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Okelo K, Murray AL, King J, Kitsao-Wekulo P, Onyango S, Nampijja M, Auyeung B. Parental stress and child stimulation practices: examining associations with child developmental outcomes over time in Kenya and Zambia. BMC Psychol 2024; 12:50. [PMID: 38279153 PMCID: PMC10811884 DOI: 10.1186/s40359-024-01533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes. METHODS The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children's mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children's developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers' parenting stress, child stimulation practices, and child developmental outcomes. RESULTS The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers' stimulation practices and children's developmental outcomes were not universally supported. CONCLUSION The findings show that improved caregiver stimulation practices are likely to improve children's developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs. TRIAL REGISTRATION Pan African Clinical Trials Registry ( https://pactr.samrc.ac.za/ ) database (ID number: PACTR20180774832663 Date: 26/July/2018.
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Affiliation(s)
- Kenneth Okelo
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, UK.
| | - Aja Louise Murray
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, UK
| | - Josiah King
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, UK
| | | | - Silas Onyango
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Bonnie Auyeung
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, UK
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Onyango S, Kitsao-Wekulo P, Langat N, Okelo K, Murdock DE, Utzinger J, Fink G. Maternal stimulation and early child development in sub-saharan Africa: evidence from Kenya and Zambia. BMC Public Health 2023; 23:2418. [PMID: 38053131 PMCID: PMC10696819 DOI: 10.1186/s12889-023-17235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/15/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings. METHODS We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey. RESULTS Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16). CONCLUSION Our study findings suggest a strong positive link between maternal stimulation activities and children's developmental outcomes among communities in poor rural settings. TRIAL REGISTRATION NA (not a clinical trial).
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Affiliation(s)
- Silas Onyango
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland.
- University of Basel, Petersplatz, Basel, CH-4051, Switzerland.
- Human Development Theme, African Population and Health Research Center, Nairobi, 10787-00100, Kenya.
| | - Patricia Kitsao-Wekulo
- Human Development Theme, African Population and Health Research Center, Nairobi, 10787-00100, Kenya
| | - Nelson Langat
- Human Development Theme, African Population and Health Research Center, Nairobi, 10787-00100, Kenya
| | - Kenneth Okelo
- Human Development Theme, African Population and Health Research Center, Nairobi, 10787-00100, Kenya
| | - Dawn E Murdock
- Episcopal Relief & Development, 815 Second Avenue, New York, NY, 10017, USA
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Petersplatz, Basel, CH-4051, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland
- University of Basel, Petersplatz, Basel, CH-4051, Switzerland
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Giese S, Dawes A, Biersteker L, Girdwood E, Henry J. Using Data Tools and Systems to Drive Change in Early Childhood Education for Disadvantaged Children in South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1470. [PMID: 37761431 PMCID: PMC10529679 DOI: 10.3390/children10091470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023]
Abstract
In line with United Nations Sustainable Development Goal (SDG) 4.2, South Africa's National Development Plan commits to providing high-quality early childhood education to all children by 2030 to drive improved child outcomes. Prior to 2016, South Africa lacked reliable, locally standardised, valid, and cross-culturally fair assessment tools for measuring preschool quality and child outcomes, suitable for use at scale within a resource-constrained context. In this paper we detail the development and evolution of a suite of early learning measurement (ELOM) tools designed to address this measurement gap. The development process included reviews of literature and other relevant assessment tools; a review of local curriculum standards and expected child outcomes; extensive consultation with government officials, child development experts, and early learning practitioners, iterative user testing; and assessment of linguistic, cultural, functional, and metric equivalence across all 11 official South African languages. To support use of the ELOM tools at scale, and by users with varying levels of research expertise, administration is digitised and embedded within an end-to-end data value chain. ELOM data collected since 2016 quantify the striking socio-economic gradient in early childhood development in South Africa, demonstrate the relationship between physical stunting, socio-emotional functioning and learning outcomes, and provide evidence of the positive impact of high-quality early learning programmes on preschool child outcomes. To promote secondary analyses, data from multiple studies are regularly collated into a shared dataset, which is made open access via an online data portal. We describe the services and support that make up the ELOM data value chain, noting several key challenges and enablers of data-driven change within this context. These include deep technical expertise within a multidisciplinary and collaborative team, patient and flexible capital from mission-aligned investors, a fit-for-purpose institutional home, the appropriate use of technology, a user-centred approach to development and testing, sensitivity to children's diverse linguistic and socio-economic circumstances, careful consideration of requirements for scale, appropriate training and support for a non-professional assessor base, and a commitment to ongoing learning and continuous enhancement. Practical examples are provided of ways in which the ELOM tools and data are used for programme monitoring and enhancement purposes, to evaluate the relative effectiveness of early learning interventions, to motivate for greater budget and inform more effective resource allocation, to support the development of enabling Government systems, and to track progress towards the attainment of national and global development goals. We share lessons learnt during the development of the tools and discuss the factors that have driven their uptake in South Africa.
