A Developmental Analysis of Caregiving Modalities Across Infancy in 38 Low- and Middle-Income Countries

Prevalence, Pattern and Factors Associated with Developmental Delay amongst Under-5 Children in Nigeria: Evidence from Multiple Indicator Cluster Survey 2011-2017

BACKGROUND

Children develop dynamically, and when a child fails to reach age-appropriate developmental milestones compared to their peers, it is considered a developmental delay. In developing nations like Nigeria, several demographics, socioeconomic, childcare and external factors may influence the highly individualised process. This study assessed the prevalence and pattern of developmental delay, across Nigeria's geopolitical zones including identified factors associated with developmental delay, providing insight for appropriate interventions to prevent disability in affected children.

METHODS

This was a secondary analysis of data from the Multiple Indicator Cluster Survey (MICS), which was carried out in rounds 4 (2011) and 5 (2016/2017). Every 5 years, the UNICEF-supported MICS cross-sectional household survey is carried out using the cluster sampling method. A semi-structured, questionnaire administered by the interviewer was used to obtain individual and household-level data. This study comprised a weighted sample of 17,373 under-5 children who had complete data from both survey rounds on characteristics deemed significant for the study. Data were analysed using SPSS version 23. Using the Chi-square test and multivariate binomial logistic regression, factors linked to developmental delay were identified, with 95% confidence intervals (CIs) provided and the significance level set at 5%.

RESULTS

The mean age and sex distribution of the children surveyed in both rounds was comparable, with a male preponderance of 51.2% in round 4 and 50.4% in round 5. In both round 4 (51.2%) and round 5 (49.0%), the Northeast zone had the highest prevalence of overall developmental delay while the least prevalence was seen in the Southwest zone (20.3%) and the Southeast zone (14.7%) in round 4 and round 5, respectively. Across all the zones, delay in the literacy-numeracy domain of development was the most prevalent, with the highest (91.3% and 86.7%, respectively) in the Northeast zone during both rounds of the survey. Delay in the physical domain was, however, the least prevalent form of developmental delay across the zones, with the least in South South (20.6%) and Southeast (5.4%) in rounds 4 and 5. The odds of developmental delay were 1.5 and 1.7 times higher amongst children 4 years old than 3 years old in both rounds of the survey. The likelihood of having developmental delay was found to increase with the severity of stunting amongst the children during both rounds of the survey (odds ratio [OR] =1.5; 95% CI = 1.20-1.78 in round 4 and OR = 1.4; 95% CI = 1.16-1.58 in round 5). Children from the poorest wealth index had higher odds of developmental delay (OR = 5.8; 95% CI = 4.92-6.82 in round 4 and OR = 2.5; 95% CI = 1.99-3.10 in round 5).

CONCLUSION

The prevalence of developmental delay is high across all zones; however, the burden varies amongst them. The age of the child, nutritional status and wealth index were indicators of developmental delay in Nigerian under-5 children. This underscores the need for surveillance and interventions focussed on improving child literacy, nutritional status and household standard of living across the zones.

Relations of maternal health literacy and parenting practices with early childhood development: a cross-sectional study

This study aimed to examine the relations of early childhood development with maternal health literacy and mothers' early parenting practices. This cross-sectional study was conducted on mothers with children aged 36-59 months (n = 503) with a survey form, Early Childhood Development Index (ECDI) and Turkish Health Literacy Scale-32. Children of mothers with sufficient/excellent health literacy levels, children who are breastfed for 12 months and longer, and children with a screen time of 2 h or less were more likely to be ECDI-on-track (AOR (CI) = 2.52 (1.53-4.15); 2.28 (1.41-3.70); 2.04 (1.18-3.50); respectively). In conclusion, children whose mothers were adequately health literate, who were breastfed longer and who had less screen time were better on ECDI indicators. Increasing the knowledge and skills of mothers on early parenting practices and supporting them to be good health literacy will contribute positively to the early development of children.

Cultural considerations in the assessment of sensitivity in low-income caregivers in Ethiopia

Background

Caregiver sensitivity is associated with positive child outcomes, and improving sensitivity is often the aim of parenting-directed interventions. However, sensitivity was conceptualized in Western cultures, and its application in populations with different backgrounds is still limited.

