Trajectories of resilience among young children involved with child protective services

Although child maltreatment is associated with short- and long-term maladaptive outcomes, some children are still able to display resilience. Currently, there is a limited understanding of how children's resilience changes over time after experiencing maltreatment, especially for young children. Therefore, the current study used a longitudinal, multidimensional approach to examine trajectories of resilience among very young children involved in child protective services and determine whether placement setting and caregiving behaviors are associated with resilience trajectories. This study used data from National Survey of Child and Adolescent Well-Being I and conducted repeated measures latent class analysis, focusing on children under 2 years old at baseline (n = 1,699). Results suggested that there were three trajectories of resilience: increasing resilience, decreasing resilience, and stable, low resilience. Caregiver cognitive stimulation was related to increasing trajectories of resilience compared to both decreasing and stable, low resilience. These findings illustrate the importance of caregiving behaviors for promoting resilience among a particularly vulnerable population.

Effectiveness of a government-led, multiarm intervention on early childhood development and caregiver mental health: a study protocol for a factorial cluster-randomised trial in rural China

INTRODUCTION

The high incidences of both the developmental delay among young children and the mental health problems of their caregivers are major threats to public health in low-income and middle-income countries. Parental training interventions during early childhood have been shown to benefit early development, yet evidence on strategies to promote caregiver mental health remains limited. In addition, evidence on the optimal design of scalable interventions that integrate early child development and maternal mental health components is scarce.

METHODS AND ANALYSIS

We design a single-blind, factorial, cluster-randomised controlled, superiority trial that will be delivered and supervised by local agents of the All China Women's Federation (ACWF), the nationwide, government-sponsored social protection organisation that aims to safeguard the rights and interests of women and children. We randomise 125 villages in rural China into four arms: (1) a parenting stimulation arm; (2) a caregiver mental health arm; (3) a combined parenting stimulation and caregiver mental health arm and (4) a pure control arm. Caregivers and their children (aged 6-24 months at the time of baseline data collection) are selected and invited to participate in the 12-month-long study. The parenting stimulation intervention consists of weekly, one-on-one training sessions that follow a loose adaptation of the Reach Up and Learn curriculum. The caregiver mental health intervention is comprised of fortnightly group activities based on an adaptation of the Thinking Healthy curriculum from the WHO. Primary outcomes include measures of child development and caregiver mental health. Secondary outcomes include a comprehensive set of physical, psychological and behavioural outcomes. This protocol describes the design and evaluation plan for this programme.

ETHICS AND DISSEMINATION

This study received approval from the Institutional Review Board of Stanford University (IRB Protocol #63680) and the Institutional Review Board of the Southwestern University of Finance and Economics in Chengdu, Sichuan, China. Informed oral consent will be obtained from all caregivers for their own and their child's participation in the study. The full protocol will be publicly available in an open-access format. The study findings will be published in economics, medical and public health journals, as well as Chinese or English policy briefs.

TRIAL REGISTRATION NUMBER

AEA RCT Registry (AEARCTR-0010078) and ISRCTN registry (ISRCTN84864201).

Early-life adversity is associated with poor iron status in infancy

Exposure to early-life adversity (ELA) and iron deficiency early in life are known risk factors for suboptimal brain and socioemotional development. Iron deficiency may arise from and co-occur with ELA, which could negatively affect development. In the present study, we investigated whether ELA is associated with iron deficiency in infants receiving no iron supplementation. This study is a secondary analysis of extant data collected in the 1990s; participants were healthy infants from working-class communities in Santiago, Chile (N = 534, 45.5% female). We measured stressful life events, maternal depression, and low home support for child development during infancy and assessed iron status when the infant was 12 months old. Slightly more than half of the infants were iron-deficient (51%), and 25.8% were iron-deficient anemic at 12 months. Results indicated that ELA was associated with lower iron levels and iron deficiency at 12 months. The findings are consistent with animal and human prenatal models of stress and iron status and provide evidence of the association between postnatal ELA and iron status in humans. The findings also highlight a nutritional pathway by which ELA may impact development and present a nutritionally-focused avenue for future research on ELA and psychopathology.

Validation of the StimQ2: A parent-report measure of cognitive stimulation in the home

Considerable evidence demonstrates the importance of the cognitive home environment in supporting children's language, cognition, and school readiness more broadly. This is particularly important for children from low-income backgrounds, as cognitive stimulation is a key area of resilience that mediates the impact of poverty on child development. Researchers and clinicians have therefore highlighted the need to quantify cognitive stimulation; however existing methodological approaches frequently utilize home visits and/or labor-intensive observations and coding. Here, we examined the reliability and validity of the StimQ2, a parent-report measure of the cognitive home environment that can be delivered efficiently and at low cost. StimQ2 improves upon earlier versions of the instrument by removing outdated items, assessing additional domains of cognitive stimulation and providing new scoring systems. Findings suggest that the StimQ2 is a reliable and valid measure of the cognitive home environment for children from infancy through the preschool period.

Home environment factors associated with early childhood development in rural areas of Bangladesh: evidence from a national survey

Background

Knowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4  years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4  years.

Methods

We used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4  years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally "on track".

Results

The findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children's activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08-1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09-1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4  years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts.

Conclusion

Home environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study's findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context.

Predictive validity of a parental questionnaire for identifying children with developmental language disorders

Background

The underdiagnosis of developmental language disorder (DLD) in children is a serious problem in developing countries with limited resources. It has long been noted that the concerns parents have about their children's health and development are richly informative, and if this information can be used for diagnosis, it may provide a means to address the problem of underdiagnosis of DLD. This study aimed to quantify the utility of parental linguistic concern questions (PLCQ) on the identification of language disorders in monolingual Spanish-speaking children in Mexico. It also explored whether a combination of biological and environmental conditions questions (BECQ) might improve the performance of a screening test to identify DLD.

