Influences of early child nutritional status and home learning environment on child development in Vietnam

The Relationship of Preterm and Small for Gestational Age with Child Cognition During School-Age Years

BACKGROUND

Children born preterm and/or small for gestational age (SGA) are at increased risk of poor cognitive outcomes, particularly in low and middle-income countries (LMICs).

OBJECTIVES

This study aimed to examine the cognitive and academic deficits during the school-age years in children born preterm or SGA compared with those in children born term adequate for gestational age (AGA) in rural Vietnam.

METHODS

Children born to women in a preconception micronutrient supplementation trial in Vietnam were classified into 3 groups: preterm AGA (n =138), term SGA (n =169), and term AGA (n = 1134). Cognitive abilities were assessed using the Wechsler Intelligence Scale for Children, measuring 4 domains [verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI) scores] and full-scale intelligence quotient (FSIQ) at 6-7 and 10-11 y. Academic achievement was assessed with mathematic and language tests. Analysis of variance and multiple regression models were used to analyze differences in cognitive function and academic achievement at 6-7 and 10-11 y by birth phenotypes.

RESULTS

Compared with term AGA children, those born SGA had lower cognitive scores at both 6-7 y (VCI, -2.3; PRI, -3.7; PSI -2.1; and FSIQ, -2.9) and 10-11 y (VCI, -3.7; PRI, -3.5; WMI, -2.7; PSI, -1.9; and FSIQ, -3.9). Children born SGA also had poorer academic achievement with lower language (5.3) and mathematic (2.5) scores. Adjustments for maternal factors and home environment attenuated the associations, but the differences in VCI, PRI, FSIQ, and language at 10-11 y remained significant. There were no differences in cognitive function and academic achievement between children born preterm and AGA.

CONCLUSIONS

Our findings highlight the enduring association of birth phenotype on cognitive functioning and academic achievement during the school years, despite adjustments for maternal education and family environment. Further research is needed to implement effective interventions to improve birth outcomes and optimize child health and development in LMICs. The trial was registered at clinicaltrials.gov as NCT01665378 (URL: https://clinicaltrials.gov/ct2/show/NCT01665378).

Online educational intervention: Improving maternal knowledge and attitudes in providing developmental stimulation for stunting toddlers

Stunting remains a significant public health concern, impacting physical growth and impeding children's development. Mothers, who play a crucial role in stimulating children's development, often encounter barriers in providing effective stimulation, primarily due to limited access to appropriate resources and information. Online education can bridge this gap by offering easily accessible learning. This aim of this study was to determine the effect of online education on maternal knowledge and attitudes in providing developmental stimulation for stunting toddlers. A quasi-experimental research design was employed, comprising a treatment group and a control group, each consisting of 46 mothers with stunting toddlers, sampled purposively. The treatment group received an online developmental stimulation educational intervention through WhatsApp groups for twelve meetings, each lasting 1.5 to 2 hours. Meanwhile, the control group participated in a stunting assistance program provided by the community health centers (Puskesmas). To compare the knowledge and attitudes between groups, Mann-Whitney and independent Student t-test were used. The assessment of intervention effects on knowledge and attitudes was conducted using Wilcoxon and paired Student t-test within each group. Following the educational intervention on developmental stimulation, there was a significant increase in knowledge; however, there was no significant difference in attitudes. The treatment group (mean score 3.9±1.76) had a higher increase in knowledge scores compared to the control group (2.0±2.25) with a p<0.001. Nonetheless, no significant difference in attitudes was observed between the two groups with the mean change scores was 5.8±15.31 in treatment group and 2.5±18.69 for control group, with a p=0.335. This study suggests that providing online education leads to increased knowledge scores but does not impact attitudes significantly. Additional educational approaches should be considered to enhance maternal attitudes.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION NUMBER

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

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BACKGROUND

Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China.

METHODS

Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition.

RESULTS

Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates.