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Affiliation(s)
- Sonja Giese
- DataDrive2030, Westlake, Cape Town 7945, South Africa; (L.B.); (E.G.); (J.H.)
| | - Andrew Dawes
- Psychology Department, University of Cape Town, Rondebosch, Cape Town 7700, South Africa;
| | - Linda Biersteker
- DataDrive2030, Westlake, Cape Town 7945, South Africa; (L.B.); (E.G.); (J.H.)
| | - Elizabeth Girdwood
- DataDrive2030, Westlake, Cape Town 7945, South Africa; (L.B.); (E.G.); (J.H.)
| | - Junita Henry
- DataDrive2030, Westlake, Cape Town 7945, South Africa; (L.B.); (E.G.); (J.H.)
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Abdoola S, Swanepoel DW, Graham MA, van der Linde J. Developmental characteristics of young children in a low-income South African community. J Child Health Care 2023:13674935231173023. [PMID: 37150599 DOI: 10.1177/13674935231173023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Adequate early childhood development is critical for later-life success. Developmental profiles of specific populations are required to support implementation of early intervention services. Three hundred fifty-three caregivers of children with mean age 17.9 months (SD = 10.5) were selected from a primary healthcare clinic. Overall positive identification of signs of a developmental delay, with the Bayley Scales of Infant and Toddler Development III, was 51.8% (n = 183). Logistic regression analysis determined the effect of age and gender on results. Prevalence of developmental delay increased with age from 33.1% for children under 12 months to 61.7% and 66.3% for children between 13-24 months and 25-36 months, respectively. Females were 1.82 times (95% CI [1.16, 2.85]) more likely to have had no signs of developmental delay; 2.30 times (95% CI [1.14, 4.65]) in motor and 2.06 times (95% CI [1.23, 3.45]) in adaptive behaviour domains. One-third of children presented with low levels of adaptive behaviour functioning. One hundred and one (28.6%) participants across age groups displayed superior social-emotional ability, possibly due to familial structures and relationships. One-third of children presented with poor adaptive behaviour function, attributed to cultural differences. This study contributes to information on developmental characteristics of children in South Africa.
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Affiliation(s)
- Shabnam Abdoola
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science Mathematics and Technology Education, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Prioreschi A, Pearson R, Richter L, Bennin F, Theunissen H, Cantrell SJ, Maduna D, Lawlor D, Norris SA. Protocol for the PLAY Study: a randomised controlled trial of an intervention to improve infant development by encouraging maternal self-efficacy using behavioural feedback. BMJ Open 2023; 13:e064976. [PMID: 36882258 PMCID: PMC10008478 DOI: 10.1136/bmjopen-2022-064976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The early infant caregiving environment is crucial in the formation of parent-child relationships, neurobehavioural development and thus child outcomes. This protocol describes the Play Love And You (PLAY) Study, a phase 1 trial of an intervention designed to promote infant development through encouraging maternal self-efficacy using behavioural feedback, and supportive interventions. METHODS AND ANALYSIS 210 mother-infant pairs will be recruited at delivery from community clinics in Soweto, South Africa, and individually randomised (1:1) into two groups. The trial will consist of a standard of care arm and an intervention arm. The intervention will start at birth and end at 12 months, and outcome assessments will be made when the infants are 0, 6 and 12 months of age. The intervention will be delivered by community health helpers using an app with resource material, telephone calls, in person visits and behavioural feedback with individualised support. Every 4 months, mothers in the intervention group will receive rapid feedback via the app and in person on their infant's movement behaviours and on their interaction styles with their infant. At recruitment, and again at 4 months, mothers will be screened for mental health risk and women who score in the high-risk category will receive an individual counselling session from a licensed psychologist, followed by referral and continued support as necessary. The primary outcome is efficacy of the intervention in improving maternal self-efficacy, and the secondary outcomes are infant development at 12 months, and feasibility and acceptability of each component of the intervention. ETHICS AND DISSEMINATION The PLAY Study has received ethical approval from the Human Research Ethics Committee of the University of the Witwatersrand (M220217). Participants will be provided with an information sheet and required to provide written consent prior to being enrolled. Study results will be shared via publication in peer-reviewed journals, conference presentation and media engagement. TRIAL REGISTRATION NUMBER This trial was registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 10 February 2022 (identifier: PACTR202202747620052).