Methods

A total of 680 monolingual Mexican Spanish-speaking children and their parents from urban areas in Mexico participated in the study. The distribution of responses to questions about DLD concerns was compared between 185 children diagnosed with DLD and 495 control subjects, and multiple logistic regression analysis was performed to select questions with high predictivity, based on the Akaike information criterion. The diagnostic utility of the questions was assessed by receiver operating characteristic (ROC) curves, stratum-specific likelihood ratios (SSLRs), and changes in pretest and post-test probabilities of DLD. A similar procedure was used to explore whether adding BECQ would improve the diagnostic utility of questions about DLD concerns using data of 128 children.

Results

Four questions regarding parental linguistic concerns were found to be useful in identifying children with DLD. When all four concerns were present, the SSLR was 8.79, while it was only 0.27 when there were no concerns at all. The estimates of DLD probability increased from 0.12 to 0.55 at pretest and post-test. On the other hand, the BECQ did not perform as well as the PLCQ in identifying DLD, and the improvement in diagnostic performance it provided was limited to one question.

Conclusion

The parental questionnaire can be used as a screening tool to help in identifying children with DLD. The data presented in this study underscore the importance of considering linguistic parental concerns as part of the screening process. This is a realistic option to provide a solution to the current problem of underdiagnosis of DLD in Mexico.

Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance.

Effectiveness of an integrated multilevel early child development intervention on caregiver knowledge and behavior: a quasi-experimental evaluation of the Malezi program in Tanzania

BACKGROUND

The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.

METHODS

This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0-24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF's Care for Child Development package, used ECD videos in home- and facility-based sessions with caregivers. We used McNemar's testing (pre-post pairs) within intervention group to describe how the intervention was associated with change in five outcomes: ECD knowledge, early stimulation, father engagement, responsive care, and environment safety. Logistic regression was used to describe the relative benefits of the combined intervention package (RMV-ECD) compared to radio messaging (RM).

RESULTS

In the RMV-ECD arm, all outcomes at endline except environment safety significantly improved after the intervention with the largest change seen in ECD knowledge (35.8% increase, p < .0001) and the smallest in father engagement (6.7%, p = .015). In the RM arm, ECD knowledge (5.7%, p = .031) and environment safety (18.1%, p = <.0001) improved. High measures of parenting stress were associated with lower likelihood of having good ECD knowledge (AOR 0.50, 95%CI: 0.35, 0.71), father engagement (AOR 0.72, 95%CI: 0.52, 0.99) and responsive care (AOR 0.31, 95%CI: 0.18, 0.54).

CONCLUSIONS

An intervention that includes mass media, educational video content and CHWs who counsel caregivers in their homes and health facilities was associated with significant improvements in ECD parenting knowledge and behaviors but a relationship with responsive care could not be established. The less costly mass media-only intervention was associated with improved parenting knowledge and household environment safety. Parenting interventions targeting young children could be improved by incorporating more messaging and caregiver coaching in managing parental stress.

TRIAL REGISTRATION

NCT05244161 (17/02/2022); retrospectively registered with the US National Institutes of Health ClinicalTrials.gov.

Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda

Background

Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda.

Methods

The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months.

Conclusion

Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [NCT053 68714].

The effect of ECD program on the caregiver's parenting knowledge, attitudes, and practices: based on a cluster-randomized controlled trial in economically vulnerable areas of China

BACKGROUND

The first three years of life are the critical and sensitive periods for the formation of individual abilities. However, existing data indicates that early childhood development (ECD) in economically vulnerable areas of China is lagging, which is closely related to the lack of parenting knowledge and poor parenting practices.

METHODS

We conducted a non-masked cluster-randomized controlled trial in a former nationally designated poverty county of China. All 6-36-month-old children and their caregivers living in 18 communities/clusters (10 towns and 8 districts of the county seat) were enrolled in a 9-month parenting training program. In the treatment-group communities, ECD centers were installed where community workers provided parenting training sessions. If caregivers were unable to visit the center, home-based parenting training was offered. No intervention was provided to the control group. Furthermore, we assigned half of the treatment group to receive monthly developmental feedback in addition to the parenting training. Based on the baseline and follow-up data, we investigated the treatment effects on parenting knowledge, attitudes, and practices through Intention-to-Treat (ITT) and Treatment-on-the-Treated (TOT) analyses.

RESULTS

We found no effects on the parenting knowledge and attitudes of the caregivers but significant effects on the parenting practices. The effects were heterogeneous among families with different characteristics. Specifically, on average, the program had the largest effect on internally oriented caregivers, mothers with higher education, and mothers who are primary caregivers. We want to emphasize that, although the ITT effect on parenting practices (the average treatment effect) were stronger for mothers with higher education, the TOT effect on parenting practices (the local average treatment effect, LATE) were stronger for mothers with less education. That is, even though on average the program helped mothers with higher education, but among complier families, the program benefited mothers with less education.

CONCLUSION

The findings indicate that, at least in the short run, the program can directly change caregivers' parenting practices without changing their knowledge and attitudes. Future studies are needed to investigate whether parenting knowledge and attitudes can change in the long run.

Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District

Background

Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana.

Objectives

Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243).

Methods

A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates.

Results

Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women.

Conclusions

Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members.The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy.

Effectiveness of family-centered program for enhancing competencies of responsive parenting among caregivers for early childhood development in rural India

BACKGROUND

Responsive parenting constitutes an essential part of the context in which children live and has shown a positive effect on child development in the early years of life.

AIMS

This study aimed to assess the effectiveness of family parenting programs for enhancing competencies of responsive parenting among caregivers.

STUDY DESIGN

Cluster-RCT in 50 Anganwadi center areas. Twenty-five intervention clusters received responsive parenting intervention. Anganwadi workers delivered sessions after support and training.

