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Pandolfini C, Clavenna A, Campi R, Cartabia M, Finazzi S, Bonati M. Parental practices that influence children's development: how often are they implemented and by whom-results from the NASCITA birth cohort study. Eur J Pediatr 2024; 183:3029-3038. [PMID: 38644455 DOI: 10.1007/s00431-024-05564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/23/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024]
Abstract
This study aims to assess how commonly 15 parental practices, known to have positive effects on child and adult health, are carried out by families in Italy, if they are related, and which characteristics are associated with implementation. Children participating in the NASCITA Cohort, a prospective study in which family pediatricians in Italy collect data on children and their families, were included if they had sufficient data. Data on practice implementation, socio-demographic characteristics, and interrelatedness between practices were analyzed. In all, 3337 children were included. Their mothers had an average age at birth of 33 years (range 17-52) and medium-high levels of education (86% of mothers) and employment (72%). No smoking or alcohol in pregnancy, supine infant sleeping position, and tummy time were the most commonly implemented practices (by over 85% of mothers, each), while the least common was exclusive breastfeeding at 6 months (28%). Parental practices are related and several socio-demographic characteristics influence their implementation, with mother's educational level and geographic area of residence influencing most of the practices (each influencing 12 of 15 practices). Low educational level (OR 0.34; 95% CI 0.26-0.44), being born abroad (OR 0.43; 95% CI 0.34-0.56), and residing in the South (OR 0.49; 95% CI 0.41-0.58) most reduce the probability of implementing numerous supportive practices (all three P < 0.001). Conclusion: Socio-demographic factors contribute significantly to carrying out supportive practices. Future interventions should address the identified inequalities, prioritizing families most in need. Direct involvement of pediatricians is warranted given their favorable position for promoting positive behaviors. What is Known: • Several parental actions in the early life of a child are known to have positive effects on later child health and development. • While folic acid supplementation and exclusive breastfeeding have been promoted for years, other supporting actions are less well-known. What is New: • Rates of parental adherence to the different supportive actions varied greatly and actions were often scantly adopted. • Socio-demographic characteristics influenced adherence, with young, unemployed mothers with low educational levels, living in the South, or who were born abroad adhering significantly less.
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Affiliation(s)
- Chiara Pandolfini
- Laboratory of Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Antonio Clavenna
- Laboratory of Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Rita Campi
- Laboratory of Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Massimo Cartabia
- Laboratory of Geriatric Epidemiology, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Stefano Finazzi
- Laboratory of Clinical Data Science, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- Laboratory of Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
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Smith JA, Powell CA, Chang SM, Ganga E, Tanyanyiwa H, Walker SP. A cluster randomised controlled trial of an early childhood parenting programme delivered through early childhood education centres in rural Zimbabwe. Child Care Health Dev 2024; 50:e13189. [PMID: 37882173 DOI: 10.1111/cch.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Early childhood is a critical period for child development. Effective approaches to support families in low-resource settings in the use of responsive and stimulating parenting are needed. AIM The aim of this study was to examine the effects of the Reach Up early childhood parenting programme on children's development, parenting attitudes and practices, when delivered through early childhood development (ECD) centres in Zimbabwe. METHODS A cluster randomised controlled trial was conducted in Sanyati, a rural district in Zimbabwe. Twenty-four of 51 available centres were randomised to intervention (n = 12) or control (n = 12) groups. Sixteen mothers with a child aged 12-30 months were recruited from each centre's catchment area (n = 189 intervention; n = 193 control). The intervention comprised two home visits per month delivered by centre teaching assistants over a period of 27 months. Primary outcomes were child Developmental Quotient (DQ), Language, Eye and Hand coordination, Performance and Practical Reasoning subscale scores assessed at follow-up. Secondary outcomes were mothers' attitudes about child development, parenting practices and maternal depressive symptoms all measured at baseline and follow-up. Intention to treat analyses was conducted using mixed-effects regression models with the standard error adjusted for cluster and inverse proportionality weights to adjust for attrition. Significance was set at P < 0.05. RESULTS A total of 285 (74.6%) of 382 children enrolled were tested, with 97 children lost to follow-up. The intervention improved the children's DQ by 3.55 points (95% CI 0.82 to 6.28), Eye and Hand by 3.58 (95% CI 0.59 to 6.56) and Practical Reasoning by 4.19 (95% CI 0.96 to 7.42). No significant improvements to Performance or Language scores, parenting attitudes, parenting practices and depressive symptoms were identified. CONCLUSIONS A home visiting intervention delivered by ECD teaching assistants promoted children's development. This suggests that outreach from preschools may be an effective platform for delivery of parenting interventions.
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Affiliation(s)
- Joanne A Smith
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Christine A Powell
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Susan M Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Emily Ganga
- Robert Mugabe School of Education and Culture, Great Zimbabwe University, Masvingo, Zimbabwe
| | | | - Susan P Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
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Purgato M, Prina E, Ceccarelli C, Cadorin C, Abdulmalik JO, Amaddeo F, Arcari L, Churchill R, Jordans MJ, Lund C, Papola D, Uphoff E, van Ginneken N, Tol WA, Barbui C. Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries. Cochrane Database Syst Rev 2023; 10:CD014722. [PMID: 37873968 PMCID: PMC10594594 DOI: 10.1002/14651858.cd014722.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma. OBJECTIVES To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021. SELECTION CRITERIA Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs. DATA COLLECTION AND ANALYSIS Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2. MAIN RESULTS Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants). AUTHORS' CONCLUSIONS The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.