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Pearson
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Academic Mental Health, Addiction and Suicide Research, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona Bennin
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Helene Theunissen
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah J Cantrell
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Dumsile Maduna
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Lawlor
- Department of Social Medicine, MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Brittain K, Zerbe A, Phillips TK, Gomba Y, Mellins CA, Myer L, Abrams EJ. Impact of adverse childhood experiences on women's psychosocial and HIV-related outcomes and early child development in their offspring. Glob Public Health 2022; 17:2779-2791. [PMID: 34613893 PMCID: PMC8983791 DOI: 10.1080/17441692.2021.1986735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Adverse childhood experiences (ACEs) may have a critical influence on adult outcomes and subsequent offspring development, but few data have explored the effects of ACEs in low-resource settings where the burdens of childhood adversity and HIV are high. Among mothers living with HIV in Cape Town, we examined the effects of ACEs on maternal psychosocial and HIV-related outcomes, as well as early child development in their offspring aged 36-60 months. The World Health Organization's Adverse Childhood Experiences International Questionnaire was used to measure maternal reports of ACEs, and the Ages & Stages Questionnaire to screen for developmental delays in their offspring. Among 353 women (median age: 32 years), 84% reported ≥1 ACEs. Increased report of ACEs was strongly associated with depressive symptoms, hazardous alcohol use, intimate partner violence and self-reported suboptimal adherence to antiretroviral therapy. These associations were driven by more severe childhood experiences, including abuse, neglect and exposure to collective violence. Among 255 women who reported on their child's development, maternal ACEs were associated with poorer socioemotional development. These data suggest that childhood adversity has long-term effects on maternal outcomes as well as their children's socioemotional development and point to ACEs that might be targeted for screening and intervention.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Tamsin K. Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Yolanda Gomba
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
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Onyango S, Kimani-Murage E, Kitsao-Wekulo P, Langat NK, Okelo K, Obong’o C, Utzinger J, Fink G. Associations between exclusive breastfeeding duration and children's developmental outcomes: Evidence from Siaya county, Kenya. PLoS One 2022; 17:e0265366. [PMID: 35358207 PMCID: PMC8970373 DOI: 10.1371/journal.pone.0265366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Exclusive breastfeeding (EBF) during the first 6 months of life is widely promoted as a key strategy to enhance child health, growth, and development. Even though a high proportion of children in Kenya are currently breastfed exclusively, there is little evidence regarding the developmental benefits during the first year of life. This paper aims to fill this gap by establishing an association between EBF and early childhood developmental outcomes among children below the age of 6 months in Kenya. METHODS We used data collected as part of a cluster-randomized controlled trial conducted in Bondo sub-county in the western part of Kenya to assess the associations between EBF and development in the first year of life. The primary exposure variable was EBF, and the outcome variable was child development as measured by the Ages and Stages Questionnaire-Third Edition (ASQ-3). RESULTS We analyzed data from 570 children aged below 6 months at the time of the interview. Breastfeeding children exclusively between 3 and 6 months was associated with 0.61 standard deviation (SD) higher ASQ-3 scores in the adjusted model. When specific domains were considered, in the adjusted models, EBF in the 3-6 months period was associated with 0.44 SD, 0.34 SD and 0.36 SD higher ASQ-3 scores in communication, gross motor, and problem solving domains, respectively. There were weak associations in the fine motor and social-emotional domains. CONCLUSION EBF in the 3- to 6-month age range has significant positive associations with child development, especially for communication, gross motor, and problem-solving. Programs encouraging mothers to continue EBF in this period may have substantial benefits for children.
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Affiliation(s)
- Silas Onyango
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Kenneth Okelo
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Ndayizigiye M, McBain R, Whelley C, Lerotholi R, Mabathoana J, Carmona M, Curtain J, Birru E, Stulac S, Miller AC, Shin S, Rumaldo N, Mukherjee J, Nelson AK. Integrating an early child development intervention into an existing primary healthcare platform in rural Lesotho: a prospective case-control study. BMJ Open 2022; 12:e051781. [PMID: 35121599 PMCID: PMC8819803 DOI: 10.1136/bmjopen-2021-051781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study evaluated a novel early childhood development (ECD) programme integrated it into the primary healthcare system. SETTING The intervention was implemented in a rural district of Lesotho from 2017 to 2018. PARTICIPANTS It targeted primary caregivers during routine postnatal care visits and through village health worker home visits. INTERVENTION The hybrid care delivery model was adapted from a successful programme in Lima, Peru and focused on parent coaching for knowledge about child development, practicing contingent interaction with the child, parent social support and encouragement. PRIMARY AND SECONDARY OUTCOMES MEASURES We compared developmental outcomes and caregiving practices in a cohort of 130 caregiver-infant (ages 7-11 months old) dyads who received the ECD intervention, to a control group that did not receive the intervention (n=125) using a case-control study design. Developmental outcomes were evaluated using the Extended Ages and Stages Questionnaire (EASQ), and caregiving practices using two measure sets (ie, UNICEF Multiple Indicator Cluster Survey (MICS), Parent Ladder). Group comparisons were made using multivariable regression analyses, adjusting for caregiver-level, infant-level and household-level demographic characteristics. RESULTS At completion, children in the intervention group scored meaningfully higher across all EASQ domains, compared with children in the control group: communication (δ=0.21, 95% CI 0.07 to 0.26), social development (δ=0.27, 95% CI 0.11 to 0.8) and motor development (δ=0.33, 95% CI 0.14 to 0.31). Caregivers in the intervention group also reported significantly higher adjusted odds of engaging in positive caregiving practices in four of six MICS domains, compared with caregivers in the control group-including book reading (adjusted OR (AOR): 3.77, 95% CI 1.94 to 7.29) and naming/counting (AOR: 2.05; 95% CI 1.24 to 3.71). CONCLUSIONS These results suggest that integrating an ECD intervention into a rural primary care platform, such as in the Lesothoan context, may be an effective and efficient way to promote ECD outcomes.