SUBJECTS

We enrolled 530 mother-child dyads; 264 (49.9 %) from the intervention arm and 266 (50.1 %) from the control arm.

OUTCOME MEASURES

We assessed caregivers' knowledge and skills about child development using a parenting quiz. We evaluated the effect of an intervention on the home environment, mother-child interaction, and development outcomes at the endpoint.

RESULTS

We conducted 200 parenting sessions in 25 intervention clusters. Caregivers attended, on average, five sessions out of the nine scheduled. Caregivers with improved knowledge and skills about nutrition, shelter & care, play & stimulation for responsive parenting were significantly more in the intervention than in the control arm (p < 0.05). Mean difference in scores of home environment (1.24; SE-0.75 & ICC-0.088) and mother to child interaction (2.36; SE-0.87 & ICC-0.023) motor development (1.71; SE-0.61 & ICC-0.002), language development (2.97; SE-0.85 & ICC-0.002) and socioemotional development (1.45; SE-0.56 & ICC-0.066) between intervention and control arm was statistically significant (p < 0.05).

CONCLUSIONS

A locally adapted, family parenting curriculum was a practical approach for enhancing parents' competencies and confidence to promote early child development.

Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial

BACKGROUND

Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students' mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale.

OBJECTIVES

This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students.

METHODS

Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers' use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness.

DISCUSSION

This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children's mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327 ) on May13, 2020.

Exploring protective and risk factors in the home environment in high-risk families - results from the Danish High Risk and Resilience Study-VIA 7

BACKGROUND

Exposure to inadequate home environment may put the healthy development of familial high-risk children at risk. This study aimed to investigate associations between risk factors and an adequate home environment of children having a parent diagnosed with schizophrenia or bipolar disorder.

METHODS

From a cohort of 522 children, data from 463 7-year-old children was included. Of these 172 children had familial risk for schizophrenia, 109 children had familial risk for bipolar disorder, and 190 were population-based controls. As part of a comprehensive battery, all participants were assessed with the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory) measuring the quality of the home environment.

RESULTS

When analyzing all families together, we found that having a parent diagnosed with schizophrenia would have a negative impact on the home environment (ß = -1.08; 95% CI (-2.16;-0.01); p = 0.05), while familial risk for bipolar disorder did not show significant predictive value. Being a single caregiver and child having experienced severe life events from ages 4 to 7 showed significant negative impact, while child having a mental illness diagnosis did not. Being a female caregiver, good social functioning of the caregiver, high child IQ and not being a single caregiver were found to predict positive values for the home environment. We found similar results when analyzing caregivers with and without a diagnosis separately.

CONCLUSIONS

Knowledge of what predicts good home environment should be used to inform development of early interventions for families at risk.

Development and Construct Validation of a Questionnaire for Measuring Affordances for Motor Behavior of Schoolchildren

Environments where children move about provide affordances that play a significant role in their development. This research presents the Affordances for Motor Behavior of Schoolchildren assessment tool, which aims to assess the interdependent systems, such as home, school, and sports activities, that can influence 6- to 10-year-old children’s motor development, motor learning, and motor competence. After establishing face validity, 259 south Brazilian families completed the questionnaire. We assessed construct validity on the whole sample with confirmatory factor analysis. The model testing showed a very good fit, and the structural model presented significative loading coefficients from the identified variables to the theoretically specified latent variables (factors). Significant correlation values were found between factors: home and materials (r = .77), home and school (r = .41), and materials and school (r = .56). Our results suggest that the Affordances for Motor Behavior of Schoolchildren can assess the opportunities for action provided to children by their home, the materials in it, and their school.

Home Environment and Early Development of Rural Children: Evidence from Guizhou Province in China

Delays in early child development are among the aspects underlying the persistent developmental gaps between regions and social strata. This study seeks to examine the relationship between the home environment and early child development in less-developed rural areas by drawing on data from 445 children from villages in Guizhou province in southwest China. A demographic questionnaire, the Home Observation Measurement of the Environment (HOME), and the Bayley Scales of Infant Development, version III (BSID-III), were used to measure the child’s demographic characteristics, home environment, and early development outcomes, respectively. Our data show that the sample children suffer a delay in various dimensions of child development and a deficit in the HOME scale. The results from a hierarchical regression model suggest that the availability of learning material at home, caregivers’ responsiveness and organization sub-scales are significantly positively correlated with the early development of sample children, after controlling for general socioeconomic status, health, and nutrition, and this correlation differs by gender. These results imply that the provision of learning material to households, promoting caregivers’ responsiveness and organization in less-developed rural areas could improve early child development among deprived children.

An Implementation Evaluation of A Group-Based Parenting Intervention to Promote Early Childhood Development in Rural Kenya

Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora ("Good Foundation" in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558.

Home environment: Short-term trends and predictors in early childhood from an Indian community birth cohort

BACKGROUND

Early childhood home environment is intricately linked to child development and later cognitive and academic skills. There is limited literature evaluating home environmental trends and predictors in the low- and middle-income country settings.

AIMS

Determine the trends of early childhood home environment changes between 6 and 36 months of age, and the factors associated with these changes.

STUDY DESIGN

Longitudinal community-based birth cohort follow-up study in a semi-urban slum in Vellore, South India.

SUBJECTS

Consecutive sampling of a birth cohort between March 2010 and February 2012.

OUTCOME MEASURES

Home environment was objectively assessed using the 'Home Observation for the Measurement of the Environment' (HOME) scale. Predictors of change in the home environment over time also were analyzed. Multivariable linear regression models and linear mixed effect models were used to identify the factors associated with HOME score at individual time points and over-a-time period, respectively.

RESULTS

The birth cohort enrolled 251 children with a follow-up of 235, 228 and 218 children at 6, 24 and 36 months, respectively. The socio-economic status (SES) was the single biggest predictor for the HOME score at each time point, with increasing strength over time. Maternal education predicted home environment at 24 months, while maternal depression was negatively associated at 6 and 24 months of age. SES and maternal factors contributed to the overall change in the HOME score. Maternal factors predicted relational home environmental change over time.