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Affiliation(s)
- Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy
| | | | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Rachel Churchill
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Jd Jordans
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Bulterys MA, Njuguna I, Mahy M, Gulaid LA, Powis KM, Wedderburn CJ, John-Stewart G. Neurodevelopment among children exposed to HIV and uninfected in sub-Saharan Africa. J Int AIDS Soc 2023; 26 Suppl 4:e26159. [PMID: 37909232 PMCID: PMC10618877 DOI: 10.1002/jia2.26159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/21/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION The population of 16 million children exposed to HIV and uninfected (CHEU) under 15 years of age continues to expand rapidly, and the estimated prevalence of CHEU exceeds 20% in several countries in sub-Saharan Africa with high HIV prevalence. Some evidence suggests that CHEU experience suboptimal neurodevelopmental outcomes compared to children born to women without HIV. In this commentary, we discuss the latest research on biologic and socio-behavioural factors associated with neurodevelopmental outcomes among CHEU. DISCUSSION Some but not all studies have noted that CHEU are at risk of poorer neurodevelopment across multiple cognitive domains, most notably in language and motor skills, in diverse settings, ages and using varied assessment tools. Foetal HIV exposure can adversely influence infant immune function, structural brain integrity and growth trajectories. Foetal exposure to antiretrovirals may also influence outcomes. Moreover, general, non-CHEU-specific risk factors for poor neurodevelopment, such as preterm birth, food insecurity, growth faltering and household violence, are amplified among CHEU; addressing these factors will require multi-factorial solutions. There is a need for rigorous harmonised approaches to identify children at the highest risk of delay. In high-burden HIV settings, existing maternal child health programmes serving the general population could adopt structured early child development programmes that educate healthcare workers on CHEU-specific risk factors and train them to conduct rapid neurodevelopmental screening tests. Community-based interventions targeting parent knowledge of optimal caregiving practices have shown to be successful in improving neurodevelopmental outcomes in children and should be adapted for CHEU. CONCLUSIONS CHEU in sub-Saharan Africa have biologic and socio-behavioural factors that may influence their neurodevelopment, brain maturation, immune system and overall health and wellbeing. Multidisciplinary research is needed to disentangle complex interactions between contributing factors. Common environmental and social risk factors for suboptimal neurodevelopment in the general population are disproportionately magnified within the CHEU population, and it is, therefore, important to draw on existing knowledge when considering the socio-behavioural pathways through which HIV exposure could impact CHEU neurodevelopment. Approaches to identify children at greatest risk for poor outcomes and multisectoral interventions are needed to ensure optimal outcomes for CHEU in sub-Saharan Africa.
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Affiliation(s)
- Michelle A Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Laurie A Gulaid
- UNICEF, eastern and southern Africa Regional Office, Nairobi, Kenya
| | - Katheen M Powis
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine J Wedderburn
- Department of Pediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
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Anago R, Forzy T, Guei S, Pelras C, Ramde S, Tevenart C, Vera Rueda J, Macours K. Piloting, testing and scaling parental training: a multi-partnership approach in Côte d'Ivoire. Front Public Health 2023; 11:1106565. [PMID: 37655283 PMCID: PMC10466389 DOI: 10.3389/fpubh.2023.1106565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Background and objectives Early Childhood Development is high on the policy agenda in Côte d'Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how "MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale," one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of "How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)? Methods Five training approaches to improve caregivers' knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD. Results The evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation. Conclusion The iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis.
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Affiliation(s)
- Romuald Anago
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Sosthene Guei
- Transformer L’éducation Dans Les Communautés de Cacao, Abidjan, Côte d'Ivoire
| | | | - Samuel Ramde
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | | | - Karen Macours
- Paris School of Economics, Paris, France
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), Paris, France
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Wright AS, Guthrie-Dixon N, Tulloch-Reid MK, Chang SM, Walker SP. Maternal feeding styles in infancy predict child body mass index z-scores at 72 months: findings from a cohort of Jamaican children. Front Public Health 2023; 11:1161808. [PMID: 37457271 PMCID: PMC10349535 DOI: 10.3389/fpubh.2023.1161808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To explore whether maternal feeding styles at 12 months predict child Body Mass Index (BMI) z-scores at 72 months and evaluate whether BMI z-scores at 18 months mediates the association. Methods Data from 239 mother-child pairs participating in a parenting intervention were analyzed. Feeding information was ascertained at 12 months by questionnaire with feeding styles identified using factor analysis. Children's weight and length/height were measured at 18 and 72 months and BMI z-scores computed. Maternal sociodemographic data, depressive symptoms and language skills were obtained by questionnaire. Multilevel linear regression analysis was used to examine whether feeding styles predicted 72 month BMI z-scores. Complete case analysis was conducted and multiple imputation used to treat missing values of explanatory and outcome variables at 18 and 72 months. Mediational analysis was performed to assess the indirect effects of feeding styles on 72 month BMI z-scores via 18 month BMI z-scores. Results Restrictive feeding at age 12 months predicted higher 72 month BMI z-scores in both complete case analysis [β (95%CI): 0.19 (0.02, 0.37)] and multiple imputation [β (95%CI): 0.20 (0.02, 0.39)]. Uninvolved, forceful, indulgent and responsive feeding styles were not significant predictors of 72 month BMI z-scores. A significant indirect effect was observed between restrictive feeding and child BMI z-scores at 72 months via 18 month BMI z-scores [β (95% CI) 0.12 (0.03, 0.22)]. Conclusion Restrictive feeding at 12 months was associated with higher BMI z-scores at 72 months and appeared to be mediated by BMI z-scores at 18 months.
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Orlando JM, Cunha AB, Alghamdi Z, Lobo MA. Information Available to Parents Seeking Education about Infant Play, Milestones, and Development from Popular Sources. Behav Sci (Basel) 2023; 13:bs13050429. [PMID: 37232666 DOI: 10.3390/bs13050429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Parents commonly seek information about infant development and play, yet it is unclear what information parents find when looking in popular sources. Play, Milestone, and Development Searches in Google identified 313 sources for content analysis by trained researchers using a standardized coding scheme. Sources included websites, books, and apps created by professional organizations, commercial entities, individuals, the popular press, and government organizations/agencies. The results showed that for popular sources: (1) author information (i.e., qualifications, credentials, education/experience) is not consistently provided, nor is information about the developmental process, parents' role in development, or determining an infant's readiness to play; (2) milestones comprise a majority of the content overall; (3) search terminology impacts the information parents receive; (4) sources from the Milestone and Development Searches emphasized a passive approach of observing developmental milestones rather than suggesting activities to actively facilitate learning and milestone development. These findings highlight the need to discuss parents' online information-gathering process and findings. They also highlight the need for innovative universal parent-education programs that focus on activities to facilitate early development. This type of education has potential to benefit all families, with particular benefits for families with children who have unidentified or untreated developmental delays.