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Affiliation(s)
| | - Ryan McBain
- RAND Corporation, Santa Monica, California, USA
- Partners In Health, Boston, Massachusetts, USA
| | | | | | | | | | - Joe Curtain
- Partners In Health, Boston, Massachusetts, USA
| | | | - Sara Stulac
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Ann C Miller
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joia Mukherjee
- Partners In Health, Boston, Massachusetts, USA
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Connery AK, Raghunathan RS, Colbert AM, Erdodi L, Warschausky S, Huth-Bocks A, Gerry Taylor H, Raghunathan T, Berglund P, Staples AD, Lukomski A, Kirkland J, Cano J, Lajiness-O'Neill R. The influence of sociodemographic factors and response style on caregiver report of infant developmental status. Front Pediatr 2022; 10:1080163. [PMID: 36714661 PMCID: PMC9875053 DOI: 10.3389/fped.2022.1080163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
Caregiver report is the most feasible way to assess early childhood development but is susceptible to the influences of response style and sociodemographic factors. In a sample of 571 caregiver-infant dyads (47.8% female; 48% White), we compared caregiver reports on the Ages and Stages Questionnaire-Third Edition (ASQ-3) with reports on a novel, web-based assessment, PediaTrac™. Ratings on PediaTrac correlated with ratings on the ASQ-3 at all time points (2, 4, 6, and 9 months). Caregiver age, response style, and sociodemographic factors accounted for significant variance on both measures. Developmental reporting of early childhood skills is influenced by caregiver response style and sociodemographic factors. These influences must be considered in order to ensure the accurate identification of infant developmental status.
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Affiliation(s)
- Amy K Connery
- Children's Hospital Colorado, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Radhika S Raghunathan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alison M Colbert
- Children's Hospital Colorado, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laszlo Erdodi
- Psychology, University of Windsor, Ontario, ON, Canada
| | - Seth Warschausky
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, United States
| | - Alissa Huth-Bocks
- Pediatrics, Case Western Reserve University, University Hospitals, Cleveland, OH, United States
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Pediatrics, The Ohio State University, Columbus, OH, United States
| | | | - Patricia Berglund
- Institute of Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Angela D Staples
- Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Angela Lukomski
- Nursing, Eastern Michigan University, Ypsilanti, MI, United States
| | - Jazmine Kirkland
- Pediatrics, Case Western Reserve University, University Hospitals, Cleveland, OH, United States
| | - Jennifer Cano
- Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Renee Lajiness-O'Neill
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, United States.,Psychology, Eastern Michigan University, Ypsilanti, MI, United States
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Colbert AM, Connery AK, Lamb MM, Bauer D, Olson D, Paniagua-Avila A, Martínez MA, Arroyave P, Hernández S, Mirella Calvimontes D, Bolaños GA, El Sahly HM, Muñoz FM, Asturias EJ. Caregiver rating of early childhood development: Reliability and validity of the ASQ-3 in rural Guatemala. Early Hum Dev 2021; 161:105453. [PMID: 34530320 DOI: 10.1016/j.earlhumdev.2021.105453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although performance-based assessment of early childhood development is preferred, there are a number of limitations to this methodology in low resource settings (LRSs). Hence, clinicians and researchers often rely on caregiver report screening tools. The Ages and Stages Questionnaire 3 (ASQ) is one of the most widely used caregiver report measures globally. Adequate psychometric properties have been demonstrated in high income settings, especially when used in older children, high- risk children, or those with severe neurodevelopmental delays. However, its utility is more variable within very young children and for use in LRSs. METHODS The reliability and validity of the ASQ was determined for children ages 0-5 years living in rural Guatemala. Internal consistency and test-retest reliability were assessed, as well as concurrent and predictive validity. Sensitivity, specificity, positive and negative predictive values related to performance-based developmental assessment (Mullen Scales of Early Learning; MSEL) and growth status (i.e. stunting) were also calculated. RESULTS Internal consistency reliability for the ASQ was adequate, except when results were limited by small sample size. Test-retest reliability ranged from low to moderate (r = 0.08-0.43; p < 0.05-0.01). However, there was significant variability in mean scores over time across ASQ domain scores. In terms of validity, the ASQ did not discriminate adequately between children who performed within or below age-expectations on performance-based developmental testing or those with and without stunting. CONCLUSIONS The ASQ did not demonstrate adequate psychometric properties in rural Guatemala, consistent with concerns documented in other LRSs. These results indicate that existing caregiver report screening measures of early childhood development should be utilized with caution in LRSs, and alternative methods for assessment or in the development and utilization of caregiver report measures should be considered.