CONCLUSION

SES and maternal factors consistently predicted early childhood home environment at 6, 24 and 36 months of age and its change over time. It is important to support maternal education and wellbeing along with socio-economic measures to optimize early childhood environment.

Assessing the play and learning environments of children under two years in peri-urban Lima, Peru: a formative research study

BACKGROUND

Home-based interventions have potential for improving early child development (ECD) in low-resource settings. The design of locally acceptable strategies requires an in-depth understanding of the household context. In this formative research study, we aimed to characterize the home play and learning environments of children 6-23 months of age from low-income households in peri-urban Lima, Peru.

METHODS

Drawing on the developmental niche framework, we used quantitative and qualitative methods to understand children's physical and social settings, childcare practices, and caregiver perspectives. We conducted interviews, unstructured video-recorded observations, and spot-checks with 30 randomly selected caregiver-child dyads, 10 from each child age group of 6-11, 12-17, and 18-23 months of age, as well as key informant interviews with 12 daycare instructors. We analyzed the data for key trends and themes using Stata and ATLAS.ti and employed an adapted version of the Indicator of Parent-Child Interaction to evaluate the observations.

RESULTS

Children's social settings were characterized by multi-generational homes and the presence of siblings and cousins as play partners. Access to books and complex hand-eye coordination toys (e.g., puzzles, building blocks) in the home was limited (30.0 and 40.0%, respectively). Caregivers generally demonstrated low or inconsistent levels of interaction with their children; they rarely communicated using descriptive language or introduced novel, stimulating activities during play. Reading and telling stories to children were uncommon, yet 93.3% of caregivers reported singing to children daily. On average, caregivers ascribed a high learning value to reading books and playing with electronic toys (rated 9.7 and 9.1 out of 10, respectively), and perceived playing with everyday objects in the home as less beneficial (rated 6.8/10). Daycare instructors reinforced the problems posed by limited caregiver-child interaction and supported the use of songs for promoting ECD.

CONCLUSIONS

The features of the home learning environments highlighted here indicate several opportunities for intervention development to improve ECD. These include encouraging caregivers to communicate with children using full sentences and enhancing the use of everyday objects as toys. There is also great potential for leveraging song and music to encourage responsive caregiver-child interactions within the home setting.

A Systematic Overview of Meta-Analyses on Socioeconomic Status, Cognitive Ability, and Achievement: The Need to Focus on Specific Pathways

Meta-analyses on the relation between socioeconomic status (SES) and performance on measures of cognitive ability and achievement arrive at the same general conclusion of a small to medium association. Advancements in methods make possible for meta-analyses to examine specific pathways linking SES to cognitive ability and achievement, as well as the moderators of these pathways. In this study, we conducted a systematic overview of meta-analyses on SES to address three research questions: 1) what is the direction and overall strength of association between SES and performance on measures of cognitive ability and achievement, and how precise are the effect sizes reported? 2) to what extent have meta-analyses examined moderation by components of SES, age, sex, and race/ethnicity? and 3) to what extent have meta-analyses examined mechanisms linking SES to cognitive ability and achievement? We conducted a systematic search using online archives (i.e., PsycINFO, ERIC, PubMed, Sociological Abstracts, and Web of Science), searching issues in Psychological Bulletin and Review of Educational Research, and examining references and citations. We identified 14 meta-analyses published between 1982 and 2019. These meta-analyses consistently reported positive associations of small to medium magnitude, indicating that SES is a meaningful contributor to the development of cognitive ability and achievement. Fewer meta-analyses reported evidence of moderation by age, sex, and race/ethnicity. None of the meta-analyses directly examined mechanisms, but provided evidence of possible mechanisms for future research. We suggest that meta-analyses can increase their contribution to future research, interventions, and policy by narrowing their focus on specific pathways.

A complementary feeding and play intervention improves the home environment and mental development among toddlers in rural India

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants (n = 521) were assessed for development (Bayley-II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F(2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales 'Opportunities for Variety in Daily Stimulation' and 'Caregiver Promotion of Child Development' (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F(2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group (P < 0.04); no differences were noted in psychomotor development index (PDI) scores (P = 0.48). The subscales of HOME associated with MDI at 15 months were 'CPCD' and 'Cleanliness of Child' (R2 = 0.076). 'CPCD' was also associated with PDI (R2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months.

Children with Developmental Disabilities in Low- and Middle-Income Countries: More Neglected and Physically Punished

Little is known about parenting in the context of developmental disabilities in low- and middle-income countries (LMIC), penalized by both lack of data and a research bias toward western societies. In this study, we apply data mining methods on a large (N = 25,048) dataset from UNICEF to highlight patterns of association between developmental disabilities of children and parental involvement. We focus on the co-presence of multiple disabilities and the quality of childcare in three parenting domains: discipline, caregiving, and education. Our results show that, in LMIC, children with more severe developmental conditions are also more likely to receive low-quality parental care. Specific policies of parental training are needed to improve parental practices in LMIC.

Early Life Experiences and Trajectories of Cognitive Development

BACKGROUND

Multiple factors constrain the trajectories of child cognitive development, but the drivers that differentiate the trajectories are unknown. We examine how multiple early life experiences differentiate patterns of cognitive development over the first 5 years of life in low-and middle-income settings.

METHODS

Cognitive development of 835 children from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite observational cohort study was assessed at 6, 15, 24 (Bayley Scales of Infant and Toddler Development), and 60 months (Wechsler Preschool and Primary Scale of Intelligence). Markers of socioeconomic status, infection, illness, dietary intake and status, anthropometry, and maternal factors were also assessed. Trajectories of development were determined by latent class-mixed models, and factors associated with class membership were examined by discriminant analysis.

