Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level

Association between epigenome-wide DNA methylation changes and early neurodevelopment in preschool children: Evidence from a former impoverished county in Central China

BACKGROUND

Existing epigenome-wide association studies (EWAS) investigating the association between DNA methylation (DNAm) and child neurodevelopment have been predominantly conducted within Western populations, and yielded inconsistent results, leading to a significant gap within non-Western setting, particularly in resource-limited rural areas of Central China.

OBJECTIVES

To investigate the association between altered epigenome-wide DNAm and neurodevelopment in preschool children from resource-limited rural areas of Central China.

METHODS

This case-control study involved 64 preschoolers. We assessed children's neurodevelopment using the Gesell Developmental Diagnostic Scale. The neurodevelopmental potential was expressed as a global developmental quotient (DQ) score. We conducted an EWAS with an Illumina Infinium MethylationEPIC v1.0 BeadChip array, using blood samples from 32 suspected developmental delay children (DQ scores < 85) and 32 controls (DQ scores ≥ 85). Differentially methylated probes (DMPs) and differentially methylated regions (DMRs) between the suspected developmental delay and control groups were analyzed. Multivariate linear regression models were used to evaluate the association between global DQ scores and DNAm. Functional enrichment analyses were conducted using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). The BECon tool was utilized to estimate the concordance of CpGs between blood and the human brain.

RESULTS

A total of 66 DMRs (PFDR < 0.05) were identified between the two groups, but no DMPs were found. After FDR correction, 844 methylated CpG sites exhibited significant associations with the global DQ scores in children. Genes annotated by methylated CpGs were mainly enriched in the "oxytocin signaling pathway", "mTOR signaling pathway", and "thyroid hormone signaling pathway". They were also involved in the "regulation of cell development", "cell-cell junction", and "ATPase activity". Among the top 20 CpGs, nine global DQ scores related-CpGs had blood-brain DNA methylation correlations, and six CpGs among them had an absolute Spearman correlation coefficient bigger than 0.2.

CONCLUSIONS

Preschoolers from a former impoverished county exhibited epigenome-wide DNAm changes strongly linked to early neurodevelopment. This study enhances our understanding of the epigenetic landscape associated with early neurodevelopment, and suggests the potential for developmenting epigenetic biomarkers that could facilitate the early identification of children at a higher risk of compromised neurodevelopment, as well as holding implication to inform novel interventions, especially in underprivileged regions.

Co-Occurrence of Stunting and Off-Track Early Child Development in Low- and Middle-Income Countries

Importance

Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children's potential to thrive.

Objectives

To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors.

Design, Setting, and Participants

This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024.

Exposure

Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics.

Main Outcomes and Measures

Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither.

Results

In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only.

Conclusions and Relevance

This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.

Home-based nurturing care practices for children under five with low socioeconomic position in Santo Domingo, Dominican Republic

BACKGROUND

In the Dominican Republic about 14.5% of children do not reach their full potential by age five, with children of low socioeconomic position most affected. The Nurturing Care Framework is an evidence-informed actionable framework to help children thrive, but we must first understand cultural contexts and childrearing practices that contribute to delay. This study applies the Nurturing Care Framework to explore the context of home-based care among young children in the Dominican Republic.

METHODS

We conducted a sociodemographic survey and semi-structured qualitative interview with 25 mothers ages 19-42 (7 under the age of 18 at first birth) with low socioeconomic position and children under five that live in the capital city Santo Domingo. We asked in-depth questions about the Nurturing Care Framework's domains of responsive caregiving and opportunities for early learning. We used consensual coding and deductive thematic analysis to analyze transcriptions, examined convergence and divergence in themes between adolescent and adult mothers, and organized themes using concept mapping.

RESULTS

A few mothers provide responsive caregiving to their child, but they are unaware of its benefit to their child's development. Adolescent mothers expressed lower confidence in their mothering skills. Across age groups, mothers did not see themselves as agents of change in their child's early learning process and allow several hours of videos each day. Mothers provide children opportunities for learning through social interaction, a possible strength among this population. With regards to security and safety, about half of mothers use corporal punishment, all but one of these is an adolescent mother.

CONCLUSION

Findings highlight the need for parenting programs that build on strengths such as child-to-child social interaction and provide parents with opportunities to develop knowledge and skills to provide early learning opportunities. Interventions should target families with low socioeconomic position and adolescent mothers.

Childhood brain morphometry in children with persistent stunting and catch-up growth

BACKGROUND

Early childhood stunting affects around 150 million young children worldwide and leads to suboptimal human potential in later life. However, there is limited data on the effects of early childhood stunting and catch-up growth on brain morphometry.

METHODS

We evaluated childhood brain volumes at nine years of age in a community-based birth-cohort follow-up study in Vellore, south India among four groups based on anthropometric assessments at two, five, and nine years namely 'Never Stunted' (NS), 'Stunted at two years and caught up by five years' (S2N5), 'Stunted at two and five years and caught up by nine years' (S2N9), and 'Always Stunted' (AS). T1-weighted magnetic resonance imaging (MRI) images were acquired using a 3T MRI scanner, and brain volumes were quantified using FreeSurfer software. Analysis of Variance (ANOVA) was used to determine the differences in brain volumetry between the stunting groups, with age and sex as covariates. The effect size ANOVA models was evaluated using Eta squared.

FINDINGS

Amongst 251 children from the initial cohort, 178 children with a mean age of 9.54 underwent neuroimaging and considered for further analysis. The total brain volume, subcortical volume, bilateral cerebellar white matter, and posterior corpus callosum showed a declining trend from NS to AS. Regional cortical brain analysis showed significant lower bilateral lateral occipital volumes, right pallidum, bilateral caudate, and right thalamus volumes between NS and AS.

INTERPRETATION

To the best of our knowledge, this first neuroimaging analysis to investigate the effects of persistent childhood stunting and catch-up growth on brain volumetry indicates impairment at different brain levels involving total brain and subcortical volumes, networking/connecting centres (thalamus, basal ganglia, callosum, cerebellum) and visual processing area of lateral occipital cortex.

Validation of the Global Scales of Early Development (GSED) tool in rural Western Kenya

BACKGROUND

Early childhood development (ECD) is a key determinant of long-term health, education, and wellbeing. However, one major global challenge is the lack of ECD assessment tools validated for use in low- and middle-income countries. To address this gap, the World Health Organization (WHO) launched in 2023 the Global Scales for Early Development, an open-access tool designed to generate reliable, valid, and internationally-comparable data on ECD for children aged 0-3 years globally. In this study, we examined the concurrent and convergent validity of the Global Scales for Early Development-long form (GSED-LF) for use with children aged 0-24 months in Kenya.

METHODS

We analyzed baseline data collected in October-November 2023 as part of a cluster-randomized controlled trial evaluating a parenting program for improving ECD in rural Western Kenya. Primary caregivers (91% mothers) with a child under 24 months were enrolled across 64 villages in Busia and Homabay counties. The GSED-LF was administered to all children (N = 647). In a randomly selected sub-sample of children (N = 116), the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Caregiver Reported Early Development Instruments (CREDI) were also administered to compare their scores with those from the GSED-LF. Concurrent validity of GSED-LF was assessed in terms of its correlations with Bayley-III and CREDI. Convergent validity of GSED-LF was examined with respect to parenting outcomes, including parental stimulation, home caregiving environment, and maternal mental health.

RESULTS

GSED-LF scores had moderate associations with those on the Bayley and CREDI across the domains of cognitive, language, and motor development. GSED-LF had small associations with socioemotional development and relatively weaker concurrent validity for younger children under 12 months. GSED-LF also demonstrated good convergent validity in terms of showing moderate associations with maternal and paternal stimulation and the home caregiving environment.

CONCLUSIONS

Overall, this study demonstrated the feasibility and initial validity of the GSED-LF as a direct assessment tool for use in rural Western Kenya. Additional psychometric analyses across diverse settings are needed to strengthen the reliability and validity evidence of the GSED-LF and establish it as a robust, globallyapplicable tool for assessing ECD in resource-limited settings.

Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

OBJECTIVE

To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.

STUDY DESIGN

Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation. Associations between log2-transformed biomarker concentrations and anthropometric (height-for-age z-score [HAZ], weight-for-height z-score, and weight-for-age z-score) and developmental (Global Scales of Early Development development for age z-score and saccadic reaction time [SRT]) outcomes were assessed using linear regression analyses adjusted for background characteristics.

