels was significantly associated with lower HAZ scores in all populations, except Ethiopia. The findings also indicate that the reduction in the HAZ scores between waves 1 and 2 was not statistically significant by the type of cooking fuel after controlling for potential confounding factors. The study provides further evidence of a strong association between household use of solid fuels and childhood stunting in low- and middle-income countries using longitudinal data. The findings highlight the need to reduce exposure to smoke from the combustion of solid fuels, by shifting households to cleaner cooking fuels, where feasible, by providing cooking stoves with improved combustion of solid fuels and improved venting, and by designing and implementing public information campaigns to inform people about the health risks of exposure to cooking smoke.
Collapse
|
48
|
Fishell AK, Arbeláez AM, Valdés CP, Burns-Yocum TM, Sherafati A, Richter EJ, Torres M, Eggebrecht AT, Smyser CD, Culver JP. Portable, field-based neuroimaging using high-density diffuse optical tomography. Neuroimage 2020; 215:116541. [PMID: 31987995 DOI: 10.1016/j.neuroimage.2020.116541] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 12/17/2022] Open
Abstract
Behavioral and cognitive tests in individuals who were malnourished as children have revealed malnutrition-related deficits that persist throughout the lifespan. These findings have motivated recent neuroimaging investigations that use highly portable functional near-infrared spectroscopy (fNIRS) instruments to meet the demands of brain imaging experiments in low-resource environments and enable longitudinal investigations of brain function in the context of long-term malnutrition. However, recent studies in healthy subjects have demonstrated that high-density diffuse optical tomography (HD-DOT) can significantly improve image quality over that obtained with sparse fNIRS imaging arrays. In studies of both task activations and resting state functional connectivity, HD-DOT is beginning to approach the data quality of fMRI for superficial cortical regions. In this work, we developed a customized HD-DOT system for use in malnutrition studies in Cali, Colombia. Our results evaluate the performance of the HD-DOT instrument for assessing brain function in a cohort of malnourished children. In addition to demonstrating portability and wearability, we show the HD-DOT instrument's sensitivity to distributed brain responses using a sensory processing task and measurements of homotopic functional connectivity. Task-evoked responses to the passive word listening task produce activations localized to bilateral superior temporal gyrus, replicating previously published work using this paradigm. Evaluating this localization performance across sparse and dense reconstruction schemes indicates that greater localization consistency is associated with a dense array of overlapping optical measurements. These results provide a foundation for additional avenues of investigation, including identifying and characterizing a child's individual malnutrition burden and eventually contributing to intervention development.
Collapse
Affiliation(s)
- Andrew K Fishell
- Washington University School of Medicine, Division of Biology and Biomedical Sciences, St. Louis, MO, USA; Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Ana María Arbeláez
- Washington University School of Medicine, Department of Pediatrics, St. Louis, MO, USA
| | | | - Tracy M Burns-Yocum
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Arefeh Sherafati
- Washington University School of Medicine, Division of Biology and Biomedical Sciences, St. Louis, MO, USA; Washington University, Department of Physics, St. Louis, MO, USA
| | - Edward J Richter
- Washington University, Electrical and Systems Engineering, St. Louis, MO, USA
| | | | - Adam T Eggebrecht
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA; Washington University School of Medicine, Department of Pediatrics, St. Louis, MO, USA
| | - Christopher D Smyser
- Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA; Washington University School of Medicine, Department of Pediatrics, St. Louis, MO, USA; Washington University School of Medicine, Department of Neurology, St. Louis, MO, USA
| | - Joseph P Culver
- Washington University School of Medicine, Division of Biology and Biomedical Sciences, St. Louis, MO, USA; Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA; Washington University, Department of Physics, St. Louis, MO, USA; Washington University, Department of Biomedical Engineering, MO, St. Louis, USA.
| |
Collapse
|
49
|
Villagomez AN, Muñoz FM, Peterson RL, Colbert AM, Gladstone M, MacDonald B, Wilson R, Fairlie L, Gerner GJ, Patterson J, Boghossian NS, Burton VJ, Cortés M, Katikaneni LD, Larson JCG, Angulo AS, Joshi J, Nesin M, Padula MA, Kochhar S, Connery AK. Neurodevelopmental delay: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7623-7641. [PMID: 31783983 PMCID: PMC6899448 DOI: 10.1016/j.vaccine.2019.05.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Adrienne N Villagomez
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Flor M Muñoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Robin L Peterson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Alison M Colbert
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Rebecca Wilson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Gwendolyn J Gerner
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jackie Patterson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vera Joanna Burton
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jennifer C G Larson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Abigail S Angulo
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Jyoti Joshi
- Center for Disease Dynamics Economics & Policy, Amity Institute of Public Health, Amity University, India
| | - Mirjana Nesin
- Division of Microbiology and Infectious Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Padula
- Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA
| | - Sonali Kochhar
- Global Healthcare Consulting, India; University of Washington, Seattle, USA; Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amy K Connery
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA.
| |
Collapse
|
50
|
Weber AM, Rubio-Codina M, Walker SP, van Buuren S, Eekhout I, Grantham-McGregor SM, Araujo MC, Chang SM, Fernald LCH, Hamadani JD, Hanlon C, Karam SM, Lozoff B, Ratsifandrihamanana L, Richter L, Black MM. The D-score: a metric for interpreting the early development of infants and toddlers across global settings. BMJ Glob Health 2019; 4:e001724. [PMID: 31803508 PMCID: PMC6882553 DOI: 10.1136/bmjgh-2019-001724] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Early childhood development can be described by an underlying latent construct. Global comparisons of children's development are hindered by the lack of a validated metric that is comparable across cultures and contexts, especially for children under age 3 years. We constructed and validated a new metric, the Developmental Score (D-score), using existing data from 16 longitudinal studies. METHODS Studies had item-level developmental assessment data for children 0-48 months and longitudinal outcomes at ages >4-18 years, including measures of IQ and receptive vocabulary. Existing data from 11 low-income, middle-income and high-income countries were merged for >36 000 children. Item mapping produced 95 'equate groups' of same-skill items across 12 different assessment instruments. A statistical model was built using the Rasch model with item difficulties constrained to be equal in a subset of equate groups, linking instruments to a common scale, the D-score, a continuous metric with interval-scale properties. D-score-for-age z-scores (DAZ) were evaluated for discriminant, concurrent and predictive validity to outcomes in middle childhood to adolescence. RESULTS Concurrent validity of DAZ with original instruments was strong (average r=0.71), with few exceptions. In approximately 70% of data rounds collected across studies, DAZ discriminated between children above/below cut-points for low birth weight (<2500 g) and stunting (-2 SD below median height-for-age). DAZ increased significantly with maternal education in 55% of data rounds. Predictive correlations of DAZ with outcomes obtained 2-16 years later were generally between 0.20 and 0.40. Correlations equalled or exceeded those obtained with original instruments despite using an average of 55% fewer items to estimate the D-score. CONCLUSION The D-score metric enables quantitative comparisons of early childhood development across ages and sets the stage for creating simple, low-cost, global-use instruments to facilitate valid cross-national comparisons of early childhood development.
Collapse
Affiliation(s)
- Ann M Weber
- School of Community Health Sciences, University of Nevada Reno, Reno, Nevada, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
- Methodology & Statistics, Utrecht University, Utrecht, Netherlands
| | - Iris Eekhout
- Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
| | | | | | - Susan M Chang
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lia CH Fernald
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Simone M Karam
- Department of Pediatrics, Federal University of Rio Grande, Rio Grande, Brazil
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- International Education, RTI International, Research Triangle Park, North Carolina, USA
| |
Collapse
|