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Affiliation(s)
- Julie M Orlando
- Biomechanics & Movement Science Program, University of Delaware, Newark, DE 19713, USA
| | - Andrea B Cunha
- Physical Therapy Department, Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68106, USA
| | - Zainab Alghamdi
- Biomechanics & Movement Science Program, University of Delaware, Newark, DE 19713, USA
| | - Michele A Lobo
- Biomechanics & Movement Science Program, University of Delaware, Newark, DE 19713, USA
- Physical Therapy Department, University of Delaware, Newark, DE 19713, USA
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Wright AS, Tulloch‐Reid MK, Chang SM, Walker SP. Maternal feeding styles and the risk of overweight in a cohort of Caribbean infants. LIFESTYLE MEDICINE 2023. [DOI: 10.1002/lim2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
- Amika S. Wright
- Epidemiology Research Unit, Caribbean Institute for Health Research The University of the West Indies Kingston 7 Jamaica
| | - Marshall K. Tulloch‐Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research The University of the West Indies Kingston 7 Jamaica
| | - Susan M. Chang
- Epidemiology Research Unit, Caribbean Institute for Health Research The University of the West Indies Kingston 7 Jamaica
| | - Susan P. Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research The University of the West Indies Kingston 7 Jamaica
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Antelman G, Ferla J, Gill MM, Hoffman HJ, Komba T, Abubakar A, Remes P, Jahanpour O, Mariki M, Mang’enya MA, van de Ven R. Effectiveness of an integrated multilevel early child development intervention on caregiver knowledge and behavior: a quasi-experimental evaluation of the Malezi program in Tanzania. BMC Public Health 2023; 23:19. [PMID: 36600280 PMCID: PMC9811787 DOI: 10.1186/s12889-022-14956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
- Gretchen Antelman
- grid.463111.0Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Josephine Ferla
- grid.463111.0Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Michelle M. Gill
- grid.420931.d0000 0000 8810 9764Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, USA
| | - Heather J. Hoffman
- grid.253615.60000 0004 1936 9510The George Washington University, Milken Institute School of Public Health Washington DC, Washington DC, USA
| | - Teopista Komba
- grid.463111.0Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Amina Abubakar
- grid.470490.eInstitute for Human Development Aga Khan University (South-Central Asia, East Africa, UK), Nairobi, Kenya
| | - Pieter Remes
- Development Media International, Mwanza, Tanzania
| | - Ola Jahanpour
- grid.463111.0Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Martha Mariki
- President’s Office Regional and Local Government, Dodoma, Tanzania
| | - Mary A. Mang’enya
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, Tanzania
| | - Roland van de Ven
- grid.463111.0Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
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10
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Mehrin SF, Salveen NE, Kawsir M, Grantham-McGregor S, Hamadani JD, Baker-Henningham H. Scaling-up an early childhood parenting intervention by integrating into government health care services in rural Bangladesh: A cluster-randomised controlled trial. Child Care Health Dev 2022. [PMID: 36513387 DOI: 10.1111/cch.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
AIMS We evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties. METHODS We randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions (n = 59 health workers, n = 24 clinics) were trained to deliver a group-based parenting intervention, with training and supervision provided by government supervisors. In each of the 24 intervention clinics, we recruited 24 mothers of children aged 6-24 months to participate in the parenting sessions (n = 576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four to five participants for 6 months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers' attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control) and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother-reported home stimulation, measured at baseline and endline. RESULTS Supervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs [3.4%] refused) and mothers' attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size = 0.53SD, 95% confidence interval: 0.50, 0.56, p < 0.001). HW burnout was low in both groups. CONCLUSION Integration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.
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Affiliation(s)
- Syeda Fardina Mehrin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur-E Salveen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Masuma Kawsir
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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11
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Wani JI, Almushayt NO, Abbag WF, Buhran LA, Nadeem M. Pediatric first aid, trauma knowledge, and attitude among parents and general population in Aseer region, Southern Saudi Arabia. SAGE Open Med 2022; 10:20503121221126762. [PMID: 36267494 PMCID: PMC9577076 DOI: 10.1177/20503121221126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Around the world, accidents and injuries are the leading causes of death
among children. Because mothers and family members commonly administer first
aid at home and at preschools, it’s critical to learn what parents and the
public think about children’s mishaps. Our objective was to assess parents’
knowledge and attitude toward pediatric first aid in the Aseer region of
Saudi Arabia. Methods: A cross-sectional study was conducted in the Aseer region of Saudi Arabia to
assess the parents’ level of knowledge and attitude about pediatric first
aid and trauma with an electronic- and paper-based multiple-choice
self-administered questionnaire covering different medical emergencies. The
Arabic and English versions of the questionnaire were made from the
information obtained from the first aid educational content of the Saudi
Ministry of Health. Results: When the participants were asked about their knowledge of pediatric first
aid, arranged in descending order from most answers, 37% (n = 135) answered
it was good, 30% (n = 111) answered that it was very good, 20% (n = 74)
answered that it was not enough, and 13% (n = 47) answered that it was
excellent. Results of the multiple linear regression analysis showed the
knowledge score to be significantly higher among participants who had higher
education levels (t = 2.039, p < 0.001), who had received first aid
training before (t = 2.786, p = 0.0001), those who were already healthcare
providers (t = 4.336, p < 0.001), those who were from rural districts
(t = 2.5, p = 0.355), and younger personnel (t = 0.821, p = 0.345) The
difference was not statistically significant. Conclusion: Although this study shows that the level of first aid knowledge among
personnel who care for children was low, it also shows that they are
interested in obtaining proper training.
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Affiliation(s)
| | | | | | | | - Mir Nadeem
- Mir Nadeem, Department of Medicine, King
Khalid University, Abha, 62217, Saudi Arabia.
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12
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Bai Y, Abulitifu R, Wang D. Impact of an Early Childhood Development Intervention on the Mental Health of Female Caregivers: Evidence from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11392. [PMID: 36141665 PMCID: PMC9516973 DOI: 10.3390/ijerph191811392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Investing in early childhood development is an effective way to enhance human capital accumulation. Caregivers' mental health is one of the most important factors influencing children's development. Previous studies have found that mental health issues in caregivers are widespread all over the world, especially in low- and middle-income countries. In this study, we explored the effects of the "Integrated Program for Early Childhood Development" on the mental health of female caregivers in Southwest China through a randomized intervention trial, with infants aged 5-25 months and their caregivers as the target subjects. The heterogeneity of the effects of different characteristics of the caregivers and the mechanism of the intervention effect were also analyzed. Primary caregivers were provided comprehensive early development interventions for the children in the treatment group via bi-weekly home visiting activities and monthly family group activities. The results showed that the prevalence of depression, anxiety, and stress symptoms among female caregivers in this rural area were 32%, 42%, and 30%, respectively. Whether the child was breastfed, parent's age, parent's education level, primary caregiver type, the ratio of the number of months the mother was at home full time to the child's age, the grandmother's rearing ability, and the family asset index were the factors influencing the mental health of female caregivers. The intervention significantly increased the proportion of depressive symptoms in 28% of the grandmothers. It significantly reduced the anxiety symptoms of daughters-in-law not from the local town, while the social interactions of both local and non-local daughters-in-law were significantly improved.