CONCLUSIONS

Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

How the home learning environment contributes to children's social-emotional competence: A moderated mediation model

Introduction

The home learning environment is the earliest contact learning environment in early childhood development, which plays an important role in the development of children's social-emotional competence. However, previous studies have not clarified the precise mechanisms by which the home learning environment influences children's social-emotional competence. Therefore, the purpose of the study is to explore the relationship between the home learning environment and its intrinsic structure (i.e. structural family characteristics, parental beliefs and interests, and the educational processes) and children's social-emotional competence, and whether gender plays a moderating role in the relationship.

Method

The study randomly selected a sample of 443 children from 14 kindergartens in western China. The Home Learning Environment Questionnaire and the Chinese Inventory of Children's Social-emotional competence scale were used to investigate the home learning environment and social-emotional competence of these children.

Results

(1) Structural family characteristics and parental beliefs and interests both had a significant positive predictive effect on children's social-emotional competence. (2) The educational processes fully mediate between structural family characteristics, parental beliefs and interests, and children's social-emotional competence. (3) Gender moderated the effect of the home learning environment on children's social-emotional competence. Gender moderates not only the indirect effects between parental beliefs and interests and children's social-emotional competence, but also the indirect effects between structural family characteristics and children's social-emotional competence. At the same time, gender also moderated the direct effects between parental beliefs and interests and children's social-emotional competence.

Discussion

The results emphasize the crucial role of the home learning environment in the development of children's early social-emotional competence. Therefore, parents should pay attention to the home learning environment and improve their ability to create a home learning environment that promotes the positive development of children's social-emotional competence.

Investigating the impact of a home-centred cognitive development support programme on the cognitive development of infants aged between 18 and 24 months

BACKGROUND

The experiences acquired in the first years when development and learning are most rapid make up the basis for subsequent periods. The aim in this research to determine whether the 'Home-Centered Cognitive Development Support Program', delivered to socio-economically disadvantaged infants aged between 18 and 24 months, had an impact on the cognitive development of the infants.

METHODS

An experimental design with pre-test, post-test and retention test control group was used as methodology for the research. Thirty infants, 15 in the experiment group and 15 in the control group, were included in the study. The Cognitive Assessment Tool for Young Children - CAYC, which was adapted to Turkish, was used to measure the cognitive development of infants in the study. In line with the objective of the study, a cognitive development support programme was implemented for infants aged 18 to 24 months, 2 days a week during 12 weeks, through home visits. To assess the effectiveness of the programme, pre-test, post-test and retention test results were compared.

RESULTS

Based on the results of the study, the Home-Centered Cognitive Development Support Program revealed a significant difference in the cognitive development of infants in the experiment group. The post-test mean score for all infants in the experimental group was significantly higher compared with the pre-test score.

CONCLUSION

The outcomes related to the Home-Centered Cognitive Development Support Program, which was applied individually to infants aged between 18 and 24 months, were discussed in terms of the cognitive development of the infants.

Age heterogeneities in child growth and its associated socio-demographic factors: a cross-sectional study in India

BACKGROUND

The impacts of socio-demographic and environmental risk factors on child growth have been widely documented. However, it remains unclear whether the impacts of such risk factors on child growth have remained static or changed with child's age. The present study aims to assess the underlying age heterogeneities in child growth and its potential determinants over age in under-five children.

METHODS

Cross-sectional data on child height (measured as height-for-age z-score, i.e., HAZ) and weight (measured as weight-for-age z-score, i.e., WAZ) and potential confounding factors from India's 2015-16 National Family Health Survey (NFHS) were used to construct anthropometric age-profiles by a number of bio-demographic and socioeconomic characteristics. Further, age-interacted multilevel regression analyses were performed to examine differential effects of such/those risk factors on child height and weight by age.

RESULTS

Faltered height and weight growth during first two years of life was noticed in children of all socioeconomic groups studied, albeit with varying magnitude. In case of child's height, factors such as short birth interval, higher birth order, maternal education, household wealth, district level mortality rate have shown strong interaction with child's age during the first 23 months, signifying their age-varying role in different developmental stages of child growth. These factors explain the observed upward and downward shifts in height curve during first two years. Some of these variables (e.g., household wealth) have shown even stronger age interactions after the second birthday of children. For child's weight, interactive effects of most socio-demographic risk factors attenuated parabolically with child's age.