Objective

This study aimed to foster a contextualized cultural understanding of the meaning and nature of sensitivity by assessing the possibility of evaluating sensitivity in a low-income population living in Ethiopia and describing the nature of (in)sensitive parenting. Moreover, the associations between sensitivity and discipline, the quality of the environment, and individual characteristics were explored.

Methods

Parental sensitivity was coded on naturalistic video-recorded observations of free interactions between 25 female primary caregivers and their children. Caregivers completed questionnaires on discipline strategies and the level of satisfaction with the environment (access to basic needs, quality of house condition, community and family support, quality of learning opportunities, and working conditions).

Results

The assessment of sensitivity in this population was possible, with caregivers showing the full range of sensitivity levels. A description of manifestations of sensitivity in this population is provided. A K-means cluster analysis evidenced that high sensitivity was associated with high satisfaction regarding housing conditions and family environment. No association between sensitivity and discipline emerged.

Conclusion

The findings show the feasibility of assessing sensitivity in this sample. The descriptions of observed behaviors contribute to understanding culturally specific aspects of sensitivity to consider when assessing sensitivity in similar populations. The study provides considerations and guidelines to inform the structure of culturally-based interventions to promote sensitive parenting in similar cultural and socioeconomic situations.

Shared reading: Parental attitudes, practices and barriers in Turkey

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Early childhood development and its association with maternal parity

BACKGROUND

Maternal parity, which is usually measured as the number of children born to a mother, has a substantial impact on the social and environmental factors around children and their development. This paper estimates the Early Childhood Development Index (ECDI) of 3- and 4-year-old children in Bangladesh and examines the relationship between maternal parity and early childhood development.

METHODS

The study analysed nationally representative data from the Bangladesh Multiple Indicator Cluster Survey 2019. The dataset had 9453 children aged from 36 to 59 months. The ECDI was computed following the UNICEF's approach involving psychometric computation of four domains of development: physical, literacy-numeracy, learning and social-emotional. Since the dataset has a hierarchical structure, we used multilevel logistic regression.

RESULTS

A quarter (25%) of the children were not on track in their early childhood development. Seventy-one percent were not developmentally on track in the literacy-numeracy domain, 27% were not in the social-emotional and smaller percentages were not in learning (9%) and physical (1%) domains. There was a significant negative association between maternal parity and ECDI (adjusted odds ratio [AOR] 0.95; 95% CI: 0.91-0.99). Attendance at early childhood education programmes was significantly associated with early childhood development (AOR 1.73; 95% CI: 1.47-2.03). Also, female children, those who were not stunted, located in rural areas, received parental stimulation activities, lived in relatively wealthy households or had mothers who had received secondary or further education were more likely than others to be on track of early childhood development.

CONCLUSIONS

Early childhood development is negatively correlated with maternal parity. The literacy-numeracy domain constitutes the major developmental delay. Programmes for parental awareness should be widely expanded.

Feeding, caregiving practices, and developmental delay among children under five in lowland Nepal: a community-based cross-sectional survey

Background

Nurturing care, including adequate nutrition, responsive caregiving and early learning, is critical to early childhood development. In Nepal, national surveys highlight inequity in feeding and caregiving practices for young children. Our objective was to describe infant and young child feeding (IYCF) and cognitive and socio-emotional caregiving practices among caregivers of children under five in Dhanusha district, Nepal, and to explore socio-demographic and economic factors associated with these practices.

Methods

We did a cross-sectional analysis of a subset of data from the MIRA Dhanusha cluster randomised controlled trial, including mother-child dyads (N = 1360), sampled when children were median age 46 days and a follow-up survey of the same mother-child dyads (N = 1352) when children were median age 38 months. We used World Health Organization IYCF indicators and questions from the Multiple Indicator Cluster Survey-4 tool to obtain information on IYCF and cognitive and socio-emotional caregiving practices. Using multivariable logistic regression models, potential explanatory household, parental and child-level variables were tested to determine their independent associations with IYCF and caregiving indicators.