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Affiliation(s)
- Yu Bai
- School of Economics, Minzu University of China, Beijing 100081, China
- China Institute for Vitalizing Border Areas and Enriching the People, Beijing 100081, China
| | - Reyila Abulitifu
- School of Economics, Minzu University of China, Beijing 100081, China
| | - Dan Wang
- School of Economics, Minzu University of China, Beijing 100081, China
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13
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Attanasio O, Baker-Henningham H, Bernal R, Meghir C, Pineda D, Rubio-Codina M. Early Stimulation and Nutrition: The Impacts of a Scalable Intervention. JOURNAL OF THE EUROPEAN ECONOMIC ASSOCIATION 2022; 20:1395-1432. [PMID: 35965610 PMCID: PMC9372035 DOI: 10.1093/jeea/jvac005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Early childhood development is becoming the focus of policy worldwide. However, the evidence on the effectiveness of scalable models is scant, particularly when it comes to infants in developing countries. In this paper, we describe and evaluate with a cluster-Randomized Controlled Trial an intervention designed to improve the quality of child stimulation within the context of an existing parenting program in Colombia, known as FAMI. The intervention improved children's development by 0.16 of a standard deviation (SD) and children's nutritional status, as reflected in a reduction of 5.8 percentage points of children whose height-for-age is below -1 SD.
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Luby JL, Rogers C, McLaughlin KA. Environmental Conditions to Promote Healthy Childhood Brain/Behavioral Development: Informing Early Preventive Interventions for Delivery in Routine Care. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:233-241. [PMID: 35855293 PMCID: PMC9291732 DOI: 10.1016/j.bpsgos.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022] Open
Abstract
Environmental experiences early in life have strong and enduring consequences for cognitive, emotional, and neurobiological development and related physical and mental health trajectories. The powerful influence of early caregiver nurturance and stimulation on promoting positive neurodevelopmental outcomes has been demonstrated across species. These findings elucidate the environmental conditions known to facilitate healthy neurodevelopment and underscore the potential for modifiable psychosocial factors in the environment to be harnessed to inform early preventive interventions to promote health and adaptive development. A framework for early preventive interventions to enhance nurturing and responsive caregiving for implementation during early sensitive periods of brain development delivered within existing health or educational infrastructures is proposed. Emotional development during sensitive periods is an important, under-recognized, and abundantly modifiable predictor of mental and physical health outcomes that warrants investment of resources and integration of interventions into public health infrastructure for children worldwide. Future studies are needed to further clarify whether and when sensitive periods are present for key developmental domains to inform the optimal timing and targets of these interventions. Numerous available empirically supported early interventions may be modified and applied in briefer and more feasible modalities of delivery to broader populations of developing children. As well established in growth and development across species, essential environmental inputs that are particularly important at specified developmental periods facilitate optimal growth trajectories. Such principles hold great potential in application to early child neurodevelopment to facilitate a thriving and resilient human population.
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Affiliation(s)
- Joan L. Luby
- Department of Psychiatry (Child), Washington University School of Medicine, St. Louis, Missouri
| | - Cynthia Rogers
- Department of Psychiatry (Child), Washington University School of Medicine, St. Louis, Missouri
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Shah R, Herekar V, Metgud D, Kim H, Atkins M, Dhaded S. Implementing an early childhood development intervention with routine immunization visits in India: a feasibility trial. Eur J Pediatr 2022; 181:2799-2808. [PMID: 35508559 PMCID: PMC9447954 DOI: 10.1007/s00431-022-04485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Integrating an early childhood development (ECD) intervention within routine healthcare visits offers an important opportunity for a population-level approach to support ECD in low- and middle-income countries (LMICs) where 250 million children under the age of 5 years fail to reach their full developmental potential. This paper reports on the feasibility of integrating an adapted healthcare-based ECD intervention (Sit Down and Play) in primary health centers (PHCs) serving low-income rural communities in Karnataka, India, and its potential to support research-informed components needed to improve ECD (e.g., opportunities for learning). Using a prospective cluster nonrandomized pilot and feasibility trial, caregivers with infants 6-10 weeks of age were recruited from 2 PHCs: one which delivered the intervention at two subsequent immunization visits (n = 25) and the other as care as usual (n = 28). Feasibility was assessed using the following indicators: implementation, practicality, acceptability, demand, and limited efficacy. Quality of home stimulation and opportunities for learning were explored with key items from the UNICEF Multiple Cluster Index Surveys with generalized estimating equation models. While outcome measures were to be obtained from all participants 3-month post-enrollment, due to COVID19 restrictions, there was variability in timing of follow-up interviews; however, outcome data from all participants were obtained and no significant group differences existed in contact time. Results suggest the feasibility of delivery of SDP during routine immunization visits, high satisfaction with adapted content, and utility of developed training and fidelity measures. Though not powered for hypothesis testing, our exploratory analyses reveal the intervention group demonstrated greater improvements on quality of home stimulation over time than the control group. CONCLUSION Our findings suggest integrating an ECD intervention with routine healthcare visits is a feasible and promising strategy for supporting ECD in India. Further studies are needed to determine the effectiveness of SDP on children's development. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04167254. WHAT IS KNOWN • Interventions are increasingly being developed to target responsive caregiving and opportunities for learning because of their potential to support early childhood development (ECD) in low- and middle-income countries where 250 million children under the age of 5 years fail to reach their full developmental potential. • A critical issue in ECD intervention research is the gap between what is known to be effective treatment to protect healthy brain development and what is provided to millions of caregivers during routine care who live in low-income communities. WHAT IS NEW • We adapted a brief, ECD intervention for use with routine healthcare visits in India as a population-level strategy to support ECD in LMICs. • Our results demonstrate feasibility, acceptability, and improvements in key parenting behaviors that promote ECD.