RESULTS

Mean ± SD HAZ was -1.94 ± 1.10. Higher sCD14 and I-FABP concentrations were significantly associated with lower HAZ (β: -0.21, 95% CI: -0.41, -0.01 and β: -0.20, 95% CI: -0.32, -0.08, respectively). Higher I-FABP concentrations were significantly associated with lower development-for-age z-score (β: -0.22, 95% CI: -0.40, -0.03) and slower SRT (β: 7.37 ms, 95% CI: 2.02, 12.72) as were higher alpha-1-acid glycoprotein concentrations (HAZ β: -0.38, 95% CI: -0.72, -0.03; SRT β: 11.14 ms, 95% CI: 0.94, 21.72).

CONCLUSIONS

In children in Lusaka, biomarkers of EED were associated with poor anthropometric and developmental outcomes, underscoring the need for interventions to address EED to improve child health globally.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov identifier for parent trial: NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.

Parenting in the Digital Age: A Scoping Review of Digital Early Childhood Parenting Interventions in Low- and Middle-Income Countries (LMIC)

Objectives

This scoping review examines the evidence and knowledge gaps regarding the effectiveness of digital early childhood parenting interventions in Low- and Middle-Income Countries (LMICs).

Methods

Using PRISMA-ScR and PICOS frameworks, we systematically reviewed studies published since 2010 from four databases, focusing on the impact of digital parenting interventions on Early Childhood Development and parent-level outcomes.

Results

Of 1,399 studies identified, 13 met inclusion criteria, evaluating digital interventions for parents of children aged 0-5 years. These interventions included digital-only and hybrid approaches, leveraging technologies for tasks such as sharing health and ECD information, reminders, group chats, or screening. Among ECD studies, three of four with parent-reported outcomes found positive effects, but none of three using direct assessments did. Parent-level outcomes, such as mental health and parenting behaviors, showed consistent positive impacts.

Conclusion

Digital parenting interventions are feasible in LMICs but face challenges in implementation and reaching vulnerable families. Most studies are small-scale with variable designs and outcomes. Rigorous, high-quality studies are needed to establish effectiveness and optimize implementation strategies before these programs are deployed at scale.

Food insecurity and early childhood development among children 24-59 months in Nigeria: A multilevel mixed effects modelling of the social determinants of health inequities

Food insecurity (FI) has been identified as a determinant of child development, yet evidence quantifying this association using the newly developed Early Childhood Development Index 2030 (ECDI2030) remains limited. Herein, we provide national estimates of early childhood development (ECD) risks using the ECDI2030 and examined to what extent FI was associated with ECD among children aged 24-59 months in Nigeria. This population based cross-sectional analyses used data from the UNICEF-supported 2021 Multiple Indicator Cluster Survey in Nigeria. The analytic sample comprised children aged 24-59 months (weighted N = 12,112). We measured early childhood development for each child using the ECDI2030, measured across three domains: learning, psychosocial well-being and health. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES), categorized as none/mild, moderate and severe. We fitted mixed-effects multilevel logistic regression models, with random intercepts, to estimate the odds of association between FI status and ECD. A total of 11,494 children aged 24-59 months (mean ± SD age, 43.4 ± 9.9 months), including 5,797 boys (50.2%) and 5,697 girls (49.8%), were included in the study. Approximately 46.4% of children were developmentally off track and about 76% of children lived in food-insecure households. The intercept-only model indicated significant variation in ECD prevalence across communities (τ00 = 0.94, intraclass correlation = 0.22, p < 0.0001), suggesting nonignorable variability in ECD across communities. Adjusting for confounders, we observed no significant association between FI and ECD. However, increasing child's age and disability status appeared as significant risk factors for higher odds of children being developmentally off track. These findings highlight that while FI alone may not explain ECD, a combination of individual and contextual factors plays a crucial role. Future interventions addressing ECD in Nigeria should consider these multidimensional influences to promote optimal child development.

Factors associated with early childhood development: results from the Brazilian National Survey on Child Nutrition (ENANI-2019)

Introduction

The full achievement of early childhood development (ECD) is a human right and adhering to the nurturing care framework may facilitate it.

Objective

To evaluate the association between distal and proximal variables and developmental quotient (DQ).

Methods

Data from 14 159 children <5 years were evaluated in the Brazilian National Survey on Child Nutrition. The Survey of Well-being of Young Children-Brazilian version milestones questionnaire was used to evaluate ECD. The developmental age was estimated using the graded response models. DQ was calculated by dividing developmental age by chronological age. The expected age milestones are attained when DQ=1. DQ predictors were defined considering distal and proximal levels/variables using a multiple linear regression model and a hierarchical approach.

Results

The DQ mean was significantly lower among children aged 36-59 months (0.91 (0.88 to 0.93)), boys (1.03 (1.01 to 1.06)) and those from the North region (0.98 (0.93 to 1.04)) compared with children aged 1-35 months (1.18 (1.15 to 1.22)), girls (1.11 (1.08 to 1.13)) and from the Southeast region (1.11 (1.07 to 1.16)). For children aged 1-35 months, DQ was inversely associated with emergency C-section (β=-0.08; p<0.01), consumption of ultra-processed food (β=-0.33; p<0.01), and positively associated with attendance at daycare/school (private: β=0.09; p=0.02 and No: β=0.12; p<0.01). For children aged 36-59 months, attendance to private daycare/school (β=0.08; p<0.01) was positively associated with DQ, and small for gestational age at birth (β=-0.05; p=0.01) and access to public health services (no-primary care) (β=-0.07; p<0.01) were inversely associated with DQ.

Conclusions

Adverse health, nutrition and learning factors predicted the ECD, demonstrating an inequitable environment for Brazilian children. These findings indicate a need for public policies to ensure social and health equity in early childhood.

Proof of concept of the Universal Baby video innovation for early child development in Lima, Peru

OBJECTIVE

Community-based video interventions offer an effective and potentially scalable early interaction coaching tool for caregivers living in low resource settings. We tested the Universal Baby (UB) video innovation; an early interaction coaching tool using video sourced and produced locally with early child development (ECD) expert supervision.

METHODS

This proof-of-concept study enrolled 40 caregivers of children ages 10-18 months assigned to intervention and control groups by health establishments in Carabayllo, Lima, Peru. Mother/child dyads received 12 weekly group health education sessions with social support. Of those, 16 caregivers also received 6 UB videos featuring brain science education and local clips of responsive, reciprocal interaction, also known as "serve and return" interaction. Survey data assessed feasibility and acceptability of the intervention. We assessed improved quality of mother/child interaction using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO).

RESULTS

We found the program feasible. We successfully trained the local team to produce UB videos using locally-sourced footage and delivered the videos as part of a community-based intervention. We also found it to be acceptable in that participants enthusiastically received the UB videos, reporting they enjoyed being videotaped, and learned how to recognize and appropriately respond to their child's nuanced sounds and gestures. The median change in total PICCOLO scores favored the intervention group compared to the control group.

CONCLUSIONS

UB offers great potential as a sustainable, potentially scalable, and culturally appropriate tool to promote equity for child development among young children living in low resource homes globally.

Child developmental delay and its associated factors among children aged 12-59 months in Dembecha district, Northwest Ethiopia: a community-based cross-sectional study

Background

Developmental delay is a group of disorders that cause common deficits of adaptive and intellectual function in children. It happens when a child fails to achieve one aspect of developmental skills. Limited information is available regarding the prevalence of developmental delay among children aged 12-59 months in the study area. Therefore, this study aimed to assess the prevalence of developmental delay and its associated factors among this population.

Methods

A community-based cross-sectional study was conducted in Dembecha district among 702 children aged 12-59 months. Data were gathered through face-to-face interviews, and by taking anthropometric measurements using a pretested structured questionnaire. Data were entered into Epi Data version 4.2 software and exported into Statistical Package for Social Science (SPSS) version 25 software for analysis. The WHO Anthro software was used to analyze anthropometric-related data. Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with developmental delay. The odds ratio with a 95% Confidence Interval (CI) was estimated to determine the strength of the association.