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Affiliation(s)
- Alison M Colbert
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States.
| | - Amy K Connery
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Molly M Lamb
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Desiree Bauer
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Daniel Olson
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Alejandra Paniagua-Avila
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - María Alejandra Martínez
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Paola Arroyave
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Sara Hernández
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - D Mirella Calvimontes
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Guillermo A Bolaños
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Hana M El Sahly
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Flor M Muñoz
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
| | - Edwin J Asturias
- Department of Rehabilitation, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, United States
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11
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Rousseau M, Dionne C, Savard RT, Schonhaut L, Londono M. Translation and Cultural Adaptation of the Ages and Stages Questionnaires (ASQ) Worldwide: A Scoping Review. J Dev Behav Pediatr 2021; 42:490-501. [PMID: 33990508 DOI: 10.1097/dbp.0000000000000940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This scoping review aims to provide a data mapping and narrative synthesis of the available peer-reviewed scientific literature on the translation and cultural adaptation processes relative to the Ages and Stages Questionnaires (ASQ) as reported by the authors. It also seeks to paint an overall portrait of the implementation of the translated and culturally adapted ASQ worldwide. METHODS Articles published between 1995 and May 11, 2018, were identified via systematic searches of peer-reviewed literature carried out using CINAHL, Scopus, MEDLINE, Education Source, PsycINFO, and ERIC. The articles included in the qualitative synthesis were coded based on an extraction form developed for the study. RESULTS In the 46 articles surveyed, 37 different cultural adaptations were identified in 29 languages and 27 countries. Translations were included in 33 cultural adaptations, and language modifications were reported in 18 adaptations. The forward-backward translation method was reported in 25 cases. The authors declared having made cultural content, language, visual, and/or conceptual modifications in 26 adaptations. Cultural content modifications were reported in 24 adaptations. At least one method (pilot study, individual interview, survey or focus group with respondents) was reported in 24 adaptations. CONCLUSION Cultural modifications were relatively minor and were, in general, made to establish equivalence with the source version. As well, the processes used to translate and culturally adapt the ASQ varied widely based on the types of methods. Additional work should be conducted to document the process of this crucial phase.
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Affiliation(s)
- Michel Rousseau
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Carmen Dionne
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Roselyne T Savard
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Luisa Schonhaut
- Department of Pediarics, Clinica Alemana-Facultad de Medicina Universidad del Desarrollo, Santiago, Chile
| | - Maria Londono
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Kitsao-Wekulo P, Kipkoech Langat N, Nampijja M, Mwaniki E, Okelo K, Kimani-Murage E. Development and feasibility testing of a mobile phone application to track children's developmental progression. PLoS One 2021; 16:e0254621. [PMID: 34265009 PMCID: PMC8282085 DOI: 10.1371/journal.pone.0254621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Given that mobile phone usage has increased rapidly throughout the world, one possibility to increase parental involvement in monitoring their children's progression is to train parents or primary caregivers on the use of mobile phone technology to track their children's developmental milestones. The current paper aimed to describe the development of a mobile phone application for use among primary caregivers and establish the feasibility and preliminary impact of caregivers using a mobile phone application to track the progression of their children's development in a context where there is a paucity of similar studies. This study is a substudy that focusses on the intervention group only of a recently completed two-armed quasi-experimental study in an informal settlement in Nairobi. The mobile phone application which consisted of questions on children's developmental progression, as well as stimulation messages, was developed through a step-wise approach. The questions covered five child developmental domains: communication; fine motor; gross motor; personal-social; and, problem-solving. Depending on the response received, the child would be classified as having 'achieved a milestone' or 'milestone not achieved.' If a child had achieved the milestone for a specific age, a caregiver would receive an SMS on how to stimulate the child to achieve the next milestone. Where the milestone was not achieved, the caregiver would get a message to enhance development in the area of delay. Caregivers with children aged between six months and two years were recruited into the study and received questions and messages regarding their children's development (age-specific) on a monthly basis for 12 months. Caregiver adherence to the intervention was above 90% in the first three months of implementation. Thereafter, the response rate fluctuated between 76% and 86% across the subsequent months of the intervention. The high level and fairly stable caregivers' rate of response to the 12 rounds of messaging indicated feasibility of the mobile technology. Further, in the first three months of intervention implementation, the majority of caregivers were able to keep track of how their children attained their developmental milestones. The intervention seems to be scalable, practical and potentially low-cost because of the wide coverage of phones.
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Affiliation(s)
- Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Nelson Kipkoech Langat
- Data, Measurement and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Margaret Nampijja
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Elizabeth Mwaniki
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Kenneth Okelo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Elizabeth Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
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13
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Jensen SK, Placencio-Castro M, Murray SM, Brennan RT, Goshev S, Farrar J, Yousafzai A, Rawlings LB, Wilson B, Habyarimana E, Sezibera V, Betancourt TS. Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda. BMJ Glob Health 2021; 6:bmjgh-2020-003508. [PMID: 33514591 PMCID: PMC7849888 DOI: 10.1136/bmjgh-2020-003508] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Families living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda’s social protection system to promote ECD and reduce violence compared with usual care (UC). Methods Families with children aged 6–36 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments. Results A total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI −0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth. Conclusion Social protection programmes provide a means to deliver ECD intervention. Trial registration number NCT02510313.