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Affiliation(s)
- Reshma Shah
- Departments of Pediatrics, University of Illinois at Chicago, Chicago, United States.
| | - Veena Herekar
- Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, Belgavi, India
| | - Deepa Metgud
- Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, Belgavi, India
| | - Hajwa Kim
- Department of Clinical and Translational Science, Jawaharlal Nehru Medical College, Belgavi, India
| | - Marc Atkins
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Sangappa Dhaded
- Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, Belgavi, India
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16
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Mehrin SF, Hasan MI, Tofail F, Shiraji S, Ridout D, Grantham-McGregor S, Hamadani JD, Baker-Henningham H. Integrating a Group-Based, Early Childhood Parenting Intervention Into Primary Health Care Services in Rural Bangladesh: A Cluster-Randomized Controlled Trial. Front Pediatr 2022; 10:886542. [PMID: 35783319 PMCID: PMC9245711 DOI: 10.3389/fped.2022.886542] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Over 250 million children globally do not reach their developmental potential. We tested whether integrating a group-based, early childhood parenting program into government healthcare clinics improved children's development, growth, and behavior. Methods We conducted a cluster-randomized controlled trial in 40 community clinics in the Kishorganj district of Bangladesh. We randomly assigned clinics (1:1) to deliver a group-based parenting interventions or to a comparison group that received no intervention. Participants were children aged 5-24 months, with weight-for-age z-score of ≤ -1.5 SDs of the WHO standards, living within a thirty-minute walking distance from the clinic (n = 419 intervention, 366 control). Government health staff facilitated parenting sessions in the clinic with groups of four mother/child dyads fortnightly for one year as part of their routine duties. Primary outcomes measured at baseline and endline were child development assessed using the Bayley scales, child behaviors during the test by tester ratings, and child growth. The trial is registered at ClinicalTrials.gov, NCT02208531. Findings 91% of children were tested at endline (396 intervention, 319 control). Multilevel analyses showed significant benefits of intervention to child cognition (effect size 0.85 SDs, 95% CI: 0.59, 1.11), language (0.69 SDs, 0.43, 0.94), and motor development (0.52 SDs, 0.31, 0.73), and to child behaviors during the test (ranging from 0.36 SDs, 0.14, 0.58, to 0.53 SDs, 0.35, 0.71). There were no significant effects on growth. Conclusion A scalable parenting intervention, integrated into existing government health services and implemented by government health staff, led to significant benefits to child development and behavior.
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Affiliation(s)
- Syeda Fardina Mehrin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Imrul Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shamima Shiraji
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deborah Ridout
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Jena D. Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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17
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Shah R, Camarena A, Park C, Martin A, Clark M, Atkins M, Schwartz A. Healthcare-Based Interventions to Improve Parenting Outcomes in LMICs: A Systematic Review and Meta-Analysis. Matern Child Health J 2022; 26:1217-1230. [PMID: 35579803 DOI: 10.1007/s10995-022-03445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although a number of early childhood development (ECD) interventions in healthcare settings in low- and middle-income countries (LMICs) have been developed to improve parent-directed outcomes and support ECD, their impact have yet to be established. This review assesses the effectiveness of healthcare-based ECD interventions in LMICs on the following key evidence-informed parenting outcomes affecting ECD: (1) responsive caregiving (2) cognitive stimulation and (3) parental mental health. Impacts on parental knowledge regarding ECD and parenting stress were also assessed. METHODS PubMed, PsycINFO, Scopus, CINAHL and Embase were searched. We included randomized controlled trials reporting effects of healthcare-based ECD interventions in LMICs on parent-directed outcomes in the first five years of life. Data extraction included study characteristics, design, sample size, participant characteristics, settings, intervention descriptions, and outcomes. Meta-analyses were conducted using random effects models. RESULTS 8 articles were included. Summary standardized mean differences demonstrated significant benefits of healthcare-based interventions in LMICs for improving: (1) cognitive stimulation (n = 4; SMD = 0.32; 95% CI: 0.08 to 0.56) and (2) ECD knowledge (n = 4; SMD = 0.44; 95% CI: 0.27 to 0.60). No significant effects were seen on maternal depression and parenting stress; only one study assessed parent-child interactions in the context of responsiveness. Limitations included small number of studies for moderation analysis, high heterogeneity, variability in measures used for outcomes and timing of assessments. CONCLUSIONS FOR PRACTICE Our results demonstrate statistically significant effects of healthcare-based interventions in LMICs on improving key evidence-based parenting outcomes and offers one promising strategy to support children reach their full developmental potential.
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Affiliation(s)
- Reshma Shah
- Department of Pediatrics, University of Illinois at Chicago, 856 South Wood Street, 60612, Chicago, IL, United States.
| | - Andrea Camarena
- School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - Christen Park
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Aleah Martin
- Department of Pediatrics, University of Illinois at Chicago, 856 South Wood Street, 60612, Chicago, IL, United States
| | - Maureen Clark
- Library of the Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL, United States
| | - Marc Atkins
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois at Chicago, 856 South Wood Street, 60612, Chicago, IL, United States
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL, United States
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18
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Kruk ME, Lewis TP, Arsenault C, Bhutta ZA, Irimu G, Jeong J, Lassi ZS, Sawyer SM, Vaivada T, Waiswa P, Yousafzai AK. Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services. Lancet 2022; 399:1830-1844. [PMID: 35489361 PMCID: PMC9077444 DOI: 10.1016/s0140-6736(21)02532-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/10/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health and Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Grace Irimu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tyler Vaivada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Waiswa
- Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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19
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Jiang Q, Dill SE, Sylvia S, Singh MK, She X, Wang E, Medina A, Rozelle S. Parenting centers and caregiver mental health: Evidence from a large-scale randomized controlled trial in China. Child Dev 2022; 93:1559-1573. [PMID: 35481708 DOI: 10.1111/cdev.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study conducts an exploratory analysis of the impacts of a center-based early childhood development intervention on the mental health of caregivers, using data from a cluster-randomized controlled trial of 1664 caregivers (Mage = 36.87 years old) of 6- to 24-month-old children in 100 villages in rural China. Caregivers and children in 50 villages received individual parenting training, group activities and open play space in village parenting centers. The results show no significant overall change in caregiver-reported mental health symptoms after 1 year of intervention. Subgroup analyses reveal heterogeneous effects by caregiver socioeconomic status and identity (mother vs. grandmother). Findings suggest that early childhood development interventions without targeted mental health components may not provide sufficient support to improve caregiver mental health.