CONCLUSIONS

The impacts of several risk factors, measured at the child, mother, community, and district levels, on child growth indicators varied significantly with the child's age. Nutritional interventions aimed at preventing poor linear growth in children in India should consider these underlying age heterogeneities for growth determinants into account.

What matters most for early childhood development? Evidence from Malda district, India

BACKGROUND

The early period of a child's life is considered to be the most important developmental stage throughout the lifespan. Around 250 million children of age below five years in low-and middle- income countries (LMICs) are at risk of not attaining their developmental potential. A cross-sectional case study was conducted to assess the early childhood developmental (ECD) status and to investigate the factors influencing the same in Malda, India.

METHODS

Information on 731 pre-school children aged 36 to 59 months was collected in 2018 using a structured questionnaire following a multi-stage, stratified simple random sampling procedure. ECD was measured following the UNICEF's Multiple Indicator Cluster Survey, which monitors early child development in LMICs. A path analysis using structural equation modelling was carried out to examine the relationship between possible associated factors and ECD status.

RESULTS

It has been found that only about 25% of children are developmentally on track of literacy-numeracy domain of ECD. Although, in the other domains, the situation is better. Results of the path analysis revealed that there are certain proximal factors, i.e., home environment, mother's time for care, having home tuition and attending private pre-school, which are influenced by certain distal factors and subsequently affecting ECD. The total effects revealed that place of residence (urban or rural) affects ECD mostly (Coef. -0.87, p = <0.001) directly or via mothers' time for stimulating activities, home environment and having home tuition for children. Further, it revealed that private pre-schools (Coef. 0.76, p = <0.001) and home tuition (Coef. 0.43, p = <0.001) also play a significant role in ECD.

CONCLUSION

Urgent attention from policymakers or other stakeholders is needed to promote ECD for the betterment of children and society of Malda district. In addition to that, special attention needs to be given to the children who belong to Muslim families, socially deprived communities and living in rural areas.

Mother Empowerment Model in Stunting Prevention and Intervention through Stunting Early Detection Training

BACKGROUND: Stunting is a condition of failure to thrive under 5-year-old due to chronic malnutrition causing the children become too short for their age. The contribution of this research is to prevent and reduce stunting through Stunting Early Detection training. AIM: The objective of the current research is to develop a model for mother empowerment in preventing and intervention stunting in children through stunting early detection training. METHODS: Phase I is the development of a mother empowerment model in the prevention and intervention of stunting in children using a survey with a cross sectional design. Phase II is the implementation of the model using Quasi Experimental Nonrandomized Prepost Control Group Design. RESULTS: The results of the study obtained that mothers who had good characteristics increased their knowledge 0.423 (p = 0.000). Mothers who have good knowledge increase their mother commitment 0.230 (p = 0.004), mothers who have a good commitment reduce stunting in children 0.448 (p = 0.000), mothers who have good knowledge increase family support 0.236 (p = 0.040), and good family support reduces stunting 0.257 (p = 0.011). CONCLUSION: A new finding is the formation of a Mother Empowerment Model in the Prevention and Intervention of Stunting through Stunting Early Detection Training where mother commitment is the most influential factor.

Stunting, maternal investment, and early child development in Serbian Roma children aged 36-59 months

Stunting has shown negative associations with poor child developmental indicators. However, in poor ethnic minority populations the evidence for associations of anthropometric growth indicators and child development is limited. This study examined associations between stunting, height for age z scores (HAZ) and other determinants, with Early Child Development (ECD) among children in poor Roma communities. Publicly available data from Multiple Indicator Cluster Surveys for Serbian Roma settlements were used to assess a cohort of 1075 Roma children aged 36-59 months. Indicators of child growth and nutrition included children?s HAZ scores and stunting. ECD assessed physical, learning/cognition, literacy/numeracy and socio-emotional developmental domains. Multiple regressions were used to assess the association between HAZ and stunting with ECD, controlling for maternal and child confounders. Sum score for ECD in Roma children was low, and 18% of children were stunted. After adjusting for potential confounders, HAZ and stunting revealed no significant associations with developmental outcomes. Instead, increasing maternal investment was positively associated with overall ECD score and higher scores in each of the individual developmental domains, except socio-emotional. In a low-resource setting, maternal investment appeared a good predictor of child development: it may buffer against the effects of poverty and stimulate child development.