Results

The prevalence of feeding indicators varied. IYCF indicators, including ever breastfed (99%), exclusive breastfeeding (24-hour recall) (89%), and vegetable/fruit consumption (69%) were common. Problem areas were early initiation of breastfeeding (16%), colostrum feeding (67%), no pre-lacteal feeding (53%), timely introduction of complementary feeding (56%), minimum dietary diversity (49%) and animal-source food consumption (23%). Amongst caregiving indicators, access to 3+ children’s books (7%), early stimulation and responsive caregiving (11%), and participation in early childhood education (27%) were of particular concern, while 64% had access to 2+ toys and 71% received adequate care. According to the Early Child Development Index score, only 38% of children were developmentally on track. Younger children from poor households, whose mothers were young, had not received antenatal visits and delivered at home were at higher risk of poor IYCF and caregiving practices.

Conclusions

Suboptimal caregiving practices, inappropriate early breastfeeding practices, delayed introduction of complementary foods, inadequate dietary diversity and low animal-source food consumption are challenges in lowland Nepal. We call for urgent integrated nutrition and caregiving interventions, especially as interventions for child development are lacking in Nepal.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13776-8.

What is the expected human childhood? Insights from evolutionary anthropology

In psychological research, there are often assumptions about the conditions that children expect to encounter during their development. These assumptions shape prevailing ideas about the experiences that children are capable of adjusting to, and whether their responses are viewed as impairments or adaptations. Specifically, the expected childhood is often depicted as nurturing and safe, and characterized by high levels of caregiver investment. Here, we synthesize evidence from history, anthropology, and primatology to challenge this view. We integrate the findings of systematic reviews, meta-analyses, and cross-cultural investigations on three forms of threat (infanticide, violent conflict, and predation) and three forms of deprivation (social, cognitive, and nutritional) that children have faced throughout human evolution. Our results show that mean levels of threat and deprivation were higher than is typical in industrialized societies, and that our species has experienced much variation in the levels of these adversities across space and time. These conditions likely favored a high degree of phenotypic plasticity, or the ability to tailor development to different conditions. This body of evidence has implications for recognizing developmental adaptations to adversity, for cultural variation in responses to adverse experiences, and for definitions of adversity and deprivation as deviation from the expected human childhood.

Annual Research Review: Cross-cultural similarities and differences in parenting

This article reviews contemporary research on cross-cultural similarities and differences in parenting. The article begins by providing a definition of culture and how both parenting and culture can change over historical time. The article then presents some classic theoretical frameworks for understanding culture and parenting before considering why parenting may be similar across cultures and why parenting may be different across cultures. The article next turns to a review of cross-cultural similarities and differences in several aspects of parenting, including physical caregiving, cognitive stimulation, warmth and acceptance, control and monitoring, and discipline. Cultural normativeness and beliefs on the legitimacy of parental authority are then considered as potential moderators that contribute to cross-cultural similarities and differences in relations between parenting and child outcomes. The article then considers implications for parenting interventions and laws and policies related to parenting. Finally, the article suggests directions for future research.

Communicative Functions in Children Raised in Three Different Social Contexts in Colombia: The Key Issue of Joint Attention

Children’s sociocultural experiences vary around the world. Colombia is a South American country where the differences between socioeconomic statuses (SES) are huge. In this study, through the ECSP-E Scale, translated to Spanish and validated for linguistic and cultural equivalence, the development of three communicative functions was evaluated through an interactive sociopragmatic approach. The participants comprised 36 24-month-old children, raised in three different social contexts in Colombia, with the goal of comparing them across groups of SES. The lowest SES group sample subjects were representative of extreme poverty and members of an ethnic group, the Wayuú. Results for the communicative functions, namely social interaction (SI), joint attention (JA), and behavior regulation (BR), showed that the only function with no significant differences across SES was joint attention. This supports the hypothesis that the development of this function may be universal, in light of the fact that the Wayuú not only differed from other subjects in terms of their socioeconomic status but also in their culture. Higher SES was related to better social interaction, while Low SES was associated with better behavior regulation than their High SES peers. Consequently, results are discussed considering socioeconomic and cultural differences in the development of communication and social interactions, leading us to reexamine the paradigms, theories, and practices that are used when observing children raised in very poor environments.