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Affiliation(s)
- Qi Jiang
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Sarah-Eve Dill
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Sean Sylvia
- Gillings school of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Manpreet K Singh
- School of Medicine, Stanford University, Stanford, California, USA.,Stanford Pediatric Mood Disorders Program, Stanford University, Stanford, California, USA
| | - Xinshu She
- School of Medicine, Stanford University, Stanford, California, USA
| | - Eric Wang
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
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20
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Bliznashka L, McCoy DC, Siyal S, Sudfeld CR, Fawzi WW, Yousafzai AK. Child diet and mother-child interactions mediate intervention effects on child growth and development. MATERNAL & CHILD NUTRITION 2022; 18:e13308. [PMID: 34905648 PMCID: PMC8932723 DOI: 10.1111/mcn.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022]
Abstract
This study examined whether child diet and mother-child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0-24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother-child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother-child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother-child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms.
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Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Dana C. McCoy
- Harvard Graduate School of EducationHarvard UniversityCambridgeMassachusettsUSA
| | - Saima Siyal
- Harvard Graduate School of EducationAga Khan UniversityKarachiPakistan
| | - Christopher R. Sudfeld
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Wafaie W. Fawzi
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Aisha K. Yousafzai
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Gomez ML, Bernal R, Baker-Henningham H. Qualitative evaluation of a scalable early childhood parenting programme in rural Colombia. Child Care Health Dev 2022; 48:225-238. [PMID: 34738243 DOI: 10.1111/cch.12921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 08/08/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Integrating early childhood parenting programmes into existing government services is a key strategy for reducing the loss of children's developmental potential in low- and middle-income countries. There is limited evidence of participants' perceptions of these programmes, especially when implemented at scale. We integrated an intervention into an existing government programme targeting pregnant women and mothers of children up to 2 years of age and their families in rural Colombia. METHODS As part of a cluster randomized trial, 171 government workers (facilitators) implemented the intervention. The intervention included four components: (1) structured curricula, (2) play materials, (3) nutrition and (4) training and supervision. In this qualitative evaluation of the programme, we conducted semi-structured interviews with beneficiary mothers (n = 62), facilitators (n = 40) and supervisors (n = 8). Topic guides were developed to collect information on participants' perspectives of the acceptability, feasibility and effectiveness of the intervention and the enablers and barriers to implementation. All interviews were audiotaped and transcribed, and data were analysed using the framework approach. RESULTS Participants' responses indicated that the intervention was acceptable, feasible and effective. Key enablers to implementation were (1) the use of evidence-based behaviour change techniques leading to interactive, fun and participatory sessions; (2) structured curricula with easy to use, simple activities and materials; (3) the focus on positive, supportive relationships; and (4) the perceived benefits of the programme to the beneficiary mothers, children and families, facilitators and programme supervisors. The main barriers were (1) facilitators took time to become comfortable and competent in using the new participatory methodology and (2) the logistics related to making and distributing the play materials. CONCLUSION Providing structured curricula and play materials with training and ongoing supervision to enhance an existing programme targeting mothers, families and children was reported as acceptable, feasible and effective by beneficiary mothers and programme staff.
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Affiliation(s)
| | - Raquel Bernal
- Economics Department, Universidad de Los Andes, Bogotá, Colombia
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22
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Ebert C, Vollmer S. Girls unwanted - The role of parents' child-specific sex preference for children's early mental development. JOURNAL OF HEALTH ECONOMICS 2022; 82:102590. [PMID: 35139435 DOI: 10.1016/j.jhealeco.2022.102590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
We propose a novel son preference measure that relates the preference to a specific child. We find child-specific son preference to be more common among later born children and in families with fewer sons. Using the novel measure and an interaction instrumental variables approach, we estimate a penalty in early mental functions for unwanted girls of 0.7 standard deviations. This penalty appears to be partially driven by discrimination against girls and partially by pampering of boys. Children's health and parental inputs do not mediate the effect from son preference to mental development. Our findings highlight the relevance of parents' attitudes for a nurturing home environment and healthy brain development.
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Affiliation(s)
- Cara Ebert
- RWI - Leibniz Institute for Economic Research, RWI Berlin Office, Invalidenstr. 112, Berlin 10115, Germany.
| | - Sebastian Vollmer
- University of Goettingen, Center for Modern Indian Studies, Waldweg 26, 37073 Göttingen, Germany
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Jeong J, Bliznashka L, Ahun MN, Karuskina-Drivdale S, Picolo M, Lalwani T, Pinto J, Frey M, Velthauz D, Donco R, Yousafzai AK. A pilot to promote early child development within health systems in Mozambique: a qualitative evaluation. Ann N Y Acad Sci 2022; 1509:161-183. [PMID: 34859451 PMCID: PMC8978755 DOI: 10.1111/nyas.14718] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Health systems offer unique opportunities for integrating services to promote early child development (ECD). However, there is limited knowledge about the implementation experiences of using health services to target nurturing care and ECD, especially in sub-Saharan Africa. We conducted a qualitative implementation evaluation to assess the delivery, acceptability, perceived changes, and barriers and facilitators associated with a pilot strategy that integrated developmental monitoring, nutritional screening, and early learning and nutrition counseling into the existing health facility, and community-based services for young children in rural Mozambique. We completed individual interviews with caregivers (N = 36), providers (N = 27), and district stakeholders (N = 10), and nine facility observational visits at three primary health facilities in October-November 2020. We analyzed data using thematic content analysis. Results supported fidelity to the intended pilot model and acceptability of nurturing care services. Respondents expressed various program benefits, including strengthened health system capacity and improved knowledge, attitudes, and practices regarding nurturing care and ECD. Government leadership and supportive supervision were key facilitators, whereas health system resource constraints were key barriers. We conclude that health systems are promising platforms for supporting ECD and discuss several programmatic recommendations for enhancing service delivery and maximizing potential impacts on nurturing care and ECD outcomes.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marilyn N. Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | | | | | | | | | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