Results

The prevalence of developmental delay among children was 26.7% (95% CI: 23.5, 30.2). Toddler child age (AOR = 2.60; 95% CI: 1.42, 4.87), low birth weight (LBW; AOR =4.90; 95% CI: 2.14, 11.48), cesarean section mode of delivery (AOR = 8.60; 95% CI: 3.93, 18.65), preterm delivery (AOR = 2.5; 95% CI: 1.28, 4.74), early initiation of complementary feeding (AOR = 8.40; 95% CI: 3.61, 19.63), stunting (AOR = 2.90; 95% CI: 1.67, 5.22) inadequate meal frequency (AOR = 3.20; 95% CI: 1.74, 5.94), and inadequate dietary diversity (AOR = 3.10; 95% CI: 1.68, 5.85) were significantly associated with child developmental delay.

Conclusion

The prevalence of developmental delay among children was high in Dembecha district compared to the global prevalence. Child developmental delay was associated with toddler child age, LBW, cesarean section mode of delivery, preterm delivery, initiation of complementary feeding before 6 months, stunting, inadequate meal frequency, and inadequate dietary diversity. Therefore, preventing preterm delivery and LBW, initiating complementary feeding before 6 months, stunting, and achieving the minimum meal frequency, and minimum dietary diversity are recommended to prevent child developmental delay.

Integrated child nutrition, parenting, and health intervention in rural Liberia: A mixed-methods feasibility study

In Liberia, children are exposed to multiple forms of adversity which can negatively impact their health and development. Research is needed to examine the feasibility and benefits of integrated interventions that can be incorporated into existing health delivery programs to simultaneously address low responsive stimulation, undernutrition, and infection. This study assessed the feasibility of an integrated intervention promoting psychosocial stimulation and improved child feeding by the provision of eggs and fish. The integrated intervention was incorporated into an existing government health program. Thirty female caregiver-child dyads were randomly selected from two rural communities in Liberia. Participants received fortnightly group parenting sessions and weekly eggs and fish designated for child consumption, for four weeks. Trained community health workers delivered the intervention. Assessments were conducted before and after the intervention using quantitative surveys and qualitative interviews. At baseline, we examined the home environment, caregiver-child interactions, diet, and infection control practices. At endline, we assessed the feasibility of the intervention. Descriptive analyses were conducted with quantitative data. Qualitative data were analyzed using conventional content analysis. Baseline findings indicated uncommon responsive parenting, inadequate early learning opportunities, high food insecurity, and high child morbidity. Mixed methods indicators of feasibility, including acceptability, adoption, and fidelity were high. Qualitative data from this feasibility study informed several future modifications to the program, including engaging fathers, supplementing group sessions with home visits, and broadening facilitator eligibility. This integrated intervention is feasible and can be incorporated into existing health programs to support early child development.

D, Mandal S, Menon JS, Roy A, Dixit S, Gupta R, Swaminathan S, Thankachan P, Bhavnani S, Divan G, Prabhakaran P, van Schayck OCP, Babu GR, Srinivas PN, Mukherjee D. Protocol of the Nutritional, Psychosocial, and Environmental Determinants of Neurodevelopment and Child Mental Health (COINCIDE) study

Background

Over 250 million children are developing sub-optimally due to their exposure to early life adversities. While previous studies have examined the independent effects of nutritional status, psychosocial adversities, and environmental pollutants on children's outcomes, little is known about their interaction and cumulative effects.

Objectives

This study aims to investigate the independent, interaction, and cumulative effects of nutritional, psychosocial, and environmental factors on children's cognitive development and mental health in urban and rural India. It also seeks to explain pathways leading to inequities in child outcomes at the individual, household, and neighbourhood levels.

Methods

A mixed-methods prospective cohort study will be conducted on 1600 caregiver-child dyads (child age 3-10 years) in urban and rural India. Nutritional status, psychosocial adversities, environmental pollutants, and child mental health outcomes will be assessed using parent-report questionnaires. Performance-based measures will be used to assess cognitive outcomes. Venous blood and urine samples will be used to measure nutritional and pesticide biomarkers in 500 children. Indoor air pollution will be monitored in 200 households twice, during two seasons. Multilevel regression, weighted quantile sum regression, and Bayesian kernel machine regression will assess the individual and combined effects of exposures on child outcomes. Thematic analysis of in-depth interviews and focus group discussions will explore pathways to middle-and late childhood development inequities.

Discussion

The data will be used to formulate a Theory of Change (ToC) to explain the biological, psychosocial, and environmental origins of children's cognitive and mental health outcomes across the first decade of life in diverse Indian settings, which can inform interventions targets for promoting children's outcomes beyond the first 1000 days, potentially generalizable to similar under-resourced global settings. The COINCIDE research infrastructure will comprise a valuable global health resource, including prospective cohort data, validated study tools, and stored biological and environmental samples for future studies.

Interplay of paternal caregiving and screen use habits on early childhood development and children's tantrums

BACKGROUND

This study aims to examine the association for paternal care and father-child screen use with early childhood development and children's temper tantrums.

METHOD

Study file included questions about paternal characteristics, child care, father-child screen habits, and utilized the UNICEF Early Childhood Development Index (ECDI). Factors influencing ECDI-on-track status and children's responses when screen use was restricted were investigated with Chi-square test and multiple logistic regression.

RESULTS

The study included 464 fathers having children aged 3-4 years. The findings showed that 89.7% of the children were on track in three out of the four ECDI subgroups. When screen use was restricted, 55.6% of the children engaged in another activity, while 44.4% reacted by crying. Multiple logistic regression analysis revealed that the father's education level, the child's age and gender, the starting age for screen usage, the child's reaction to screen restriction, and having three or more books were associated with ECDI. Furthermore, the child's reaction to screen restriction was related to the child's and father's screen time, the presence of three or more books, the adequacy of care, and being on track in the literacy-numeracy ECDI subgroup.

CONCLUSION

Screen usage habits significantly impact early childhood development and children's reactions to screen restrictions. These findings underscore the importance of educating fathers about the effects of their own and their child's media habits, the quality of fatherly caregiving, and the presence of books in fostering positive child development.

The gradient of social determinants of health and related inequalities and early childhood development: Analysis of two rounds of a cross-sectional survey

AIM

Social determinants of health (SDH) have a critical role in child development. Yet these determinants are often overshadowed. This study examines the effect of composites of five SDH on early childhood development (ECD) of children of age 36-59 months.

METHODS

We used two 2013 and 2019 rounds of Multiple Indicator Cluster Survey Bangladesh data. The analytical sample included ECD data for 25 721 children. ECD was computed following United Nations International Children's Emergency Fund's psychometric approach. Three composite indices of SDH were developed to examine their gradient effects on ECD. Poisson regression with robust variance was used to examine the relationship between SDH indices and ECD. The concentration index was computed, and a concentration curve was developed to measure inequalities in being on track of ECD among children with various levels of SDH.

RESULTS

Almost 69% of children were on track in their ECD, a higher percentage in 2019 (74.85%) than in 2017 (65.37%). The prevalence of children on track in their ECD significantly rises per unit in the score of three SDH composites (adjusted prevalence ratios are 1.04 (95% confidence interval (CI): 1.03-1.04) for summative and standardised indexes and 1.49 (95% CI: 1.41-1.58) for weighted index). There is almost a linear positive relationship between the SDH composite and ECD. Significant concentration indexes suggest SDH-related inequalities in ECD.

CONCLUSION

Children's early development can be hampered due to unfavourable SDH. Although ECD plays a vital role in creating and maintaining socio-economic and health inequalities through to adulthood, favourable SDH needs to be ensured during childhood.

Motor development trajectories of children with cerebral palsy in a community-based early intervention program in rural South India

BACKGROUND

Developmental trajectories are crucial for evidence-based prognostication, planning interventions, and monitoring progress in children with cerebral palsy (CP).

AIMS

To describe gross motor development patterns of children with CP in rural South India for the five Gross Motor Function Classification System (GMFCS) levels.

METHODS

Longitudinal cohort study of 302 children (176 males, 126 females) with CP aged 0 to 10 years, followed by a community-based early intervention program. GMFCS levels were 5.4 % level 1, 16.5 % level II, 22.8 % level III, 26.8 % level IV, and 28.5 % level V. Assessments were undertaken using the Gross Motor Function Measure (GMFM-66) at 6-month intervals between April 2017 and August 2020. Longitudinal analyses were performed using mixed-effects linear regression models.

OUTCOMES AND RESULTS

Five distinct motor development curves were created for ages 0 to 10 years by GMFCS levels as a function of age and GMFM-66 with a stable limit model, variation in estimated limits and rates of development.