Infant Cognitive Development and Stimulating Parenting Practices in Rural China

This study examines the prevalence of cognitive delay among infants and toddlers in rural China and its relationship with one of the potential sources of the observed delay: low levels of stimulating parenting practices (SPPs). Data were compiled from five distinct studies, resulting in a pooled sample of 4436 caregivers of 6-29-month-old infants. The sampling sites span five provinces in rural China. According to the data, on average, rates of delay are high-51 percent. The low rates of SPPs among our sample demonstrate that this may be one source of the high prevalence of delays. The results of the multivariate regression analysis reveal that reading books and singing songs are each significantly associated with an increase in infant cognitive score by 1.62 points (p = 0.003) and 2.00 points (p < 0.001), respectively. Telling stories to infants, however, is not significantly associated with infant cognitive scores. Our findings indicate that caregivers with different characteristics engage in various levels of stimulating practices and have infants with different rates of delay. Specifically, infants of better-educated mothers who have greater household assets are in families in which the caregivers provide more SPPs and have infants who score higher on the study's cognitive abilities scales.

Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of an Observational Measure for Parent-Child Responsive Caregiving

Responsive caregiving is the dimension of parenting most consistently related to later child functioning in both developing and developed countries. There is a growing need for efficient, psychometrically sound and culturally appropriate measurement of this construct. This study describes the cross-cultural validation in Brazil of the Responsive Interactions for Learning (RIFL-P) measure, requiring only eight minutes for assessment and coding. The cross-cultural adaptation used a recognized seven-step procedure. The adapted version was applied to a stratified sample of 153 Brazilian mother-child (18 months) dyads. Videos of mother-child interaction were coded using the RIFL-P and a longer gold standard parenting assessment. Mothers completed a survey on child stimulation (18 months) and child outcomes were measured at 24 months. Internal consistency (α = 0.94), inter-rater reliability (r = 0.83), and intra-rater reliability (r = 0.94) were all satisfactory to high. RIFL-P scores were significantly correlated with another measurement of parenting (r's ranged from 0.32 to 0.47, p < 0.001), stimulation markers (r = 0.34, p < 0.01), and children's cognition (r = 0.29, p < 0.001), language (r = 0.28, p < 0.001), and positive behavior (r = 0.17, p < 0.05). The Brazilian Portuguese version is a valid and reliable instrument for a brief assessment of responsive caregiving.

Age-related patterns of early childhood development practices amongst rural families in Burkina Faso: findings from a nationwide survey of mothers of children aged 0-3 years

BACKGROUND

Around two thirds of children in Sub-Saharan Africa are at risk of not meeting their developmental potential. Scalable interventions, based on an understanding of local contexts, that promote nurturing care in children's early years are needed.

OBJECTIVES

To investigate age-related patterns of Early Childhood Development (ECD) practices amongst caretakers of children aged 0-3 years in rural households in Burkina Faso, in order to inform the design of a mass media campaign to be evaluated through a randomized controlled trial.

METHODS

A household survey using a structured questionnaire was used to collect data from 960 rural mothers of children aged 0-3 years in a regionally stratified random sample of 130 villages.

RESULTS

The mother was the main caretaker and engaged most in ECD-related activities at all ages (0-3 years). The father, grandmother and older children also engaged in ECD-related activities with older children (aged 1-3 years). Singing and playing occurred moderately frequently. Singing in the last three days: 36% at age 0-5 months increasing to 84% at age 3 years; playing in the last three days: 26% at age 0-5 months, increasing to 65% at age 3 years. Activities such as reading, counting, drawing, 'showing and naming' and 'chatting' were limited, particularly in the child's first year. Reasons for not engaging in these activities include lack of literacy, lack of books and toys or playthings and a belief that the child was too young.

CONCLUSION

Opportunities for learning, especially through verbal interactions, appeared to be limited during the developmentally crucial first three years, most notably in the first year of life. The challenge for ECD intervention development in Burkina Faso will be finding ways to promote more responsive interactions at an early age and finding ways of mobilizing other family members to become more engaged in stimulating activities in the child's early years.

Maternal, paternal, and other caregivers' stimulation in low- and- middle-income countries

Background and objectives

Globally, studies have shown associations between maternal stimulation and early child development. Yet, little is known about the prevalence of paternal and other caregivers’ stimulation practices, particularly in low- and- middle-income countries (LMICs).