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Affiliation(s)
- Sarah Kg Jensen
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Matias Placencio-Castro
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shauna M Murray
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Robert T Brennan
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA.,Women's Study Research Center, Brandeis University, Waltham, Massachusetts, USA
| | - Simo Goshev
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jordan Farrar
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Briana Wilson
- The World Bank, Washington, District of Columbia, USA
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14
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Alvarez-Nuñez L, González M, Rudnitzky F, Vásquez-Echeverría A. Psychometric properties of the ASQ-3 in a nationally representative sample of Uruguay. Early Hum Dev 2021; 157:105367. [PMID: 33839477 DOI: 10.1016/j.earlhumdev.2021.105367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Ages & Stages Questionnaires Third Version (ASQ-3) identifies the risk of developmental delay in children aged 2 to 66 months. The ASQ-3 is available in many languages. However, there is little evidence of the psychometric properties of the Spanish version and using nationally-representative samples. AIMS This study evaluates the reliability and factor solution of the Spanish version of the ASQ-3 (18- to 54-month questionnaires) in a large, representative sample of Uruguayan children. Besides, it explores the association of ASQ-3 scores with sociodemographic characteristics. METHOD Participants were 4016 main caregivers selected randomly across the country who completed the ASQ-3 for their children. All participants responded to the ASQ-3 and a sociodemographic questionnaire within the context of a government-run survey of child development. RESULTS Most versions of the ASQ-3 in Spanish have acceptable-to-good psychometric properties, supporting the 5-factor-solution. Personal-Social and, to a lesser extent, Problem-solving scores were the subscales that showed more suboptimal internal consistency coefficients. Scores showed higher ceiling effects than the original US sample but varied across domains, with Gross Motor showing the highest pattern. Sex and socioeconomic status are associated with scores of most age-versions and subscales of the ASQ-3. CONCLUSIONS In general, results support the reliability and dimensionality of ASQ-3 scores, but psychometric properties varied across age-version and domains. Overall, earlier versions presented less precision, while the Personal-social domain showed reduced reliability in most age-versions.
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Affiliation(s)
- Lucía Alvarez-Nuñez
- Institute of Fundamentals and Methods in Psychology, Faculty of Psychology, University of the Republic, Uruguay
| | - Meliza González
- Institute of Fundamentals and Methods in Psychology, Faculty of Psychology, University of the Republic, Uruguay
| | - Fanny Rudnitzky
- National Directorate of Evaluation and Monitoring, Ministry of Social Development, Uruguay
| | - Alejandro Vásquez-Echeverría
- Institute of Fundamentals and Methods in Psychology, Faculty of Psychology, University of the Republic, Uruguay.
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15
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Govender V, Naidoo D, Govender P. Developmental delay in a resource-constrained environment: Screening, surveillance and diagnostic assessment. S Afr Fam Pract (2004) 2021; 63:e1-e4. [PMID: 34082557 PMCID: PMC8378019 DOI: 10.4102/safp.v63i1.5306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
The range and severity of developmental delays vary, and a systematic approach to ensuring early detection for early intervention is essential. The formative years are considered critical for nurturing and maximising developmental potential. In this article, the authors describe a clinical approach to developmental delay within resource-constrained environments of South Africa. The article unpacks the history and examination, developmental screening, surveillance and diagnostic assessment and social determinants of health. For timely interventions to occur, early and accurate assessment is necessary. Medical officers and other health professionals such as nurses, general practitioners and therapists working in low-resourced contexts may use this information in their approach to the assessment of developmental delay.
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Affiliation(s)
- Vasantha Govender
- Department of Paediatric Neurology, KwaZulu-Natal Children's Hospital, Durban, South Africa; and, Department of Paediatric Neurology, Inkosi Albert Luthuli Hospital, Durban.