Malnutrition in early life and its neurodevelopmental and cognitive consequences: a scoping review

The negative impact of stunting and severe underweight on cognitive neurodevelopment of children is well documented; however, the effect of overweight/obesity is still unclear. The 2018 Global Nutrition Report reported that stunting and overweight concurrently affect 189 million children worldwide. As existing reviews discuss undernutrition and overweight/obesity separately, this scoping review aims to document the impact of mild/moderate and severe underweight, stunting, and overweight/obesity among children aged 0-60 months on their cognitive neurodevelopmental trajectories. Twenty-six articles were analysed to extract significant information from literature retrieved from PubMed and Cochrane databases published from 1 January 2009 to 31 October 2019. Length gain is associated with cognitive neurodevelopment in normo-nourished and stunted children aged under 24 months. Among stunted children, it seems that cognitive and neurodevelopmental deficits can potentially be recovered before 8 years of age, particularly in those whose nutritional status has improved. The impact of overweight/obesity on cognitive neurodevelopment appears to be limited to attention, gross motor skills and executive control. Parental education level, birth weight/length, breastfeeding duration, and sanitation level are some identifiable factors that modify the impact of undernutrition and overweight/obesity on cognitive and neurodevelopment. In conclusion, underweight, stunting and overweight/obesity have a significant impact on cognitive neurodevelopment. Multidimensional approaches with various stakeholders should address all issues simultaneously, such as improving sanitation levels, assuring parental job security and adequate social welfare, and providing access to adequate nutrients for catch-up growth among underweight or stunted children and to affordable healthy foods for those who are overweight/obese and from low socio-economic status.

Preconception micronutrient supplementation positively affects child intellectual functioning at 6 y of age: A randomized controlled trial in Vietnam

BACKGROUND

Although there is growing evidence on the role of preconception nutrition for birth outcomes, very few studies have evaluated the long-term effects of nutrition interventions during the preconception period on offspring cognitive outcomes.

OBJECTIVE

We evaluate the impact of preconception weekly multiple micronutrients (MMs) or iron and folic acid (IFA) supplementation compared with folic acid (FA) alone on offspring intellectual functioning at age 6-7 y.

METHODS

We followed 1599 offspring born to women who participated in a double-blinded randomized controlled trial of preconception supplementation in Vietnam. Women received weekly supplements containing either 2800 μg FA only, 60 mg iron and 2800 μg FA, or MMs (15 micronutrients including IFA) from baseline until conception, followed by daily prenatal IFA supplements until delivery. We used the Wechsler Intelligence Scale for Children to measure full-scale IQ (FSIQ) and 4 related domains of intellectual functioning [Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores] at 6-7 y. Group comparisons were done using ANOVA tests for all children and the subgroup born to women who consumed the supplements ≥26 wk before conception (per-protocol analyses).

RESULTS

The final sample with data at 6-7 y (n = 1321) was similar for baseline maternal and offspring birth characteristics and age at follow-up by treatment group. Compared with the offspring in the FA group, those in the MM group had higher FSIQ (β = 1.7; 95% CI: 0.1, 3.3), WMI (β = 1.7; 95% CI: 0.2, 3.2), and PSI (β = 2.5; 95% CI: 0.9, 4.1). Similar findings were observed in the per-protocol analyses. There were no significant differences by treatment group for VCI and PRI.

CONCLUSIONS

Preconception supplementation with MMs improved certain domains of intellectual functioning at age 6-7 y compared with FA. These findings suggest the potential for preconception micronutrient interventions to have long-term benefits for offspring cognition.

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Background

Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings.

Objective

The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD)

Methods

We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study at birth from Iganga hospital between May and July 2018. We followed up the babies at an average age of 7 months (adjusted for prematurity) and assessed 211 preterm and 187 term infants for neurodevelopmental outcomes using the Malawi Developmental Assessment tool. Mothers were interviewed on care practices for the infants. Data were analyzed using STATA version 14.