CONCLUSIONS AND IMPLICATIONS

Motor development trajectories for CP in an LMIC differ from those reported in HICs. Consideration of how social determinants of health, environmental and personal factors impact motor development in low-resource contexts is crucial. Further work is needed to describe developmental trajectories of children for CP in LMICs.

The relationship between the ages and stages questionnaire, 3rd edition scores in early childhood and future cognitive abilities in young Nepalese children

BACKGROUND

The Ages and Stages Questionnaire 3rd edition (ASQ-3) could be a feasible tool in resource-poor settings. Little is known on the relationship between scores on the ASQ-3 and later intellectual abilities in these settings.

AIMS

To examine the relationship between ASQ-3 scores during the first and second year of life and intellectual abilities at 4 years of age in Nepalese children.

METHODS

In a cohort of 600 children at-risk of stunting, the ASQ-3 was performed at 6-11 and 18-23 months, and the Wechsler Preschool and Primary Scales of Intelligence, fourth edition (WPPSI-IV) at 4 years. We examined the relationship between the ASQ-3 scores and WPPSI-IV full scale IQ (FSIQ) using Spearman correlation coefficients and linear regression models.

RESULTS

Correlations between ASQ-3 total scores and FSIQ was 0.17 (95% CI 0.07, 0.27) at 6-11 and 0.34 (95% CI 0.26, 0.44) at 18-23 months explaining 2 and 12% of the variance respectively. Except for the communication subscale at 18-23 months with moderate correlations, correlations between the ASQ-3 subscales and FSIQ were weak.

CONCLUSION

Our findings suggest a modest relationship between ASQ-3 scores in early childhood and intellectual abilities at 4 years.

A parenting program delivered through existing community-based peer groups to improve early child development in Homabay and Busia Counties, Kenya: study protocol for a cluster-randomized controlled trial

BACKGROUND

Poor early childhood development (ECD) is a major global health concern that is associated with various adverse outcomes over the lifecourse. Parenting interventions especially during the earliest years of life can benefit ECD. However, there is limited evidence from Kenya about the effectiveness of parenting interventions for improving ECD outcomes especially across rural disadvantaged communities. This paper describes the study protocol for an impact and implementation evaluation of a community-based group parenting program that aims to improve ECD in rural Kenya.

METHODS

We will conduct a cluster-randomized controlled trial to determine the effectiveness of a parenting program for caregivers of young children in Homabay and Busia counties in Western Kenya. Sixty-four village clusters will be randomly assigned to either the parenting intervention arm or the waitlist control arm with stratification by county. In each village, 10 primary caregivers with a child aged 0-24 months will be enrolled. The parenting program will be delivered through existing peer groups within communities whereby caregivers will receive counseling and psychosocial support to enhance their parenting skills and wellbeing to in turn promote ECD. The intervention curriculum comprises 21 sessions targeting various nurturing care messages, including early learning, responsive caregiving, child nutrition, health, protection, and caregiver mental health. Group sessions are facilitated by a trained volunteer biweekly for a total of 11 months. The primary trial outcome is an overall measure of ECD using the Global Scales of Early Development long form version. Secondary outcomes include various caregiver outcomes (e.g., parenting practices, mental health) and other child outcomes (e.g., socioemotional development, dietary diversity). All outcomes will be assessed at baseline and endline. We will also conduct a qualitative implementation evaluation at endline and interview various stakeholders to assess program fidelity, quality, and sustainability.

DISCUSSION

This trial will evaluate the effectiveness of a parenting intervention on ECD and caregiving outcomes and assess program implementation quality as delivered through existing community-based peer groups. This study will provide rigorous evidence that can be used to inform scale-up of this program model that leverages existing community social networks and resources for improving caregivers' parenting skills and promoting ECD in rural Kenya and other similar settings across LMICs.

TRIAL REGISTRATION

ClinicalTrials.gov #NCT06165315. Registered on December 11, 2023.

Caregiver mental health and school-aged children's academic and socioemotional outcomes: Examining associations and mediators in Northern Ghana

While there is a strong link between caregiver mental health, caregiver engagement, and child development, limited research has examined the underlying mechanisms of these associations in Africa. We examined the mediating role of dimensions of caregiver engagement in the association of caregiver psychological distress with children's academic and socioemotional outcomes in Ghana. Data came from 4,714 children (aged 5-17 years) and their caregivers in five regions of northern Ghana. Caregiver psychological distress and engagement (i.e., engagement in education, emotional supportiveness, and parenting self-efficacy) were self-reported by children's primary caregiver. Children's academic (literacy and numeracy) and socioemotional (prosocial skills and socioemotional difficulties) outcomes were directly assessed using validated measures. Structural equation modelling was used to estimate mediation models. We tested moderation by caregiver exposure to formal education, child's age, and child's sex. Fourteen percent of caregivers experienced elevated psychological distress. Higher levels of psychological distress were associated with children's poorer literacy and numeracy skills, and higher socioemotional difficulties, but not prosocial skills. The mediating role of caregiver engagement varied by caregiver exposure to formal education but not child's age or sex. Caregiver engagement in education explained the association between psychological distress and children's literacy skills (but not numeracy or socioemotional) in families where the caregiver had no formal education (indirect effect: β = 0.007 [95% CI: 0.000, 0.016]), explaining 23% of the association. No mediator explained the association of psychological distress with child outcomes among families where the caregiver had some formal education. The mechanisms through which caregiver psychological distress is associated with child outcomes in rural Ghana differ as a function of caregivers' exposure to formal education. These results highlight the importance of developing multi-component and culturally-sensitive programs to improve child outcomes. Further research in similar contexts is needed to advance scientific understanding on how to effectively promote child and family wellbeing.

Paths of cognitive and social-emotional delays before age three in rural China: Predictive power on skills at preschool age

Cognitive and social-emotional development in the first three years of life is associated with later skills. However, little is known about the paths of developmental delays in both cognitive and social-emotional skills before age 3 or to what extent these paths predict later developmental outcomes. The aim of this study is to examine the associations between the different paths of developmental delays in both cognitive and social-emotional skills of children before age 3 and the levels of development of the children when they are preschool age. Using a longitudinal data collected at three time points from 1245 children and their caregivers in rural China, we identified four different paths of developmental delays in cognitive and social-emotional before age 3 and examined how these paths are associated with different levels of developmental outcomes at preschool age. We used a non-parametric standardization approach and an ordinary least squares model to perform our analyses. Findings show that rates of developmental delays in either cognitive or social-emotional domain or both domains are high at all different time points, ranging from 20% to 55% for cognitive delays and 42% to 61% for social-emotional delays. Over half of children experienced deteriorating levels of either cognitive or social-emotional development before age 3. A large share of children was found to be persistently delayed in either domain. Only a small share of children raised their levels of development in either domain before age 3. In addition, we identified certain socioeconomic status of the family that are associated with never or deteriorating path of child developmental delays. More importantly, we revealed that different paths of developmental delays before age 3 have predictive power on different levels of developmental outcomes at preschool age. Our results suggest that actions are needed at the earliest times to improve child development when children are still infants or toddlers.

A predictive model for stunting among children under the age of three

Background

In light of the global effort to eradicate stunting in childhood, the objective of this research endeavor was to assess the prevalence of stunting and associated factors, simultaneously construct and validate a risk prediction model for stunting among children under the age of three in Shenzhen, China.

Methods

Using the stratified random sampling method, we selected 9,581 children under the age of three for research and analysis. The dataset underwent a random allocation into training and validation sets, adhering to a 8:2 split ratio. Within the training set, a combined approach of LASSO regression analysis and binary logistic regression analysis was implemented to identify and select the predictive variables for the model. Subsequently, model construction was conducted in the training set, encompassing model evaluation, visualization, and internal validation procedures. Finally, to assess the model's generalizability, external validation was performed using the validation set.

Results

A total of 684 (7.14%) had phenotypes of stunt. Utilizing a combined approach of LASSO regression and logistic regression, key predictors of stunting among children under three years of age were identified, including sex, age in months, mother's education, father's age, birth order, feeding patterns, delivery mode, average daily parent-child reading time, average time spent in child-parent interactions, and average daily outdoor time. These variables were subsequently employed to develop a comprehensive prediction model for childhood stunting. A nomogram model was constructed based on these factors, demonstrating excellent consistency and accuracy. Calibration curves validated the agreement between the nomogram predictions and actual observations. Furthermore, ROC and DCA analyses indicated the strong predictive performance of the nomograms.