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Ndayizigiye M, McBain R, Whelley C, Lerotholi R, Mabathoana J, Carmona M, Curtain J, Birru E, Stulac S, Miller AC, Shin S, Rumaldo N, Mukherjee J, Nelson AK. Integrating an early child development intervention into an existing primary healthcare platform in rural Lesotho: a prospective case-control study. BMJ Open 2022; 12:e051781. [PMID: 35121599 PMCID: PMC8819803 DOI: 10.1136/bmjopen-2021-051781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study evaluated a novel early childhood development (ECD) programme integrated it into the primary healthcare system. SETTING The intervention was implemented in a rural district of Lesotho from 2017 to 2018. PARTICIPANTS It targeted primary caregivers during routine postnatal care visits and through village health worker home visits. INTERVENTION The hybrid care delivery model was adapted from a successful programme in Lima, Peru and focused on parent coaching for knowledge about child development, practicing contingent interaction with the child, parent social support and encouragement. PRIMARY AND SECONDARY OUTCOMES MEASURES We compared developmental outcomes and caregiving practices in a cohort of 130 caregiver-infant (ages 7-11 months old) dyads who received the ECD intervention, to a control group that did not receive the intervention (n=125) using a case-control study design. Developmental outcomes were evaluated using the Extended Ages and Stages Questionnaire (EASQ), and caregiving practices using two measure sets (ie, UNICEF Multiple Indicator Cluster Survey (MICS), Parent Ladder). Group comparisons were made using multivariable regression analyses, adjusting for caregiver-level, infant-level and household-level demographic characteristics. RESULTS At completion, children in the intervention group scored meaningfully higher across all EASQ domains, compared with children in the control group: communication (δ=0.21, 95% CI 0.07 to 0.26), social development (δ=0.27, 95% CI 0.11 to 0.8) and motor development (δ=0.33, 95% CI 0.14 to 0.31). Caregivers in the intervention group also reported significantly higher adjusted odds of engaging in positive caregiving practices in four of six MICS domains, compared with caregivers in the control group-including book reading (adjusted OR (AOR): 3.77, 95% CI 1.94 to 7.29) and naming/counting (AOR: 2.05; 95% CI 1.24 to 3.71). CONCLUSIONS These results suggest that integrating an ECD intervention into a rural primary care platform, such as in the Lesothoan context, may be an effective and efficient way to promote ECD outcomes.
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Affiliation(s)
| | - Ryan McBain
- RAND Corporation, Santa Monica, California, USA
- Partners In Health, Boston, Massachusetts, USA
| | | | | | | | | | - Joe Curtain
- Partners In Health, Boston, Massachusetts, USA
| | | | - Sara Stulac
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Ann C Miller
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joia Mukherjee
- Partners In Health, Boston, Massachusetts, USA
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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25
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Glenn Fowler M, Boivin MJ, Familiar I, Nyangoma B. Central Nervous System and Neurodevelopmental Outcomes of HIV+ and HIV exposed children: A Mini Review of Recent Findings and Lessons Learned from the Field. Neurosci Lett 2022; 775:136501. [PMID: 35122932 DOI: 10.1016/j.neulet.2022.136501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/11/2022] [Accepted: 01/28/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Mary Glenn Fowler
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Michael J Boivin
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Itziar Familiar
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
| | - Betty Nyangoma
- Dept of Pathology, Johns Hopkins U. School of Medicine Baltimore MD, USA; Dept of PsychiatryMichigan State U. East Lansing, MI, USA; Makerere U. Johns Hopkins U. Research Collaboration, USA; Kampala Uganda
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Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
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Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
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27
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Wright AS, Tulloch-Reid MK, Chang SM, Walker SP. Maternal characteristics influence infant feeding styles in Caribbean women. Public Health Nutr 2021; 24:6034-6045. [PMID: 34047268 PMCID: PMC11148589 DOI: 10.1017/s1368980021002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine associations between maternal characteristics and feeding styles in Caribbean mothers. DESIGN Participants were mother-child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6-8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression. SETTING Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20). PARTICIPANTS A total of 405 mother-child pairs from the larger trial. RESULTS Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = -0·30, 95 % CI (-0·56, -0·05)). Maternal vocabulary was inversely associated with uninvolved (β = -0·31, 95 % CI (-0·57, -0·06)), restrictive (β = -0·30, 95 % CI (-0·56, -0·04)), indulgent (β = -0·47, 95 % CI (-0·73, -0·21)) and forceful (β = -0·54, 95 % CI (-0·81, -0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = -0·27, 95 % CI (-0·53, -0·00)) and was lower among mothers ≥35 years (β = -0·32, 95 % CI (-0·62, -0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles. CONCLUSION Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.
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Affiliation(s)
- Amika S Wright
- Caribbean Institute for Health Research, The University of the West Indies, Kingston 7, Jamaica
| | - Marshall K Tulloch-Reid
- Caribbean Institute for Health Research, The University of the West Indies, Kingston 7, Jamaica
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies, Kingston 7, Jamaica
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston 7, Jamaica
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Kim ET, Lillie M, Gallis J, Hembling J, McEwan E, Opiyo T, Acayo P, Baumgartner JN. Correlates of early stimulation activities among mothers of children under age two in Siaya County, Kenya: Maternal mental health and other maternal, child, and household factors. Soc Sci Med 2021; 287:114369. [PMID: 34517203 DOI: 10.1016/j.socscimed.2021.114369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE The first two to three years of life are critical for early child development (ECD), which affects later life trajectories in health, development, and earning potential. Global calls for early stimulation activities to support optimal development among young children are increasing and there is a need to better understand the factors associated with maternal engagement in early stimulation activities, particularly maternal mental health. OBJECTIVE This study examined important factors associated with early stimulation activities performed by mothers of children ages 0-2 in rural Kenya. METHODS Baseline cohort data from an evaluation of an integrated maternal mental health and an ECD intervention included 374 interviews with mothers of children under 24 months. Descriptive and multivariable analyses were performed. RESULTS Maternal mental health was not associated with maternal early stimulation activities. Having worked in the past week was associated with more frequent early stimulation activities. At the child level, female sex was associated with more frequent early stimulation activities but prematurity at birth was associated with less frequent early stimulation activities. At the household level, ownership of children's toys and books was associated with more frequent early stimulation activities. CONCLUSIONS This study indicates that both mothers and families could benefit from availability of ECD-friendly resources such as homemade toys and children's books (particularly for low-income families), and tailored messaging to support early stimulation activities for both girl and boy children and for those prematurely-born. Local governments and community-based programs can aim to both raise awareness about the importance of early childhood development and educate caregivers on specific age-appropriate early stimulation activities that promote optimal growth. Future research should also explore the reciprocal and temporal relationships between maternal mental health and early stimulation activities to inform and elucidate their potential synergistic impact on ECD.