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16
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Madlala HP, Myer L, Malaba TR, Newell ML. Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa. PLoS One 2020; 15:e0242244. [PMID: 33206724 PMCID: PMC7673492 DOI: 10.1371/journal.pone.0242244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence shows that antiretroviral (ART) exposure is associated with neurodevelopmental delays in human immunodeficiency virus (HIV)-exposed uninfected (HEU) children. However, there are few insights into modifiable maternal and child factors that may play a role in improving neurodevelopment in HEU children. We used a parent-centric neurodevelopment tool, Ages & Stages Questionnaire (ASQ) to examined neurodevelopment in HEU children at 12-24 months of age, and associations with maternal and child factors. METHODS 505 HIV-infected women (initiated ART pre- or during pregnancy) with live singleton births attending primary health care were enrolled; 355 of their HEU children were assessed for neurodevelopment (gross motor, fine motor, communication, problem solving and personal-social domains) at 12-24 months using age-specific ASQ administered by a trained fieldworker. Associations with maternal and child factors were examined using logistic regression models. RESULTS Among mothers (median age 30 years, IQR, 26-34), 52% initiated ART during pregnancy; the median CD4 count was 436 cells/μl (IQR, 305-604). Most delayed neurodevelopment in HEU children was in gross (9%) and fine motor (5%) functions. In adjusted models, maternal socio-economic status (aOR 0.42, 95% CI 0.24-0.76) was associated with reduced odds of delayed gross-fine motor neurodevelopment. Maternal age ≥35 years (aOR 0.22, 95% CI 0.05-0.89) and maternal body mass index (BMI) <18.5 (aOR 6.76, 95% CI 1.06-43.13) were associated with delayed communication-problem-solving-personal-social neurodevelopment. There were no differences in odds for either domain by maternal ART initiation timing. CONCLUSIONS Delayed neurodevelopment was detected in both gross and fine motor functions in this cohort of HEU children, with strong maternal predictors that may be explored as potentially modifiable factors associated with neurodevelopment at one to two years of age.
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Affiliation(s)
- Hlengiwe P. Madlala
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Thokozile R. Malaba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marie-Louise Newell
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Tsamaase M, Harkness S, Super CM. Grandmothers' Developmental Expectations for Early Childhood in Botswana. New Dir Child Adolesc Dev 2020; 2020:93-112. [PMID: 32431026 DOI: 10.1002/cad.20335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Urban and rural grandmothers (n = 20) in Botswana participated in focus groups to learn their expectations for the acquisition of skills by preschool children. Their expectations for self-care, traditional politeness, and participation in household chores were dramatically earlier than developmental timetables reported for Western middle-class populations. There are some differences, however, in the urban and rural grandmothers' expectations. Rural grandmothers had earlier expectations for self-care skills and participation in household chores, and they had more specific expectations for mastering Setswana cultural customs. In addition, some urban grandmothers, who were generally more educated, described using more reciprocal communication, and they believed in playing with their grandchildren, whereas the rural grandmothers' communication was more instructional, and they insisted that children should play away from adults. Strikingly, there was no mention of school readiness goals or activities by either group, suggesting a "cultural misfit" between the standard early childhood curriculum, largely imported from the United States and other Western countries, and the cultural backgrounds of Batswana families. To create a more workable partnership between preschool teachers and grandparents-important caretakers of young children, both traditionally and currently-will require efforts to acknowledge and promote the values and expectations of both groups.
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Small JW, Hix-Small H, Vargas-Baron E, Marks KP. Comparative use of the Ages and Stages Questionnaires in low- and middle-income countries. Dev Med Child Neurol 2019; 61:431-443. [PMID: 29926467 DOI: 10.1111/dmcn.13938] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/28/2022]
Abstract
AIM To map the breadth of use of the Ages and Stages Questionnaires (ASQ) in low- and middle-income countries (LMICs) across world regions, and examine procedures for ASQ translation, adaptation, psychometric evaluation, and administration. METHOD We conducted a review of all original, peer-reviewed studies written in English referencing use of the ASQ in LMICs. We used a consensus rating procedure to classify each article into one of four categories: feasibility study, psychometric study, prevalence study, or research study. RESULTS We analysed 53 peer-reviewed articles written in English detailing use of the ASQ in LMICs. We found evidence of ASQ use in 23 LMICs distributed across all world regions. The ASQ was translated into 16 languages. Just over half of the studies reported parent completion of the ASQ (50.9%). We identified eight feasibility studies, 12 psychometric studies, and nine prevalence studies. Study type varied by economy and region. INTERPRETATION Findings suggest broad global use of the ASQ in a range of countries and cultural and linguistic contexts. There is need for further validation studies across all cited regions and countries and in countries ready to begin to design systems for providing universal developmental screening services. WHAT THIS PAPER ADDS The Ages and Stages Questionnaires (ASQ) has been used in at least 23 low- and middle-income countries (LMICs). The ASQ has been translated into at least 16 languages in LMICs. Over half the identified studies reported parent completion of the ASQ.