Results

The study revealed a high incidence of NDD of 20.4% (43/211) among preterm infants compared to 7.5% (14/187) among the term babies, p < 0.001, of the same age. The most affected domain was fine motor (11.8%), followed by language (9.0%). At multivariate analysis, malnutrition and Kangaroo Mother Care (KMC) at home after discharge were the key factors that were significantly associated with NDD among preterm babies. The prevalence of malnutrition among preterm infants was 20% and this significantly increased the odds of developing NDD, OR = 2.92 (95% CI: 1.27–6.71). KMC practice at home reduced the odds of developing NDD, OR = 0.46, (95% CI: 0.21–1.00). Re-admission of preterm infants after discharge (a sign of severe illness) increased the odds of developing NDD but this was not statistically significant, OR = 2.33 (95% CI: 0.91–5.94).

Conclusion

Our study has shown that preterm infants are at a high risk of developing NDD, especially those with malnutrition. Health system readiness should be improved to provide follow-up care with emphasis on improving nutrition and continuity of KMC at home.

Multi-Sectoral Participatory Design of a BabyWASH Playspace for Rural Ethiopian Households

Growing evidence suggests current water, sanitation, and hygiene interventions do not improve domestic hygiene sufficiently to improve infant health, nor consider the age-specific behaviors which increase infection risk. A household playspace (HPS) is described as one critical intervention to reduce direct fecal-oral transmission within formative growth periods. This article details both the design and development (materials and methods), and testing (results) of a HPS for rural Ethiopian households. Design and testing followed a multi-sectoral, multistep participatory process. This included a focus group discussion (FGD), two user-centered and participatory design workshops in the United Kingdom and Ethiopia, discussions with local manufacturers, and a Trials by Improved Practices (TIPs) leading to a final prototype design. Testing included the FGD and TIPs study and a subsequent randomized controlled feasibility trial in Ethiopian households. This multi-sectoral, multistage development process demonstrated a HPS is an acceptable and feasible intervention in these low-income, rural subsistence Ethiopian households. A HPS may help reduce fecal-oral transmission and infection-particularly in settings where free-range domestic livestock present an increased risk. With the need to better tailor interventions to improve infant health, this article also provides a framework for future groups developing similar material inputs and highlights the value of participatory design in this field.

Maternal Undernutrition before and during Pregnancy and Offspring Health and Development

Maternal undernutrition remains a critical public health problem. There are large regional and within-country disparities in the burden of underweight, anemia, and micronutrient deficiencies across the globe. Driving these disparities are complex and multifactorial causes, including access to health services, water and sanitation, women's status, and food insecurity as well as the underlying social, economic, and political context. Women's health, nutrition, and wellbeing across the continuum of preconception to pregnancy are critical for ensuring positive pregnancy and long-term outcomes for both the mother and child. In this review, we summarize the evidence base for nutrition interventions before and during pregnancy that will help guide programs targeted towards women's nutrition. Growing evidence from preconception nutrition trials demonstrates an impact on offspring size at birth. Preconception anemia and low preconception weight are associated with an increased risk of low birth weight and small for gestational age births. During pregnancy, several evidence-based strategies exist, including balanced-energy protein supplements, multiple micronutrient supplements, and small-quantity lipid nutrient supplements for improving birth outcomes. There, however, remain several important priority areas and research gaps for improving women's nutrition before and during pregnancy. Further progress is needed to prioritize preconception nutrition and access to health and family planning resources. Additional research is required to understand the long-term effects of preconception and pregnancy interventions particularly on offspring development. Furthermore, while there is a strong evidence base for maternal nutrition interventions, the next frontier requires a greater focus on implementation science and equity to decrease global maternal undernutrition disparities.