Methods

Data from the Multiple Indicators Cluster Survey (MICS) and the Demographic and Health Survey (DHS) were combined across 62 LMICs (2010–2018). The sample included 205,150 mothers of children aged 3 and 4 years. High levels of stimulation were defined as caregiver engagement in at least 4 out of 6 possible activities with the child. The proportion of mothers, fathers, and other caregivers providing high levels of stimulation was calculated by country, region, and for the whole sample. Socioeconomic disparities within and between countries were estimated.

Results

On average, 39.8% (95% CI 37.4 to 42.2) of mothers, 11.9% (95% CI 10.1 to 13.8) of fathers, and 20.7% (95% CI 18.4 to 23.0) of other adult caregivers provided high levels of stimulation. Stimulation varied by region, country income group, and Human Development Index (HDI), with higher levels of maternal and paternal–but not other caregivers’–stimulation in high-income and high-HDI countries. Within countries, stimulation levels were, on average, lower in the poorest relative to the richest households, and some but not all countries exhibited differences by child sex (i.e., boys vs. girls) or area (i.e., urban vs. rural).

Conclusions

Results suggest a need for intervention efforts that focus on increasing caregiver stimulation in LMICs, particularly for fathers and in low-income contexts.

Measuring the implementation of early childhood development programs

In this paper we describe ways to measure variables of interest when evaluating the implementation of a program to improve early childhood development (ECD). The variables apply to programs delivered to parents in group sessions and home or clinic visits, as well as in early group care for children. Measurements for four categories of variables are included: training and assessment of delivery agents and supervisors; program features such as quality of delivery, reach, and dosage; recipients' acceptance and enactment; and stakeholders' engagement. Quantitative and qualitative methods are described, along with when measures might be taken throughout the processes of planning, preparing, and implementing. A few standard measures are available, along with others that researchers can select and modify according to their goals. Descriptions of measures include who might collect the information, from whom, and when, along with how information might be analyzed and findings used. By converging on a set of common methods to measure implementation variables, investigators can work toward improving programs, identifying gaps that impede the scalability and sustainability of programs, and, over time, ascertain program features that lead to successful outcomes.

'Grandmother, aren't you going to sing for us?' Current childcare practices and caregivers' perceptions of and receptivity to early childhood development activities in rural Burkina Faso

INTRODUCTION

Effective stimulation and responsive caregiving during the first 2 years is crucial for children's development. By age 3-4 years, over 40% of children in sub-Saharan Africa fail to meet basic cognitive or socioemotional milestones, but there are limited data on parenting and childcare practices. This study, conducted to inform the design of a mass media intervention, explored practices, perceptions, motivators and obstacles to childhood development-related practices among parents and caregivers of children aged 0-2 years in rural Burkina Faso.

METHODS

We performed two rounds of six focus groups with 41 informants in two villages, using an adapted version of the Trials of Improved Practices methodology. These first explored beliefs and practices, then introduced participants to the principles and benefits of early childhood development (ECD) and provided illustrative examples of three practices (interactive ways of talking, playing and praising) to try with their children. One week later, further discussions explored participants' experiences and reactions. Data were analysed inductively using thematic content analysis.

RESULTS

Existing activities with young children were predominantly instructive with limited responsive interaction and stimulation. Participants were receptive to the practices introduced, noted positive changes in their children when they adopted these practices and found engagement with children personally rewarding.

CONCLUSION

Interactive, stimulating activities with young children did not appear to be widespread in the study area, but caregivers were receptive to information about the importance of early stimulation for children's development. ECD messages should be tailored to the local sociocultural context and consider time limitations.

"His mind will work better with both of us": a qualitative study on fathers' roles and coparenting of young children in rural Pakistan

Background

Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.

Methods

Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis.

Results

Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers’ coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community.

Conclusions

Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers’ direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.