Conclusions

The developed model for forecasting stunt risk, which integrates a spectrum of variables. This analytical framework presents actionable intelligence to medical professionals, laying down a foundational framework and a pivot for the conception and execution of preemptive strategies and therapeutic interventions.

Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis

BACKGROUND

Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social-emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848.

FINDINGS

We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social-emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (-0·18 [-0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results.

INTERPRETATION

Multi-component parenting and mental health interventions had a positive effect on child cognitive and social-emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes.

FUNDING

Canadian Institutes of Health Research.

Predictors of early child development for screening pregnant women most in need of support in Brazil

Background

Home visiting programmes can support child development and reduce inequalities, but failure to identify the most vulnerable families can undermine such efforts. We examined whether there are strong predictors of poor child development that could be used to screen pregnant women in primary health care settings to target early interventions in a Brazilian population. Considering selected predictors, we assessed coverage and focus of a large-scale home visiting programme named Primeira Infância Melhor (PIM).

Methods

We undertook a prospective cohort study on 3603 children whom we followed from gestation to age four years. We then used 27 potential socioeconomic, psychosocial, and clinical risk factors measurable during pregnancy to predict child development, which was assessed by the Battelle Developmental Inventory (BDI) at the age of four years. We compared the results from a Bonferroni-adjusted conditional inference tree with exploratory linear regression and principal component analysis (PCA), and we conducted external validation using data from a second cohort from the same population. Lastly, we assessed PIM coverage and focus by linking 2015 cohort data with PIM databases.

Results

The decision tree analyses identified maternal schooling as the most important variable for predicting BDI, followed by paternal schooling. Based on these variables, a group of 214 children who had the lowest mean BDI (BDI = -0.48; 95% confidence interval (CI) = -0.63, -0.33) was defined by mothers with ≤5 years and fathers with ≤4 years of schooling. Maternal and paternal schooling were also the strongest predictors in the exploratory analysis using regression and PCA, showing linear associations with the outcome. However, their capacity to explain outcome variance was low, with an adjusted R2 of 5.3% and an area under the receiver operating characteristic curve of 0.62 (95% CI = 0.60, 0.64). External validation showed consistent results. We also provided an online screening tool using parental schooling data to support programme's targeting. PIM coverage during pregnancy was low, but the focus was adequate, especially among families with longer enrolment, indicating families most in need received higher dosage.

Conclusions

Information on maternal and paternal schooling can improve the focus of home visiting programmes if used for initial population-level screening of pregnant women in Brazil. However, enrolment decisions require complementary information on parental resources and direct interactions with families to jointly decide on inclusion.

Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)- a parent group intervention for school readiness in Bangladesh, Nepal, and Tanzania: study protocol for a cluster randomized controlled trial

BACKGROUND

Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn-Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility.

METHODS

EN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent-child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is "school readiness", assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders' perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.  DISCUSSION: This protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities.

TRIAL REGISTRATION

The trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627).

Long-term effects of early life rainfall shocks on foundational cognitive skills: Evidence from Peru

Global warming is changing precipitation patterns, particularly harming communities in low-and-middle income countries (LMICs). Whilst the long-term effects of being exposed to rainfall shocks early in life on school-achievement tests are well-established, there is little population-based evidence from LMICs on the mechanisms through which these shocks operate. Executive functions (EFs) are key for children's learning abilities. This paper analyses the effects of early exposure to rainfall shocks on four foundational cognitive skills (FCSs), including EFs that have been found to be key predictors of educational success. These skills were measured via a series of tablet-based tasks administered in Peru as part of the Young Lives longitudinal study (YLS). We combine the YLS data with gridded data on monthly precipitation to generate monthly, community-level rainfall shock estimates. The key identification strategy relies on temporary climatic shocks being uncorrelated with other latent determinants of FCSs development. Our results show significant negative effects of early life exposure to rainfall shocks on EFs-especially, on working memory-measured in later childhood. We also find evidence of rainfall shocks decreasing households' abilities to invest in human capital, which may affect both FCSs and domain-specific test scores. Finally, there is suggestive, but not conclusive, evidence that a conditional-cash-transfer program providing poor households with additional financial resources might partially offset the effects of the rainfall shocks.

Growth monitoring and promotion service utilization and its associated factors among mothers of children under two years in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Growth monitoring and promotion (GMP) is a nutritional intervention designed to identify and address growth faltering before a child's nutritional status deteriorates into severe malnutrition. Despite GMP being recognized as a priority in Ethiopia's national nutrition program, there is no national aggregated figure to show the extent of GMP service utilization. Therefore, this systematic review and meta-analysis aimed to assess GMP service utilization and associated factors in Ethiopia.

METHODS

A systematic literature search was conducted using PubMed/MEDLINE, CINAHL, Hinari, EMBASE, Scopus, and grey literature sources like Google Scholar, WorldCat, and Institutional repository. The Joanna Briggs Institution (JBI) quality assessment tool was used to appraise the quality of the articles, and articles scoring > 50% were included in the analysis. The pooled prevalence and odds ratio of associated factors with 95%CI was computed using STATA version 16. A random-effect model was employed to estimate the effect size, and I-squared statistics and Egger's test were used to assess heterogeneity and identify potential publication bias, respectively. Subgroup analysis was conducted with publication year, sample size, and region to identify the source of heterogeneity.

RESULTS

Nine studies with 4,768 study participants were included in this meta-analysis. The overall pooled utilization of GMP service among children under two years of age in Ethiopia was 23.21% (95% CI: 16.02, 30.41, I2 = 97.27% & P = 0.0001). Mothers who received counselling on GMP service (OR = 3.16 (95%CI: 2.49-4.00), parents who use family health card (FHC) (OR = 3.29 (95%CI: 1.49-7.28), and mother who use postnatal care (OR = 3.93 (95%CI: 2.40-6.42), and Anti natal care (OR = 3.15 (95%CI: 1.29-7.69) were the factors associated with GMP service utilization among children under two years of age.

CONCLUSIONS

The utilization of GMP services among children under the age of two in Ethiopia remains inadequate. Therefore, it is crucial to provide health education and counselling focusing on GMP to the mothers/caregivers of the child and encourage utilization of FHC. In addition, integrating GMP with other maternal health services should be promoted.

Parenting Interventions That Promote Child Protection and Development for Preschool-Age Children with Developmental Disabilities: A Global Systematic Review and Meta-Analysis

Global guidelines emphasize the critical role of responsive caregiving in terms of reducing violence against children and promoting early childhood development. However, there is an absence of global evidence synthesis on the effects of early childhood parenting programs for children with developmental disabilities. This systematic review and meta-analysis aims to investigate the effectiveness of parenting interventions delivered for preschool-age children with developmental disabilities in reducing violence against children, altering violence-related factors, and promoting child development. We searched for randomized controlled trials with inactive control. Estimates were pooled using robust variance estimations. Meta-regressions were conducted to explore sources of heterogeneity. In all, 33 studies met the inclusion criteria. The results showed that parenting programs improved child behavior, parental mental health, parenting practices, parental self-efficacy, parent-child interaction, child language skills, and child social skills post-intervention. No studies provided data on the actual occurrence of violence against children. Effects might vary by diagnosis, delivery modality, and world region. The findings supported the delivery of parenting programs to alter factors associated with violence against children and promote child language and social skills for families of young children with developmental disabilities, especially attention deficit hyperactivity disorder, autism, intellectual disability, and language disorders. More research using rigorous methods, long-term follow-ups, and transparent reporting is needed, particularly within more low- and middle-income countries.

Early childhood development and nutritional status in urban Ethiopia

Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.

[Neurodevelopment and neuroprotection in young children]

In France, the most pessimistic estimates put the prevalence of neurodevelopmental disorders (NDD) at 15 % of births. The two largest populations of newborns at highest risk of NDD are premature babies and babies born into siblings with one or more infants who already have an autism spectrum disorder or another NDD. The high prevalence of these disorders justifies a health promotion policy, centred on the child and his or her family. Prevention is based on the early identification of high-risk factors, by informing families and training pregnancy and early childhood professionals, and implementing perinatal prevention protocols for high-risk newborns (antenatal corticosteroid therapy and magnesium sulfate for women at risk of preterm delivery before 32 weeks, developmental care, therapeutic hypothermia for full-term infants with early neonatal encephalopathy presumed to be anoxic). Preventing the severity of NDD depends on their early identification, as early as possible in the highest plastic "1000 days" developmental window, a smooth flow of diagnosis and care for mothers and children, and the establishment of an ecosystem that includes multi-modal early intervention, at the best in multi-disciplinary teams such as the early medical and social action centres, support for families through guidance programs and inclusion in the community, first in day-care centers and then in nursery schools.