Cognitive function in toddlers with congenital heart disease: The impact of a stimulating home environment

Infants born with congenital heart disease (CHD) are at increased risk of neurodevelopmental difficulties in childhood. The extent to which perioperative factors, cardiac physiology, brain injury severity, socioeconomic status, and home environment influence early neurodevelopment is not clear. Sixty-nine newborns with CHD were recruited from St Thomas' Hospital. Infants underwent presurgical magnetic resonance imaging on a 3-Tesla scanner situated on the neonatal unit. At 22 months, children completed the Bayley Scales of Infant and Toddler Development-3rd edition and parents completed the cognitively stimulating parenting scale to assess cognitive stimulation at home. Level of maternal education and total annual household income were also collected. Hospital records were reviewed to calculate days on the intensive care unit post-surgery, time on bypass during surgery, and days to corrective or definitive palliative surgical intervention. In the final analysis of 56 infants, higher scores on the cognitively stimulating parenting scale were associated with higher cognitive scores at age 22 months, correcting for gestational age at birth, sex, and maternal education. There were no relationships between outcome scores and clinical factors; socioeconomic status; or brain injury severity. Supporting parents to provide a stimulating home environment for children may promote cognitive development in this high-risk population.

Effect of Maternal Docosahexaenoic Acid (DHA) Supplementation on Offspring Neurodevelopment at 12 Months in India: A Randomized Controlled Trial

Intake of dietary docosahexaenoic acid (DHA 22:6n-3) is very low among Indian pregnant women. Maternal supplementation during pregnancy and lactation may benefit offspring neurodevelopment. We conducted a double-blind, randomized, placebo-controlled trial to test the effectiveness of supplementing pregnant Indian women (singleton gestation) from ≤20 weeks through 6 months postpartum with 400 mg/d algal DHA compared to placebo on neurodevelopment of their offspring at 12 months. Of 3379 women screened, 1131 were found eligible; 957 were randomized. The primary outcome was infant neurodevelopment at 12 months, assessed using the Development Assessment Scale for Indian Infants (DASII). Both groups were well balanced on sociodemographic variables at baseline. More than 72% of women took >90% of their assigned treatment. Twenty-five serious adverse events (SAEs), none related to the intervention, (DHA group = 16; placebo = 9) were noted. Of 902 live births, 878 were followed up to 12 months; the DASII was administered to 863 infants. At 12 months, the mean development quotient (DQ) scores in the DHA and placebo groups were not statistically significant (96.6 ± 12.2 vs. 97.1 ± 13.0, p = 0.60). Supplementing mothers through pregnancy and lactation with 400 mg/d DHA did not impact offspring neurodevelopment at 12 months of age in this setting.

Neurodevelopment at 2 years corrected age among Vietnamese preterm infants

BACKGROUND

Preterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce.

OBJECTIVES

To examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment.

DESIGN AND SETTING

Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam.

PARTICIPANTS

Infants born at <37 weeks of gestational age.

MAIN OUTCOMES

Bayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants.

RESULTS

Of 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were -6.9 (-9.1 to -4.7), -7.2 (-10.5 to -3.8) and -3.7 (-6.1 to -1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94).

CONCLUSIONS

Vietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings.

Determinants of Cognitive Development in the Early Life of Children in Bhaktapur, Nepal

Background

Children in low and middle income countries may have many risk factors for poor cognitive development, and are accordingly at a high risk of not reaching their developmental potential. Determinants for cognitive development in early life can be found among biological and socioeconomic factors, as well as in stimulation and learning opportunities.

Objective

The present study aimed to identify determinants of cognitive, language and motor development in 6–11 months old Nepalese infants.

Methods

Six hundred infants with a length-for-age z-score <-1 were assessed with the Bayley Scales of Infant and Toddler development, 3rd edition (Bayley-III). Information on socioeconomic factors, child and maternal demographics, clinical and biological factors, and the home environment were collected. In a manual stepwise variable selection procedure, we examined the association between selected biological, socioeconomic and stimulation and learning opportunity variables and the Bayley-III cognitive, language and motor development subscale scores in multiple linear regression models.

Results

The length-for-age z-scores was positively associated with the cognitive composite score [standardized beta (ß): 0.22, p < 0.001] and the motor composite score [(ß): 0.14, p = 0.001]. Children born with low birth weight (<2500 g) scored significantly lower on all subscale scores. Diarrheal history was associated with poor language composite scores, and females had higher language composite scores than boys [(ß): 0.11, p = 0.015]. Children who had been hospitalized during the first month of life had also lower cognitive and motor composite scores than those who had not been hospitalized. Parental reports of physical punishment and lack of spontaneous vocalization were associated with poor cognitive and language composite scores, respectively. The statistical models with the various subscale scores as dependent variables explained between 8 to 16 percent of the variability in the cognitive developmental outcomes.