Preschoolers' vocabulary acquisition in Chile: the roles of socioeconomic status and quality of home environment

Preschoolers' vocabulary acquisition sets the stage for later reading ability and school achievement. This study examined the role of socioeconomic status (SES) and the quality of the home environment of seventy-seven Chilean majority and Mapuche minority families from low and lower-middle-class backgrounds in explaining individual differences in vocabulary acquisition of their three-and-a-half-year-old children. Additionally, we investigated whether the relation between SES and receptive and expressive vocabulary was mediated by the quality of the home environment as the Family Investment Model suggests. The quality of the home environment significantly predicted receptive and expressive vocabulary above and beyond ethnicity, SES, parental caregiver status, and quantity of daycare. Furthermore, the quality of the home environment mediated the relation between SES and expressive and receptive vocabulary acquisition.

A Path Analysis of Nutrition, Stimulation, and Child Development Among Young Children in Bihar, India

Nutrition plays an important role in the development of a child, particularly in low‐ and middle‐income countries where malnutrition is often widespread. The relation between diet, hemoglobin, nutritional status, motor development, stimulation and mental development was examined in a cross‐sectional sample of 1,079 children 12–18 months of age living in rural Bihar, India. Path analysis revealed associations between (a) length‐for‐age z‐scores and motor development, standardized β (β) = .285, p < .001, and (b) motor and all mental development outcomes (language: β = .422; personal‐social: β = .490; memory: β = .139; and executive function: β = .072, all p < .001). Additionally, stimulation was significantly associated with language scores and hemoglobin concentration with memory. These findings inform interventions aimed at improving child development in Northern India.

Stimulating Parenting Practices in Indigenous and Non-Indigenous Mexican Communities

Parenting may be influenced by ethnicity; marginalization; education; and poverty. A critical but unexamined question is how these factors may interact to compromise or support parenting practices in ethnic minority communities. This analysis examined associations between mothers' stimulating parenting practices and a range of child-level (age; sex; and cognitive and socio-emotional development); household-level (indigenous ethnicity; poverty; and parental education); and community-level (economic marginalization and majority indigenous population) variables among 1893 children ages 4-18 months in poor; rural communities in Mexico. We also explored modifiers of associations between living in an indigenous community and parenting. Key findings were that stimulating parenting was negatively associated with living in an indigenous community or family self-identification as indigenous (β = -4.25; SE (Standard Error) = 0.98; β = -1.58; SE = 0.83 respectively). However; living in an indigenous community was associated with significantly more stimulating parenting among indigenous families than living in a non-indigenous community (β = 2.96; SE = 1.25). Maternal education was positively associated with stimulating parenting only in indigenous communities; and household crowding was negatively associated with stimulating parenting only in non-indigenous communities. Mothers' parenting practices were not associated with child sex; father's residential status; education; or community marginalization. Our findings demonstrate that despite greater community marginalization; living in an indigenous community is protective for stimulating parenting practices of indigenous mothers.

Gender disparities in child development in the east Asia-Pacific region: a cross-sectional, population-based, multicountry observational study

BACKGROUND

Gender differences in child development have been extensively studied in high-income countries, but few data are available from low-income and middle-income countries. Our objective was to assess gender disparities in child development that might arise from differential investment in child health, nutrition, and education in six countries across the east Asia-Pacific region.

METHODS

In this cross-sectional, population-based study we quantified the magnitude of gender differences in child development using the East Asia-Pacific Early Child Development Scales (EAP-ECDS) in six countries (Cambodia, China, Mongolia, Papua New Guinea, Timor-Leste, and Vanuatu). We used stratified random sampling (according to age, residence [urban vs rural], and sex) in all countries to recruit eligible children aged 3-5 years from non-ethnic minority populations with no identified or suspected special educational needs for whom EAP-ECDS scores for five or more of seven domains and urban-rural residence information were available. Gender differences in development associated with four national indicators of gender equality (sex ratio at birth, Gender Development Index, Gender Inequality Index, and Gender Parity Index for primary school enrolment) were also examined. We used generalised estimating equation regression to study moderation of differences by family socioeconomic status and wealth, and structural equation models with maximum likelihood to test mediation through health, nutrition, and education.