Roles of caregiver-child interaction on the association of socioeconomic status with early childhood development: a population-based study in rural China

OBJECTIVE

Socioeconomic status (SES) has been previously associated with children's early development, health, and nutrition; however, evidence about the potential role of caregiver-child interaction in such associations was limited. This study aimed to explore the effect of caregiver-child interaction on the associations of SES with child developmental outcomes, including early neurodevelopment and social-emotional behavior.

METHODS

A cross-sectional survey was conducted among 2078 children aged 0-6 in a rural county that just lifted out of poverty in 2020 in Central China. The Ages & Stages Questionnaires-Chinese version (ASQ-C) and the Social-Emotional (ASQ: SE) questionnaire were used to assess children's early neurodevelopment and social-emotional behavior, respectively. Caregiver-child interaction was evaluated with the Brigance Parent-Child Interactions Scale. Regression-based statistical mediation and moderation effect were conducted with the PROCESS macro of SPSS.

RESULTS

Children with low SES had an increased risk of suspected neurodevelopmental delay [OR = 1.92, 95% CI: 1.50, 2.44] and social-emotional developmental delay [OR = 1.31, 95% CI: 1.04, 1.66]. The caregiver-child interaction partially mediated the associations of SES with child developmental outcomes; the proportion of the indirect effect was 14.9% for ASQ-C total score and 32.1% for ASQ: SE score. Moreover, the caregiver-child interaction had a significant moderation effect on the association of SES with ASQ-C total score (P < 0.05). A weaker association was observed in children with high-level caregiver-child interaction than in medium and low ones. Similar moderating effects were found among boys but not girls.

CONCLUSION

Caregiver-child interaction plays a vital role in the relationship between SES and child development. Children with low SES households will benefit more in terms of their early development from intervention programs strengthening caregiver-child interaction.

Effect of a parenting and nutrition education programme on development and growth of children using a social safety-net platform in urban Bangladesh: a cluster randomized controlled trial

Background

Although sustainable development goals mandate for quality early childhood development (ECD) interventions for children <8 years, little occurs for children <3 years, especially in urban settings in low-and-middle-income countries (LMICs). Our primary objective was to measure the effect of an ECD-focused parenting and nutrition education on children's development through home visits using a social safety net platform of urban Bangladesh.

Methods

A cluster randomized controlled trial was conducted with mothers of children aged 6-16 months in 20 clusters across the Rangpur city, Bangladesh. The intervention group received fortnightly ECD-focused parenting and nutrition education at homes by local Community Health Workers (CHWs) for one year. Bayley-III was used to measure children's cognitive, language and motor development. Data were analyzed using intention to treat. ClinicalTrials.gov Identifier: NCT03753646.

Findings

Out of 599 mother-child dyads, 56.6% mothers were aged ≤ 25 years old. After one year, the intervened children had higher cognitive [Effect size Cohen's d; 0.42 SD (95% CI: 0.58-0.25)], language (0.38 SD, 95% CI: 0.55-0.22) and motor (0.17 SD, 95% CI: 0.01-0.34) development. In the intervention group, mothers experienced less violence [Odds ratio; 0.6 (95% CI: 0.4-1.0)] and fathers engaged more (0.23 SD, CI: 0.39-0.06) in ECD activities with their children compared to the comparison group. Total home stimulation and mothers' knowledge on child care were also improved in the intervention. But the children's growth was not improved.

Interpretation

This ECD programme improves the development of children of young mothers in urban settings using a social safety-net platform. The evidence may help in increasing ECD coverage in urban areas in LMICs.

Funding

Grand Challenges Canada, Saving Brains Programme Grant Number: SB-1810-20176.

Stress biomarkers and child development in young children in Bangladesh

BACKGROUND

Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh.

METHODS

We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables.

RESULTS

We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We detected a significant relationship between HPA axis activity and child development, where increased HPA axis activity was associated with poor development outcomes. Specifically, we found that cortisol reactivity (coefficient -0.15, 95% CI (-0.29, -0.01)) and post-stressor levels (coefficient -0.12, 95% CI (-0.24, -0.01)) were associated with CDI comprehension score, post-stressor cortisol was associated with combined EASQ score (coefficient -0.22, 95% CI (-0.41, -0.04), and overall glucocorticoid receptor methylation was associated with CDI expression score (coefficient -0.09, 95% CI (-0.17, -0.01)). We did not detect a significant relationship between SAM activity or oxidative status and child development.

CONCLUSIONS

Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.

Long-Term Effect of Having a Child at Risk of Developmental Delays on Parental Labor Force Participation

OBJECTIVE

This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows.

METHOD

A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1-8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave.

RESULTS

There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4-5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2-3 to 14-15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers.

CONCLUSION

Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays.

Socioeconomic determinants of early childhood development: evidence from Pakistan

This study investigates the socioeconomic determinants of early childhood development (ECD) in Pakistan by utilizing the data of sixth wave of the Multiple Indicator Cluster Survey (MICS) conducted in the four provinces of the country. The findings of the study reveal that mother's education, father's education, economic status of the household as measured by household's wealth index quintile, region of residence (province), child's gender, disability, nutrition and the practices used by the adult members of the household to discipline child are important determinants of ECD. The study highlights the crucial role of family background and importance of addressing the issue of malnutrition to foster child development.

Weight change in the first 30 days among infants born less than 2000 grams in Guinea-Bissau and Uganda

Despite the high prevalence of low birth weight infants in sub-Saharan Africa and the associated poor outcomes, weight change during the newborn period has not been well characterized for this population. We prospectively assessed growth over the first 30 days among 120 infants born < 2000 g (g) in Guinea-Bissau and Uganda, and compared it to a similar cohort of 420 infants born ≥ 2000 g. Among those born < 2000 g, mean birth weight was 1747 ± 164 g, and initial weight loss was 8.25 ± 4.40% of birth weight prior to the initiation of weight gain at a median of 3 (interquartile range 2, 4) days of age. This initial weight loss was more pronounced (8.25 vs 6.06%; p < 0.001) and lasted longer (median 3 vs 2 days; p < 0.001) than for infants born ≥ 2000 g. The initial period of weight loss was an important predictor of growth at 30 days in both cohorts. Infants born < 2000 g on average grew proportionately to their size at birth but did not experience catch-up growth; their weights at 30 days remained much lower than that of infants born ≥ 2000 g and most remained severely underweight. Targeted interventions to optimize early growth should be investigated.

Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania

More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.

Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster-randomized controlled trial

BACKGROUND

Multicomponent interventions are needed to address the various co-occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes.

METHODS

We conducted a 2×2 factorial cluster-randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard-of-care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference-in-difference approach with intention-to-treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well-being.

RESULTS

Between October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (β = .18 [95% CI: 0.01, 0.36]) and receptive language development (β = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (β = .21 [0.04, 0.38]) and availability of home learning materials (β = .25 [0.07-0.43]) and reduced paternal parenting distress (β = -.34 [-0.55, -0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (β = .45 [0.27, 0.63]).

CONCLUSIONS

Jointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.

Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso

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).

Practices and outcomes of responsive caregiving on child neurodevelopment and mental health across diverse global populations: a scoping review protocol

INTRODUCTION

Responsive caregiving (RC) leads to positive outcomes in children, including secure attachment with caregivers, emotional regulation, positive social interactions and cognitive development. Through our scoping review, we aim to summarise the practices and outcomes of RC in diverse caregiver and child populations from 0 to 8 years.