RESULTS

Five trajectory groups of cognitive development are described. The variables that best discriminated between trajectories included presence of stimulating and learning resources in the home, emotional or verbal responsivity of caregiver and the safety of the home environment (especially at 24 and 60 months), proportion of days (0-24 months) for which the child had diarrhea, acute lower respiratory infection, fever or vomiting, maternal reasoning ability, mean nutrient densities of zinc and phytate, and total energy from complementary foods (9-24 months).

CONCLUSIONS

A supporting and nurturing environment was the variable most strongly differentiating the most and least preferable trajectories of cognitive development. In addition, a higher quality diet promoted cognitive development while prolonged illness was indicative of less favorable patterns of development.

Examining the role of socioeconomic status and temperament in the hair cortisol levels of infants

Socioeconomic status (SES) appears to be an important contextual factor in children's developmental outcomes, including their responses to stress. However, some children are more susceptible to its effects than others. Hair cortisol is a newer method of assessing the activity of the HPA axis, providing cumulative cortisol levels. The present article examined whether temperament (negative emotionality) moderates the association between an SES index and the hair cortisol concentration (HCC) of infants. Sixty infants from 6 to 15 months of age were recruited, of which 49 had sufficient hair for cortisol analysis. The SES index was calculated from the education levels of the mothers, family income, and a scale measuring the quality of the home environment. Negative emotionality was measured with the three sub-scales of the Infant Behavior Questionnaire (falling reactivity, distress to limitations, and fear). Among infants low in negative emotionality, there was no association between SES and cortisol. In contrast, among those high in negative emotionality, a significant association was obtained. These infants showed lower levels of HCC in lower-SES environments. The findings suggest that there are individual differences in reacting to the environment, and low levels of cortisol (not high) were found in susceptible infants in lower-SES families.

The Interrelationships between Parental Migration, Home Environment, and Early Child Development in Rural China: A Cross-Sectional Study

A growing body of literature is providing evidence of a negative association between parental migration and child development. Meanwhile, the chain of relationships between parental migration, home environment, and early child development has not yet been well documented in China. This paper investigates the interrelationships between parental migration, home environment, and early child development in an undeveloped area of western rural China. In total, 444 households were included in the study. Bayley Scales of Infant Development version III (BSID-III), Home Observation Measurement of the Environment (HOME), and a socioeconomic questionnaire, were used to measure children’s development outcomes, home environment, and socioeconomic characteristics in sample households. A mediation effect model was used to estimate the interrelationships between parental migration, home environment, and child development. The results demonstrate that home environment works as a significant mediator, through which parental migration is associated with a 0.07 standard deviation (SD), 0.13 SD, 0.12 SD, and 0.10 SD decline in the child’s cognitive, language, motor, and social-emotional scores, respectively. For future studies, the key findings suggest that interventions aimed at improving the home environments of left-behind children might be necessary in rural China.

Vitamin B12, Folate, and Cognition in 6- to 9-Year-Olds: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Vitamin B₁₂ and folate are important for normal brain development. Our objective for this study was to measure the effects of 6-month supplementation of vitamin B₁₂ and/or folic acid in early childhood on cognition when the children were 6 to 9 years old.

METHODS

The study is a follow-up of a factorial randomized, double-blind, placebo-controlled trial in 1000 North Indian children. Children 6 to 30 months of age were randomly assigned to receive a placebo or 1.8 µg of vitamin B₁₂, 150 mg of folic acid, or both daily for 6 months. After 6 years, we re-enrolled 791 of these children for cognitive assessments. We compared the scores of the main outcomes (the Wechsler Intelligence Scale for Children, Fourth Edition [India], the Crichton Verbal Scale, and subtests of the NEPSY-II) between the study groups. We also measured the associations between markers of the B vitamins (plasma cobalamin, folate, and total homocysteine concentrations) in early childhood and the cognitive outcomes.

RESULTS

There were no differences between the intervention groups and the placebo group on the cognitive outcomes. Plasma cobalamin, folate, and total homocysteine concentrations in early childhood were associated with the cognitive outcomes at follow-up in the unadjusted models. These associations disappeared in models adjusted for relevant confounders.

CONCLUSIONS

Our findings, from both an observational and a randomized design suggest that vitamin B₁₂ and folate in children 6 to 36 months have limited public health relevance for long-term cognition.

Revision and validation of a short scale to assess home environment for elementary school children in transnational families in Taiwan

PURPOSE

To develop and test a brief scale of the home environment of elementary school children in transnational families or vulnerable families.

DESIGN AND METHODS

The scale development process took place in three phases. In the first phase, a 61-item scale was generated by an expert panel based upon related literature and Chinese Home Observation for Measurement of the Environment (C-HOME). In the second phase 15 individual transnational families with elementary school children were interviewed, and items were reduced from 61 to 55 due to understandability or other practical considerations. Phase three's item analysis with 200 such families, reduced items to 41. Factor analysis followed, further reducing items to 27. Finally, the resulting 27-item scale underwent a test-retest with 57 subsample participants.

RESULTS

An iterative process of item and factor analyses identified a seven-dimensional, 27-item Home Environment Assessment Scale (HEAS), which accounted for 52.28% of the total variance. K-R 20 was 0.76. The test-retest reliability for the full sample total score was 0.97.

CONCLUSIONS

The results provide evidence supporting the scale consistency, content validity, and construct validity, and offer a useful instrument for health care professionals, especially pediatric nurses, to identify home environment interventions for young children in vulnerable families.

PRACTICE IMPLICATIONS

The findings of HEAS-27 can serve to guide pediatric health care professionals in promptly screening, evaluating, and teaching families so that children in a vulnerable population have adequate quality and quantity of support in the home environment.