FINDINGS

Between June 1, 2013, and Dec 13, 2013, 7582 eligible children were included from Cambodia (n=1189), China (n=1618), Mongolia (n=1230), Papua New Guinea (n=1639), Timor-Leste (n=1176), and Vanuatu (n=730). Girls had significantly higher development scores than boys in Cambodia (difference in composite score: β=1·87 points, 95% CI 0·29 to 3·45; p=0·747), China (2·66 points, 1·20 to 4·13; p=0·0004), Vanuatu (3·10 points, 1·65 to 4·55; p<0·0001), and Mongolia (3·94 points, 2·67 to 5·21; p<0·0001), but not Papua New Guinea (-0·43 points, -1·19 to 0·33; p=0·272) or Timor-Leste (0·09 points, -0·96 to 1·14; p=0·861). Differences in favour of girls were the largest for language skills in Mongolia (5·30 points, 95% CI 4·45 to 6·15); differences in language skills were smallest in the two poorest countries, Timor-Leste (-0·07 points, -1·03 to 0·88) and Papua New Guinea (0·05 points, -1·02 to 1·12). Greater differences in composite scores for girls compared with boys-in favour of girls-were associated with higher national Gender Development Index values (R²=0·790). In Mongolia, smaller gender differences in development were associated with increased household wealth (6·07 points [95% CI 3·22 to 8·92] in the lowest wealth quartile vs 2·27 points [1·38 to 3·15] in the highest wealth quartile), whereas in Timor-Leste, girls only outperformed boys when living in households with higher socioeconomic status (2·87 points [0·27 to 5·47] in the highest wealth quartile and 3·74 points [2·17 to 5·31] in the highest quartile of parental socioeconomic status). Mediating pathways explained up to 37% (in Vanuatu) of the association between gender and development, controlling for family socioeconomic status.

INTERPRETATION

Girls aged 3-5 years generally outperformed boys on tests of development, and increasing levels of gender equality across six countries in the east Asia-Pacific region were associated with improved performance of young girls relative to boys. Greater opportunities for economic development are anticipated to result from improvements in gender equality and in the development of girls. Further study is warranted to understand family-level processes and societal norms that lead to gender differences in child development in the early years.

FUNDING

UNICEF, the Asia-Pacific Regional Network for Early Childhood, and the Open Society Foundations.

Infants' Social Experiences in Three African Sociocultural Contexts

This study introduces a peri-urban context of poverty to the study of child development in Africa in contrast to the more typical assessments in middle-class and rural contexts. Spot observations were used to assess universal caregiving behaviors toward seventy-six 3-month-old infants. Results show that middle-class infants experienced distal parenting behaviors instantiated by mothers, whereas rural children experienced proximal parenting practices in interactions with others. Infants growing up in poverty had mothers and other caretakers involved at mostly low levels. They experienced low levels of body contact, body stimulation, and object stimulation, and high levels of face-to-face positions. The study indicates that caregiving in the context of poverty does not necessarily follow familiar pathways and needs to be contextualized accordingly.

Paternal Stimulation and Early Child Development in Low- and Middle-Income Countries

BACKGROUND AND OBJECTIVE

Few studies have examined the relationship between paternal stimulation and children's growth and development, particularly in low- and middle-income countries (LMICs). This study aimed to estimate the prevalence of paternal stimulation and to assess whether paternal stimulation was associated with early child growth and development.

METHODS

Data from the Multiple Indicator Cluster Surveys rounds 4 and 5 were combined across 38 LMICs. The sample comprised 87 286 children aged 3 and 4 years. Paternal stimulation was measured by the number of play and learning activities (up to 6) a father engaged in with his child over the past 3 days. Linear regression models were used to estimate standardized mean differences in height-for-age z-scores and Early Childhood Development Index (ECDI) z-scores across 3 levels of paternal stimulation, after controlling for other caregivers' stimulation and demographic covariates.

RESULTS

A total of 47.8% of fathers did not engage in any stimulation activities, whereas 6.4% of fathers engaged in 5 or 6 stimulation activities. Children whose fathers were moderately engaged in stimulation (1-4 activities) showed ECDI scores that were 0.09 SD (95% confidence interval [CI]: -0.12 to -0.06) lower than children whose fathers were highly engaged; children whose fathers were unengaged showed ECDI scores that were 0.14 SD lower (95% CI: -0.17 to -0.12). Neither moderate paternal stimulation nor lack of paternal stimulation was associated with height-for-age z-scores, relative to high stimulation.

CONCLUSION

Increasing paternal engagement in stimulation is likely to improve early child development in LMICs.