Conclusion

Our findings reveal important determinants for developmental scores in infancy, and underline the role of biological risk factors faced by marginalized children in low and middle income countries such as in Nepal.

Early growth and home environment are associated with cognitive development in the first year of life of Malaysian infants

BACKGROUND

Undernutrition and poor home environment in the first 2 years of life may have long-term effects on cognitive development.

AIMS

To determine the influence of linear growth and home environment towards cognitive development in the first year of life of Malaysian infants.

STUDY DESIGN

Cross-sectional findings at 12-13 months from a prospective cohort study of infants in Malaysia.

SUBJECTS

One hundred fifty-one infants recruited at 2-5 months were visited at home at 12-13 months (M = 12.95, SD = 0.98).

OUTCOME MEASURES

Maternal and infant measures during pregnancy and at birth were obtained from patient health clinic cards. Weight and length of infants were measured at 12-13 months. Home environment and cognitive development were assessed using HOME inventory and Bayley-III, respectively.

RESULTS

About 22.5% of infants experienced stunting and 14.6% had low home environment quality. The mean cognitive score was 94.54 (SD = 12.00). Stunted infants had 7.59 lower cognitive scores than non-stunted infants, while infants with low home environment quality had 12.09 lower cognitive scores than those with high home environment quality. Cognitive scores increased with better home environment quality in both stunted and non-stunted infants, but stunted infants scored lower than non-stunted infants in all conditions.

CONCLUSION

Stunting, a form of chronic undernutrition, and poor home environment may significantly influence cognitive development of infants. Interventions to prevent undernutrition should start as early as during pregnancy and caregivers should be informed on their roles in providing cognitive stimulation within the home environment for their children.

Association between stunting and early childhood development among children aged 36-59 months in South Asia

Stunting (length‐for‐age z score < −2) before 2 years of age has shown associations with poor child developmental indicators, but information at the population level is scarce in South Asia, the region with the highest burden of stunting. We examined associations between z scores (i.e., height for age [HAZ], weight for age [WAZ], and weight for height [WHZ]) and undernutrition (i.e., stunting [HAZ < −2], wasting [WHZ < −2], and underweight [WAZ < −2]) with learning/cognition and social–emotional development among children 36–59 months of age. Data from Multiple Indicator Cluster Surveys in Bangladesh (n = 8,659), Bhutan (n = 2,038), Nepal (n = 2,253), and Pakistan (Punjab n = 11,369 and Sindh n = 6,718) were used. Children were considered developmentally “on‐track” in learning/cognition or social–emotional domains if they met specific early child development criteria. Meta‐analysis was conducted to examine regional associations, adjusting for socio‐economic status, early childhood education, and quality of care. In a pooled sample, on‐track learning/cognition development was positively associated with HAZ (OR = 1.17, 95% CI [1.07, 1.27]) and WAZ (OR = 1.18, 95% CI [1.07, 1.31]) and negatively associated with stunting (OR = 0.72, 95% CI [0.60, 0.86]) and underweight (OR = 0.75, 95% CI [0.66, 0.86]) but not associated with WHZ or wasting. On‐track development of social–emotional domain was not associated with any z scores or undernutrition indicators. Across several countries of South Asia, stunted children were less likely to be developmentally “on track” for learning/cognition. It is likely that interventions that prevent stunting may benefit child development, leading to significant individual and societal gains given the large burden of child stunting in regions like South Asia.

Low socioeconomic status and severe obesity are linked to poor cognitive performance in Malaysian children

Background

Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children.

Methods

A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven’s Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference.

Results

Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110–119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)].

Conclusions

Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.

Influences of early child nutritional status and home learning environment on child development in Vietnam

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam (n = 1,458). The Bayley Scales of Infant Development-III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (-0.11 to -0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high-quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high-quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development.