Effect of Infant Iron Deficiency on Children's Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness

BACKGROUND

Infants who are iron-deficient anemic seek and receive less stimulation from their caregivers, predisposing such children to be functionally isolated.

OBJECTIVES

To test the sequence whereby iron deficiency in infancy contributes to children's disengagement from the environment, which reduces parent stimulation which, in turn, contributes to children's poor verbal skills.

METHODS

Chilean children (N = 875, 54% male) were studied, 45% of whom were iron deficient or iron-deficient anemic in infancy. We used structural equation modeling to test the sequence outlined above and to examine the effect of infant iron status on children's verbal performance at ages 5 and 10 years including the roles of child and parent intermediate variables.

RESULTS

Severity of iron deficiency in infancy was associated with higher levels of children's dull affect and social reticence at 5 years (β = .10, B = .26, SE = .12, p < .05), and these behaviors were associated with parent unresponsiveness (β = .29, B = .13, SE = .03, p < .001), which related to children's lower verbal abilities at age 5 (β = - .29, B = - 2.33, SE = .47, p < .001) and age 10 (β = - .22, B = - 3.04, SE = .75, p < .001). An alternate model where poor iron status related directly to children's verbal ability was tested but not supported.

CONCLUSIONS

Findings support functional isolation processes resulting from a nutritional deficiency, with iron-deficient anemic infants showing affective and behavioral tendencies that limit developmentally stimulating caregiving which, in turn, hinder children's verbal abilities.

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.

A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.

Home visits in the Danish High Risk and Resilience Study - VIA 7: assessment of the home environment of 508 7-year-old children born to parents diagnosed with schizophrenia or bipolar disorder

OBJECTIVE

The home environment provided by the caregivers of a child is an influential single factor for development and well-being. We aimed to compare the quality of the home environment of children at familial high risk of schizophrenia or bipolar disorder with population-based controls.

METHODS

Danish nationwide registers were used to retrieve a cohort of 522 7-year-old children of parents diagnosed with schizophrenia (N = 202), bipolar disorder (N = 120) or none of these diagnoses (N = 200). The home environment was assessed using the Middle Childhood-Home Observation for Measurement of the Environment Inventory (MC-HOME Inventory).

RESULTS

The proportion of children living in home environments that were evaluated not to meet the needs of a 7-year-old child was significantly larger in the two familial high-risk groups. This was true for 21% of the children with familial predisposition for schizophrenia and 7% of children with familial disposition for bipolar disorder.

CONCLUSION

Children born to parents diagnosed with schizophrenia and to a lesser extent bipolar disorder are at an increased risk of growing up in a home environment with an insufficient level of stimulation and support. Identifying families with inadequate home environments is a necessary step towards specialized help and support to at-risk families.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language

OBJECTIVE

To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial).

METHODS

The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations).

RESULTS

The mean age of the children was 9±6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value<0.001, and correlation between items and domains showed a p-value<0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p<0.01.

CONCLUSIONS

The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties.

Adaptation of the Mullen Scales of Early Learning for use among infants aged 5- to 24-months in rural Gambia

Infants in low‐resource settings are at heightened risk for compromised cognitive development due to a multitude of environmental insults in their surroundings. However, the onset of adverse outcomes and trajectory of cognitive development in these settings is not well understood. The aims of the present study were to adapt the Mullen Scales of Early Learning (MSEL) for use with infants in a rural area of The Gambia, to examine cognitive development in the first 24‐months of life and to assess the association between cognitive performance and physical growth. In Phase 1 of this study, the adapted MSEL was tested on 52 infants aged 9‐ to 24‐months (some of whom were tested longitudinally at two time points). Further optimization and training were undertaken and Phase 2 of the study was conducted, where the original measures were administered to 119 newly recruited infants aged 5‐ to 24‐months. Infant length, weight and head circumference were measured concurrently in both phases. Participants from both phases were split into age categories of 5–9 m (N = 32), 10–14 m (N = 92), 15–19 m (N = 53) and 20–24 m (N = 43) and performance was compared across age groups. From the ages of 10–14 m, Gambian infants obtained lower MSEL scores than US norms. Performance decreased with age and was lowest in the 20–24 m old group. Differential onsets of reduced performance were observed in the individual MSEL domains, with declines in visual perception and motor performance detected as early as at 10–14 months, while reduced language scores became evident after 15–19 months of age. Performance on the MSEL was significantly associated with measures of growth.

DYSFUNCTIONS IN THE SOCIO EMOTIONAL DEVELOPMENT OF INFANTS AND ITS RELATED FACTORS: AN INTEGRATIVE REVIEW

ABSTRACT Objective: to synthesize factors related to dysfunctions in the socioemotional development of infants. Method: integrative review carried out between April and August 2016 with defined criteria for inclusion and exclusion of studies, search strategies, extraction and synthesis of data. The exposure factors underwent categorical thematic analysis and systematization according to the levels of the context (Microsystem, Mesosystem, Exosystem and Macrosystem) of the Bioecological Model of Human Development. Results: in the context of the Microsystem and Mesosystem, the factors found were: limitations in care; adversities in family relationships and in the social support and illness situation of the caregivers that influence the proximal processes. In the Exosystem and the Macrosystem, they were: social vulnerabilities of caregivers and fragilities of public policies that determine the material and social conditions of the family. Conclusion: the synthesis of evidence on exposure factors favors the construction of measurement scales of the contextual elements related to the social emotional development of young children. Beyond the milestones, present or not, in the evaluation of a child, these technologies can be predictive, with great potential of anticipation of the factors of exposure and prevention of developmental dysfunctions.

Physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers: A modest role of ethnicity

Mapuche represents the largest indigenous group in Chile amounting to nearly 10% of the total population. In a longitudinal cohort of 12,398 children, we analyzed the role of ethnicity in physical and psychosocial development of Mapuche and nonindigenous Chilean toddlers (age 2.5 years), taking into account sociodemographic and caregiver characteristics. As indicated by our univariate analysis, the Mapuche developmental niche was characterized by lower income, lower maternal education, poorer quality of the home environment, longer breastfeeding, and higher parental stress. Physical development showed higher body mass index. Mapuche children showed less externalizing problems. We then analyzed the incremental contribution of ethnicity in a series of hierarchical regressions with the second wave of developmental measurements (age 4.5 years) as outcome variables, showing a significant but modest incremental contribution of ethnicity to the prediction of children's development between 2.5 and 4.5 years of age. Controlling for environmental variables, Mapuche showed less externalizing and internalizing, behavior problems. Socioeconomic status, quality of the home environment, and parenting stress were stronger predictors of socioemotional development than ethnicity per se.

Resources for nurturing childcare practices in urban and rural settings: Findings from the Colombia 2010 Demographic and Health Survey

BACKGROUND

The health and development potential of young children is dependent on nurturing care (NC) provided by primary caregivers. NC encompasses attention to nutrition; symptom management; early learning, attachment, and socialization; and security and safety. Despite the importance of NC to child health and development, the measurement and study of NC are neglected. This has become a point of major concern in the public health field in low- and middle-income countries (LMICs) such as Colombia where many families are hard pressed for childcare resources. The aims of this study were therefore to (a) create age-specific NC summary indexes (0-5, 6-11, and 12-23 months) suitable for research in LMICs and (2) examine the relationship of NC to maternal resources.

METHODS

2010 Colombia Demographic and Health Survey data were obtained from mothers and their children ages 0-5 months (n = 1,357); 6-11 months (n = 1,623); and 12-23 months (n = 3,006). Age-specific NC indexes were created including information on child feeding, immunization, hygiene, response to illness symptoms, and psychosocial care. Independent variables included mother's education level and household assets, and enrolment in a government child development programme. Regression analyses with NC as the outcome variable were conducted with urban and rural subsamples in the 3 age groups.

RESULTS

Among rural children, NC was significantly higher with greater household assets, maternal decision latitude, and development programme participation, with variation by child age. Among urban children, higher maternal education and white-collar occupation also predicted higher NC, with some variation by age.

CONCLUSION

It is feasible to measure age-specific NC in survey research, and NC is related to maternal resources. Age and urban-rural differences in how NC is related to social factors are observed. The findings support the importance of subgroup analysis in the study of NC in LMICs such as Colombia.

Intimate Partner Violence, Depression, and Child Growth and Development

BACKGROUND

Evidence on the relationship between maternal depression and exposure to intimate partner violence (IPV) with child physical growth and development is equivocal. Our aim in the current study is to examine these relationships among women and their children in Tanzania.

METHODS

The Bayley Scales of Infant Development and anthropometric measures were used to assess children 18 to 36 months of age (n = 1031). Maternal exposure to IPV and depression were assessed using the Tanzania Demographic and Health Survey questionnaire and the Patient Health Questionnaire-9, respectively. We used linear regression models to calculate standardized mean differences (SMDs) for developmental outcomes and generalized linear models to estimate the associations with nutritional status.

RESULTS

Mild depressive symptoms in mothers (Patient Health Questionnaire-9 ≥5) and exposure to physical and sexual IPV were associated with lower SMDs for motor skills (-0.14 [P = .023] and -0.23 [P < .01], respectively), expressive communication (-0.13 [P = .187] and -0.23 [P < .01], respectively), receptive communication (-0.19 [P < .009] and -0.16 [P = .03], respectively), and cognitive development (-0.08 [P = .245] and -0.12 [P = .07], respectively). Exposure to physical and sexual IPV was associated with higher risk for stunting (relative risk = 1.6; P < .001).

CONCLUSIONS

This study reveals that maternal depressive symptoms and IPV are associated with adverse child nutritional and developmental outcomes. Further research is needed to develop programs to address IPV and depression among women and enhance the growth and development of their children.

The Influence of Maternal and Household Resources, and Parental Psychosocial Child Stimulation on Early Childhood Development: A Cross-Sectional Study of Children 36⁻59 Months in Honduras

Optimal early childhood development (ECD) is currently jeopardized for more than 250 million children under five in low- and middle-income countries. The Sustainable Development Goals has called for a renewed emphasis on children&rsquo;s wellbeing, encompassing a holistic approach that ensures nurturing care to facilitate optimal child development. In vulnerable contexts, the extent of a family&rsquo;s available resources can influence a child&rsquo;s potential of reaching its optimal development. Few studies have examined these relationships in low- and middle-income countries using nationally representative samples. The present paper explored the relationships between maternal and paternal psychosocial stimulation of the child as well as maternal and household resources and ECD among 2729 children 36⁻59 months old in Honduras. Data from the Demographic and Health Surveys conducted in 2011⁻2012 was used. Adjusted logistic regression analyses showed that maternal psychosocial stimulation was positively and significantly associated with ECD in the full, rural, and lowest wealth quintile samples. These findings underscore the importance of maternal engagement in facilitating ECD but also highlight the role of context when designing tailored interventions to improve ECD.

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.

Associations Among Mothers' Depression, Emotional and Learning-Material Support to Their Child, and Children's Cognitive Functioning: A 16-Year Longitudinal Study

This study examined the associations among maternal depression, mothers' emotional and material investment in their child, and children's cognitive functioning. Middle-class Chilean mothers and children (N = 875; 52% males) were studied when children were 1, 5, 10, and 16 years (1991-2007). Results indicated that highly depressed mothers provided less emotional and material support to their child across all ages, which related to children's lower IQ. Children with lower mental abilities at age 1 received less learning-material support at age 5, which led to mothers' higher depression at child age 10. Mothers' low support was more strongly linked to maternal depression as children got older. Findings elucidate the dynamic and enduring effects of depression on mothers' parenting and children's development.