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Affiliation(s)
- Jason W Small
- Oregon Research Institute, Eugene, OR, USA.,RISE Institute, Washington, DC, USA
| | - Hollie Hix-Small
- RISE Institute, Washington, DC, USA.,Graduate School of Education, Portland State University, Portland, OR, USA
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Snelling M, Dawes A, Biersteker L, Girdwood E, Tredoux C. The development of a South African Early Learning Outcomes Measure: A South African instrument for measuring early learning program outcomes. Child Care Health Dev 2019; 45:257-270. [PMID: 30682732 DOI: 10.1111/cch.12641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Assessment of early childhood development programme effectiveness in South Africa is hampered by a lack of suitable measures that account for variations in cultural and socio-economic backgrounds and can be administered by non-professionals. This contribution reports the standardisation of the South African Early Learning Outcomes Measure (ELOM), an instrument designed for population level monitoring of the developmental status of children aged 50-69 months and for evaluation of early learning programmes. METHODS The development of the ELOM was informed by South Africa's National Curriculum Framework from Birth to Four and its National Early Learning and Development Standards. ELOM items were drawn from reliable and valid instruments, particularly those used in Africa and other developing regions and were clustered in five domains: gross motor development, fine motor coordination and visual motor integration, emergent numeracy and mathematics, cognition and executive functioning, emergent literacy and language. The ELOM was standardised on a sample of 1,331 children aged 50-69 months, from five South African official languages and five socio-economic strata. Item Response Theory techniques were used to establish reliability, validity, and differential item functioning. RESULTS Confirmatory Factor Analysis established that ELOM domains are unidimensional and internally consistent. Items discriminate reliably between more and less able children and do not discriminate unfairly between children of the same ability from different language backgrounds. Socio-economic gradients were evident in children's performance. South African Early Learning Development Standards (ELDS) based on standard scores were developed and set at the 60th percentile of the sample standard score distribution. CONCLUSIONS This research produced the first South African, age-validated population-level standardised instrument that can be administered relatively cheaply by trained non-professionals. This will facilitate the assessment of the efficacy of early learning programmes in enabling children to reach ELDS prior to entering Grade R and track progress toward Sustainable Development Goal 4.2.
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Affiliation(s)
| | - Andrew Dawes
- Department of Psychology, University of Cape Town, South Africa.,Young Lives, Department of International Development, University of Oxford, Oxford, England
| | | | | | - Colin Tredoux
- Department of Psychology, University of Cape Town, South Africa.,Department of Psychology Université de Toulouse, France
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Chong KC, Zhou VL, Tarazona D, Tuesta H, Velásquez-Hurtado JE, Sadeghi R, Llanos F. ASQ-3 scores are sensitive to small differences in age in a Peruvian infant population. Child Care Health Dev 2017; 43:556-565. [PMID: 28480511 DOI: 10.1111/cch.12469] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Ages and Stages Questionnaires Edition 3 (ASQ-3) are a well-validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ-3 interval. This study aimed to determine a relationship between age and ASQ-3 score for each screening interval. METHODS This was a baseline exploratory cross-sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ-3 screening interval was administered to each subject. Subjects were divided into four 2-week chronological subgroups based on age within each 2-month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ-3 score and both aggregated and disaggregated age subgroup. RESULTS A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ-3 interval assignment. Mean total ASQ-3 was 42.2 ± 8.2. The ASQ-3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ-3 score (β = 1.8, CI: 1.7-2.0, P < 0.001), sectional ASQ-3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001). CONCLUSIONS The ASQ-3 may underestimate the sensitivity of child development to small differences in age in this population.
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Affiliation(s)
- K C Chong
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - V L Zhou
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - D Tarazona
- Ministry of Development and Social Inclusion, Lima, Peru
| | - H Tuesta
- Ministry of Development and Social Inclusion, Lima, Peru
| | - J E Velásquez-Hurtado
- Ministry of Development and Social Inclusion, Lima, Peru.,School of Medicine, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - R Sadeghi
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - F Llanos
- Ministry of Development and Social Inclusion, Lima, Peru.,School of Medicine, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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van Heerden A, Hsiao C, Matafwali B, Louw J, Richter L. Support for the feasibility of the ages and stages questionnaire as a developmental screening tool: a cross-sectional study of South African and Zambian children aged 2-60 months. BMC Pediatr 2017; 17:55. [PMID: 28209131 PMCID: PMC5312428 DOI: 10.1186/s12887-017-0802-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing global acknowledgement that improving child survival rates is no longer sufficient. Emphasis is shifting to the improvement of health and developmental trajectories in early childhood. Screening and measurement of these trajectories in low and middle income countries is difficult, however, as they currently rely on developmental tests standardised among populations of children growing up in resource rich environments. METHODS This paper presents a comparison of one such tool adapted for use with children living in Southern Africa to children from the United States, Norway, Korea and Spain. The Ages and Stages Questionnaire version 3 (ASQ-3) was adapted and administered to 853 children living in South Africa and Zambia. RESULTS Children in southern Africa were found to perform significantly better than children from other countries early in life, especially in the domains of communication, gross motor and fine motor skills. By the age of five, children in southern Africa were performing significantly worse than their peers in the domains of fine motor and problem-solving. CONCLUSION The results indicate the applicability of the ASQ-3 in southern Africa and point to the importance of early interventions to protect the early good development of African children in order to promote positive life trajectories.
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Affiliation(s)
- Alastair van Heerden
- Human Sciences Research Council, 750 Ridge Road, Durban, 4000 South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Celia Hsiao
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Julia Louw
- Human Sciences Research Council, 750 Ridge Road, Durban, 4000 South Africa
| | - Linda Richter
- MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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