METHODS AND ANALYSIS

We will use the Arksey and O'Malley framework and the Joanna Briggs Institute methodology for scoping reviews. We shall present our findings as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping review. Only peer-reviewed, English-language articles from 1982 to 2022 will be included from PubMed, Web of Science, APA PsychInfo, APA PsycArticles, SocINDEX and Google Scholar databases. Reference lists of included articles will also be screened. The search strategy will be developed for each database, and search results will be imported into Rayyan. Screening will be done in two phases: (1) titles and abstracts will be screened by two authors and conflicts will be resolved by mutual discussion between both or by consulting with a senior author; and (2) full-texts of shortlisted studies from the first phase will then be screened using the same inclusion/exclusion criteria. A data extraction form will be developed to collate relevant information from the final list of included articles. This form will be pilot tested on the first 10 papers and iteratively refined prior to data extraction from the remaining articles. Results will be presented in figures, tables and a narrative summary.

ETHICS AND DISSEMINATION

No ethics approval needed as the review shall only use already published data. We shall publish the review in an open-access, peer-reviewed journal and disseminate through newsletters, social media pages, and presentations to relevant audiences.

Prevalence and determinants of developmental delay among children in low- and middle-income countries: a systematic review and meta-analysis

Background

Developmental delay is a public health problem in low- and middle-income countries. However, there is no summarized evidence in low- and middle-income countries on developmental delay, and primary studies on this issue show varied and inconclusive results. This systematic review and meta-analysis aimed to assess the pooled magnitude of confirmed developmental delay and its determinants among children in low- and middle-income countries.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to write this systematic review and meta-analysis. Primary studies were searched from PubMed, PsycINFO, Hinari, Science Direct, African Journal of Online, Web of Science, and Google Scholar databases. The Newcastle-Ottawa Scale, adapted for the cross-sectional studies, was used to assess the quality of the included studies. Heterogeneity and publication bias were assessed by the I2 and Eggers tests, respectively. Due to the high heterogeneity, the random effects model was used for analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to show the association between developmental delay and its determinants.

Results

The pooled prevalence of confirmed developmental delay was 18.83, 95% CI (15.53-22.12). In the subgroup analysis, a high prevalence of developmental delay [26.69% (95% CI, 15.78-37.60)] was observed in studies performed in Africa. Maternal education [3.04; 95% CI (2.05, 4.52)] and low birth weight [3.61; 95% CI (1.72, 7.57)] were significant determinants of developmental delay.

Conclusion

The pooled prevalence of developmental delay in low- and middle-income countries was high as compared to that in high-income countries. Maternal education level and weight at birth were significantly associated with developmental delays. Therefore, strategies should be designed to decrease the rate of low birth weight and the number of illiterate mothers living in low- and middle-income countries.

Systematic review registration

PROSPERO, CRD42024513060.

Does early nutrition predict cognitive skills during later childhood? Evidence from two developing countries

The existing evidence linking early undernutrition to educational outcomes in developing countries is largely focused on assessing its impacts on grade attainment and achievement test scores, with limited evidence on the foundational cognitive skills required to perform well at school. We use unique data collected in Ethiopia and Peru as part of the Young Lives Study to investigate the relationship between early undernutrition and four foundational cognitive skills measured later in childhood, the first two of which measure executive functioning: working memory, inhibitory control, long-term memory, and implicit learning. We exploit the rich longitudinal data available to control for potential confounders at the household and individual level and for time-invariant community characteristics. We also take advantage of the availability of data for paired-siblings to obtain household fixed-effects estimates. In the latter specification, we find robust evidence that stunting at ~ age 5 is negatively related with executive functions measured years later, predicting reductions in working memory and inhibitory control by 12.6% and 5.8% of a standard deviation. Although the main cohort of Young Lives was around 12 years old when executive functions were measured, complementary results and analysis of the data available for the younger siblings suggest that the impact of stunting on executive functions-specifically, on working memory-starts at an earlier age. Our results shed light on the mechanisms that explain the relationship between early nutrition and school achievement tests suggesting that good nutrition is an important determinant of children's learning capacities.

Association of gestational weight gain rate in pregnant women with children's cognitive and behavioral development: A birth cohort study

BACKGROUND

The evidences on the relationship between gestational weight gain rate (GWGR) and children's cognitive and behavioral development have been limited.

METHODS

A total of 3273 singleton live birth mother-child pairs from the Ma'anshan Birth Cohort in China were included in the study. Maternal GWGR was calculated based on the weights measured at multiple antenatal checkups. Children's cognitive and behavioral development were assessed by Chinese version of Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition and Achenbach Child Behavior Checklist 1.5-5. Then generalized linear models were performed for analyses.

RESULTS

In the field of children's cognitive development, excessive GWGR in the second trimester was associated with increased visual space index (VSI), fluid reasoning index (FRI) and full scale intelligence quotient (FSIQ) scores, while excessive GWGR in the third trimester was associated with decreased VSI, working memory index (WMI) and FSIQ scores. In the field of children's behavioral development, excessive GWGR in the second trimester was associated with decreased aggressive behaviors and externalizing problems scores.

LIMITATIONS

Children's behavioral development was assessed by main caregivers and might cause a certain degree of bias. There might be other potential confounders that we did not take into account.

CONCLUSIONS

A high GWGR in the second trimester might be beneficial for children's cognitive and behavioral development, while a high GWGR in the third trimester might be harmful.

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS): study protocol for a five-arm, cluster-randomized trial

BACKGROUND

Globally, 144 million children under 5 years are undernourished and 250 million do not meet their developmental potential. Multi-input interventions, such as bundled nutrition and parenting interventions, are designed to mitigate risks for multiple child outcomes. There is limited evidence that bundled interventions have additive benefits to nutrition, growth, or development outcomes. These outcomes share common risks; therefore, designing interventions to tackle these risks using a common theory of change may optimize effectiveness. Emerging evidence suggests explicit engagement of fathers may benefit child outcomes, but few trials have tested this or included data collected from fathers.

METHODS

Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) is a community-based cluster-randomized controlled trial that will be implemented in the rural Mara Region, Tanzania. The trial aims (1) to test a bundled nutrition and parenting program delivered to mothers' groups, with or without fathers' groups, over 12 months on child and caregiving outcomes compared to a nutrition program alone, and (2) to test nutrition or bundled nutrition and parenting programs delivered to mothers' and fathers' groups over 12 months on child and caregiving outcomes compared to programs delivered to mothers alone. The trial comprises five arms: (1) mothers' groups receiving a nutrition program, (2) mothers' groups receiving a bundled nutrition and parenting program, (3) mothers' and fathers' groups receiving a nutrition program, (4) mothers' and fathers' groups receiving a bundled nutrition and parenting program, and (5) control receiving standard of care health services. The primary outcomes are child dietary diversity and early child development (mental and motor development). Parents with a child under 18 months will be enrolled in peer groups and receive twice monthly intervention by trained community health workers. Data will be collected from mothers, fathers, and children at baseline (pre-intervention), midline, and endline (post-intervention).

DISCUSSION

EFFECTS will generate evidence on the effects of bundled nutrition and parenting interventions on child nutrition, growth, and development outcomes; determine the benefits of engaging fathers on child, caregiving, and caregiver outcomes; and investigate common and unique pathways between treatments and child outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03759821. Registered on November 30, 2018.

Early full-day leg movement kinematics and swaddling patterns in infants in rural Guatemala: A pilot study

BACKGROUND

Tools to accurately assess infants' neurodevelopmental status very early in their lives are limited. Wearable sensors may provide a novel approach for very early assessment of infant neurodevelopmental status. This may be especially relevant in rural and low-resource global settings.

METHODS

We conducted a longitudinal observational study and used wearable sensors to repeatedly measure the kinematic leg movement characteristics of 41 infants in rural Guatemala three times across full days between birth and 6 months of age. In addition, we collected sociodemographic data, growth data, and caregiver estimates of swaddling behaviors. We used visual analysis and multivariable linear mixed models to evaluate the associations between two leg movement kinematic variables (awake movement rate, peak acceleration per movement) and infant age, swaddling behaviors, growth, and other covariates.

RESULTS

Multivariable mixed models of sensor data showed age-dependent increases in leg movement rates (2.16 [95% CI 0.80,3.52] movements/awake hour/day of life) and movement acceleration (5.04e-3 m/s2 [95% CI 3.79e-3, 6.27e-3]/day of life). Swaddling time as well as growth status, poverty status and multiple other clinical and sociodemographic variables had no impact on either movement variable.

CONCLUSIONS

Collecting wearable sensor data on young infants in a rural low-resource setting is feasible and can be used to monitor age-dependent changes in movement kinematics. Future work will evaluate associations between these kinematic variables from sensors and formal developmental measures, such as the Bayley Scales of Infant and Toddler Development.

Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys

Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.

Examining the influence of child nutritional disorders on early childhood development in Bangladesh: insights from the multiple indicator cluster survey

OBJECTIVE

The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh.

DESIGN

We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models.

SETTING

Bangladesh.

PARTICIPANTS

Data of 9,455 children aged 3 and 4 years.

RESULTS

Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI.

CONCLUSIONS

Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.

The medium-term impact of a micronutrient powder intervention on anemia among young children in Rural China

BACKGROUND

Poor development of young children is a common issue in developing countries and it is well established that iron deficiency anemia is one of the risk factors. Research has shown that iron deficiency is a common micronutrient deficiency among children in rural China and can result in anemia. A previous paper using data from the same trial as those used in the current study, but conducted when sample children were younger, found that after 6 months of providing caregivers of children 6-11 months of age free access to iron-rich micronutrient powder (MNP) increased the hemoglobin concentrations (Hb) of their children. However, no effects were found 12 and 18 months after the intervention. The current study followed up the children four years after the start of the original intervention (when the children were 4-5 years old) and aims to assess the medium-term impacts of the MNP program on the nutritional status of the sample pre-school-aged children, including their levels of Hb, the prevalence of anemia, and the dietary diversity of the diets of the children.

METHODS

At baseline, this study sampled 1,802 children aged 6-11 months in rural Western China. The intervention lasted 18 months. In this medium-term follow-up study that successfully followed 81% (n = 1,464) of children (aged 49-65 months) from the original study population 4 years after the start of the intervention, we used both intention-to-treat (ITT) effect and average treatment on the treated effect (ATT) analyses to assess the medium-term impacts of the MNP distribution program on the nutritional status of sample children.

RESULTS

The ITT analysis shows that the MNP intervention decreased the prevalence of anemia of young children in the medium run by 8% (4 percentage points, p < 0.1). The ATT analysis shows that consuming 100 (out of 540) MNP sachets during the initial intervention led to a decrease in anemia of 4% (2 percentage points, p < 0.1). Among children with moderate anemia at baseline (Hb < 100 g/L), the intervention reduced the probability of anemia by 45% (9 percentage points, p < 0.1), and, for those families that complied by consuming 100 (out of 540) sachets, a 25% (5 percentage points, p < 0.05) reduction in the anemia rate was found. The MNP intervention also led to a persistent increase in dietary diversity among children that were moderately anemic at baseline. The results from the quantile treatment effect analysis demonstrated that children with lower Hb levels at baseline benefited relatively more from the MNP intervention.

CONCLUSIONS

The findings of the current study reveal that the MNP intervention has medium-term effects on the nutritional status of children in rural China. The impacts of the MNP program were relatively higher for children that initially had more severe anemia levels. Hence, the implications of this study are that programs that aim to increase caregiver knowledge of nutrition and improve their feeding practices should be encouraged across rural China. Families, policymakers, and China's society overall need to continue to pay more attention to problems of childhood anemia in rural areas. This is particularly crucial for families with moderately anemic children at an early age as it can significantly contribute to improving the anemia status of children across rural areas of China.

TRIAL REGISTRATION

ISRCTN44149146 (15/04/2013).

Promoting responsive care and early learning practices in Northern Ghana: results from a counselling intervention within nutrition and health services

OBJECTIVE

This study assesses change in caregiver practices after integrating responsive care and early learning (RCEL) in nutrition and health services and community platforms in northern Ghana.

DESIGN

We trained health facility workers and community health volunteers to deliver RCEL counselling to caregivers of children under 2 years of age through existing health facilities and community groups. We assessed changes in caregivers' RCEL practices before and after the intervention with a household questionnaire and caregiver-child observations.

SETTING

The study took place in Sagnarigu, Gushegu, Wa East and Mamprugu-Moagduri districts from April 2022 to March 2023. Study sites included seventy-nine child welfare clinics (CWC) at Ghana Health Service facilities and eighty village savings and loan association (VSLA) groups.

PARTICIPANTS

We enrolled 211 adult caregivers in the study sites who had children 0-23 months at baseline and were enrolled in a CWC or a VSLA.

RESULTS

We observed improvements in RCEL and infant and young child feeding practices, opportunities for early learning (e.g. access to books and playthings) in the home environment and reductions in parental stress.

CONCLUSIONS

This study demonstrates the effectiveness of integrating RCEL content into existing nutrition and health services. The findings can be used to develop, enhance and advocate for policies integrating RCEL into existing services and platforms in Ghana. Future research may explore the relationship between positive changes in caregiver behaviour and improvements in child development outcomes as well as strategies for enhancing paternal engagement in care practices, improving child supervision and ensuring an enabling environment.

Exploratory genetic analysis in children with autism spectrum disorder and other developmental disorders using whole exome sequencing

Developmental disorders (DDs), such as autism spectrum disorder (ASD), incorporate various conditions; once identified, further diagnostics are necessary to specify their type and severity. The aim of this exploratory study was to identify genetic variants that can help differentiate ASD early from other DDs. We selected 36 children (mean age 60.1 months) with DDs using Developmental Behavioral Scales (DBS) through "EDUS-Education for All", an organization providing services for children with developmental disorders in Bosnia and Herzegovina. We further rated children's autistic traits with the preschool version of the Childhood Autism Rating Scale, second edition (CARS-II). We defined ASD if scores were >25.5 and other DDs if scores were <25.5. Diagnosis of ASD and DD were independently confirmed by child psychiatrists. Whole exome sequencing (WES) was performed by Veritas Genetics, USA, using Illumina NovaSeq 6000 (Illumina Inc., San Diego, CA, USA) next-generation sequencing (NGS) apparatus. We tested genetic association by applying SKAT-O, which optimally combines the standard Sequence Kernel Association Test (SKAT) and burden tests to identify rare variants associated with complex traits in samples of limited power. The analysis yielded seven genes (DSE, COL10A1, DLK2, CSMD1, FAM47E, PPIA, PYDC2) to potentially differentiate observed phenotypic characteristics between our cohort participants with ASD and other DDs. Our exploratory study in a small sample of participants with ASD and other DDs contributed to gene discovery in differentiating ASD from DDs. A replication study is needed in a larger sample to confirm our results.

Effectiveness of intermittent iron and high-dose vitamin A supplementation on cognitive development of school children in southern Ethiopia: a randomized placebo-controlled trial

BACKGROUND

Iron is an essential mineral whose deficiency results in cognitive alteration, impaired emotional behaviors, and altered myelination and neurotransmission. In animal models, it has been shown that vitamin A (VA) could affect cognition.

OBJECTIVES

The study aimed to evaluate the effectiveness of intermittent iron and VA supplementation on cognitive development of schoolchildren, and to assess the interaction between these supplementations.

METHODS

Considering a 2 × 2 factorial design, 504 children were randomly assigned to 1 of the 4 arms: placebo VA and placebo iron supplement; high-dose vitamin VA and placebo iron supplement; iron supplement and placebo VA; and iron and high-dose vitamin VA supplements. Cognitive development was assessed using Raven's Coloured Progressive Matrices, digit span, Tower of London, and visual search tasks.

RESULTS

The mean [± standard deviation (SD)] age of the enrolled children was 9.6 (±1.6) y. One-fifth of the children had iron deficiency or anemia, whereas 2.9%, 3.9%, and 12.1% of children had low iron stores, iron deficiency anemia, and VA deficiency, respectively. Intermittent iron supplementation did not result in any significant improvement of children's cognitive development and had a negative effect on the performance index of the visual search task compared with placebo (-0.17 SD, 95% confidence interval: -0.32, -0.02). Effects were evident among children with stunting, thinness, or children coming from understimulating home environments. High-dose VA supplementation resulted in a significant improvement of digit span z-score with a mean difference of 0.30 SD (95% confidence interval: 0.14, 0.46) compared with placebo VA. VA had a more beneficial impact for girls, children infected with helminths, and those from food secure households.

CONCLUSION

In a population where the prevalence of iron deficiency is low, intermittent iron supplementation did not have any or negative effect on the child's cognitive development outcomes. Conversely, VA supplementation improved the child's working memory.

TRIAL REGISTRATION NUMBER

The study is registered at clinicaltrials.gov as NCT04137354 (https://clinicaltrials.gov/study/NCT04137354).