Assessment of Maternal-Infant Interaction: Application of the Still Face Paradigm in a Rural Population of Working Women in Ecuador

Objectives The importance of mother-child interaction in early infancy on child development has been well documented. The purpose of this study was to assess the feasibility of using the Still Face Paradigm to measure mother interactive style, infant affect and emotional regulation in a rural Ecuador setting. Methods Infant's emotional regulation and the quality of mother's interaction were measured with the Still Face Paradigm at 4 months of age (±15 days). Twenty-four infants and their mothers were assessed in their home. Mother interactive style was coded for attention seeking and contingent responding. Emotional regulation was described by change in infant affect between Still Face episodes. Results A significant difference was found for infant affect between the five Still Face episodes (F_1,118 = 9.185, p = 0.003). A significant negative correlation was found for infant affect between episode 3 and 2 with attention seeking mother interactive style during episode 3 (rho = -0.44, p = 0.03), indicating that mothers using more contingent-responding interactions had infants with more positive affect. Conversely, a significant positive association was found for infant affect between episode 3 and 2 and contingent responding mother interactive style during episode 3 (rho = 0.46, p = 0.02), indicating that mothers who used more attention seeking play had infants who showed less positive affect. Conclusion for Practice Study results demonstrate feasibility in using the Still Face Paradigm in working populations residing in a rural region in Ecuadorian highlands and may be feasible in other similar populations in Latin America, and as a successful approach to measuring maternal-child interactions within a field-based epidemiological study design.

Introduction of iodised salt benefits infants’ mental development in a community-based cluster-randomised effectiveness trial in Ethiopia

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using mixed linear models adjusted for covariates and clusters. The trial was registered at ClinicalTrials.gov, NCT013496. We assessed 1835 infants aged 5–11 months at baseline. The same children (85 % of the sample) were re-assessed at 20–29 months when all villages had iodised salt. At endline, urinary iodine concentration was higher in children in the intervention group compared with those in the control group (median 228·0v. 155·1 µg/l,P=0·001). The intervention group had higher scores compared with the control group on the Bayley composite score (raw scores:130·60v. 128·51; standardised scores: 27·8v. 26·9;d=0·13; 95 % CI 0·02, 0·23) and three of the four subscales: cognitive (53·27v. 52·54,d=0·13; 95 % CI 0·03, 0·23), receptive language (20·71v. 20·18,d=0·13; 95 % CI 0·03, 0·24) and fine motor (35·45v. 34·94,d=0·15; 95 % CI 0·04, 0·25). The introduction of iodised salt contributes to children’s higher urinary iodine concentration and mental development.

Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia

Background

Factors influencing child development are not well studied in developing settings, and especially in Mongolia. This cohort study examined the relationship between maternal socio-demographic and psychological conditions on risk of young child developmental delay.

Methods

A total of 150 children aged between 13 ~ 24 months old participated in this study. The participants were randomly selected from a pre-existing cohort of 1297 children who were involved in a study on infant bilirubin nomogram development conducted at a tertiary health facility in Mongolia between 2012 and 2013. Child development was evaluated using the Mongolian Rapid Baby Scale (MORBAS), a validated scale for child development. The potential factors for child developmental delay were assessed using a pre-tested questionnaire comprising of 52 questions. Fisher’s exact test and multivariable logistic regression analysis were conducted.

Results

Seventeen (11%) out of the 150 children that participated in the study were at risk of developmental delay. There was a negative association between the risk of child developmental delay and higher maternal education (AOR 0.15, 95% CI: 0.03–0.66). Increasing maternal age (AOR 1.12, 95%CI: 0.98–1.27), maternal depression symptoms (AOR 4.93, 95%CI: 0.93–26.10), child gender being female (AOR 0.25, 95%CI: 0.06–1.00) and being from single mother household (AOR 0.14, 95%CI: 0.01–1.11) were also predictors for risk of developmental delay – although the association was marginal.

Conclusions

Our findings suggest that being of underprivileged social status, and poor psychological condition of mothers in Mongolia possibly increases the risk of child developmental delays. Interventions targeting these modifiable predictors are needed to develop prevention strategies for child developmental delay.

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.

Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (USA) in a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health professionals to Ugandan primary school teachers. It included large-group experiential training and small-group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model, and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and the use of EBPs were assessed at baseline and immediately post-intervention (4-5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and the use of EBPs in the classroom, and child social competence.

Vitamin-D status and neurodevelopment and growth in young north Indian children: a secondary data analysis

Background

Vitamin-D deficiency has been linked with impaired development in animal studies; however, the evidence from human studies is scanty. Evidence as to whether vitamin-D deficiency during early childhood affects growth is also limited and conflicting. We examined the extent to which vitamin-D deficiency (<10 ng/ml) is associated with neurodevelopment and physical growth in young children.

Methods

We used data from a randomized controlled trial (RCT) of daily folic acid and/ or vitamin B12 supplementation for six months in children aged 6 to 30 months conducted in Delhi, India. We measured vitamin-D status and  neurodevelopment by the Ages and Stages Questionnaire-3 (ASQ-3) at 12 to 36 months of age. Multiple logistic and linear regressions were used to examine the association between vitamin-D deficiency at baseline and neurodevelopment and growth 6 months follow-up.

Results

25-hydroxy-vitamin-D (25OHD) concentration was measured at baseline for 960 (96%) children. Of these, 331 (34.5%) children were vitamin-D deficient. The total and subscale (except for the Personal social scale) ASQ-3 scores, were not different between the vitamin-D deficient and non-deficient children. Vitamin-D deficiency was also not associated with physical growth at baseline and at follow -up.

Conclusion

Our data do not support the hypothesis that vitamin-D deficiency is associated with poor growth and neurodevelopment.

Trial registration

NCT00717730 and CTRI/2010/091/001090. Date of registration: 08 October, 2010