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Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA.
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | - John Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
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Bagheri F, Nakhaee N, Jahani Y, Khajouei R. Assessing parents' awareness about children's "first thousand days of life": a descriptive and analytical study. ACTA ACUST UNITED AC 2021; 79:154. [PMID: 34454620 PMCID: PMC8400762 DOI: 10.1186/s13690-021-00673-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022]
Abstract
Background Many adulthood illnesses are rooted in childhood, especially in the “first thousand days of life”. Despite parents’ role in children’s development, no study has examined parental awareness concerning this period. This study aimed to examine the awareness of parents concerning the “first thousand days of life” and the relationship between parents’ demographics and their awareness. Methods This study was conducted on 135 parents in Kerman, Iran, using a valid and reliable questionnaire developed by researchers based on the opinion of experts and relevant references. The relationship between participants’ demographics and their awareness was examined by multiple regression. The relationship between homogeneity of couples’ education degree and awareness was analyzed using ANOVA. Chi-square was used to examine the relationship between information sources and parents’ familiarity and to compare parents’ preferred sources. Results The average parental awareness was 41.96 ± 11.90. Eighty-three percent of the parents have not heard about the “first thousand days of life”. The source of information for 57% of the parents was friends and relatives (p < 0.0001). Overall, 87% of the parents desired to know about this period, and 47% liked using mobile applications for information (p < 0.0001). Conclusions Parents’ awareness about the “first thousand days of life” is lower than the average. Since the source of information concerning this period for most parents is friends and relatives and most parents are very interested in obtaining information, it is recommended that policy-makers use the capacity of other sources to increase parents’ awareness. Given the greater tendency of parents to obtain information through mobile applications, we suggest investing more in this source. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00673-6.
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Affiliation(s)
- Fatemeh Bagheri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Yones Jahani
- Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Abstract
Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.
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Affiliation(s)
- Heather Forkey
- Department of Pediatrics, University of Massachusetts, Worcester, Massachusetts
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Erin T Kelly
- Ambulatory Health Services, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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Garner A, Yogman M. Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics 2021; 148:peds.2021-052582. [PMID: 34312296 DOI: 10.1542/peds.2021-052582] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.
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Affiliation(s)
- Andrew Garner
- Partners in Pediatrics, Westlake, Ohio.,School of Medicine, Case Western Reserve University, Cleveland, Ohio
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32
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Emmers D, Jiang Q, Xue H, Zhang Y, Zhang Y, Zhao Y, Liu B, Dill SE, Qian Y, Warrinnier N, Johnstone H, Cai J, Wang X, Wang L, Luo R, Li G, Xu J, Liu M, Huang Y, Shan W, Li Z, Zhang Y, Sylvia S, Ma Y, Medina A, Rozelle S. Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:e005578. [PMID: 34417271 PMCID: PMC8381307 DOI: 10.1136/bmjgh-2021-005578] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. METHODS We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children's risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. CONCLUSION There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement. TRIAL REGISTRATION NUMBER This study was registered with PROSPERO (CRD42020218852).
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Affiliation(s)
- Dorien Emmers
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Leuven, Belgium
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Qi Jiang
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Yue Zhang
- National Center for Women and Children Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Bin Liu
- Xinhe Foundation, Beijing, China
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Yiwei Qian
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Nele Warrinnier
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Leuven, Belgium
- School of Economics and Finance, Queen Mary University of London, London, UK
| | - Hannah Johnstone
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Jianhua Cai
- Administrators of Training Center of the National Health Commission of the PRC, Beijing, China
| | - Xiaoli Wang
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Lei Wang
- International Business School, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Renfu Luo
- School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Guirong Li
- International Center for Action Research on Education, Henan University School of Education, Kaifeng, Henan, China
| | - Jiajia Xu
- International Center for Action Research on Education, Henan University School of Education, Kaifeng, Henan, China
| | - Ming Liu
- Save the Children International China Program, Beijing, China
| | - Yaqing Huang
- Save the Children International China Program, Beijing, China
| | - Wenjie Shan
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihui Li
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yu Zhang
- Hupan Modou Foundation, Hangzhou, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yue Ma
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Alexis Medina
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
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Zhang L, Ssewanyana D, Martin MC, Lye S, Moran G, Abubakar A, Marfo K, Marangu J, Proulx K, Malti T. Supporting Child Development Through Parenting Interventions in Low- to Middle-Income Countries: An Updated Systematic Review. Front Public Health 2021; 9:671988. [PMID: 34336768 PMCID: PMC8322584 DOI: 10.3389/fpubh.2021.671988] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions. Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted. Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [-0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes. Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts.
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Affiliation(s)
- Linlin Zhang
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Greg Moran
- Department of Psychology, Western University, London, ON, Canada
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Kofi Marfo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Kerrie Proulx
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Tina Malti
- Centre for Child Development, Mental Health, and Policy, University of Toronto Mississauga, Mississauga, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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Shi H, Li X, Fang H, Zhang J, Wang X. The Effectiveness and Cost-effectiveness of a Parenting Intervention Integrated with Primary Health Care on Early Childhood Development: a Cluster-Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:661-671. [PMID: 32419119 DOI: 10.1007/s11121-020-01126-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Developing countries require interventions that can sustainably improve early childhood development (ECD) at scale because hundreds of millions of children are at risk of poor development. This study examined the effectiveness and cost-effectiveness of a parenting intervention integrated with primary health care in terms of ECD. A cluster-randomized controlled trial was conducted in 20 urban communities in China, with 82 and 86 children aged 1-2 months enrolled in the intervention and control groups, respectively, and 71 and 69 children, respectively, followed to 14 months of age. All children in both groups received routine primary health care services. Intervention caregivers received a parenting pamphlet and two parenting training sessions during well-child clinic visits; those with children with suspected developmental delay received additional parenting guidance by telephone. Compared with controls, children receiving the intervention had similar developmental outcomes, measured with the Chinese version of the Ages & Stages Questionnaires third edition (ASQ-C), at baseline, but had significantly higher communication (adjusted mean difference = 0.26; 95% CI 0.03, 0.51), fine motor (adjusted mean difference = 0.19; 95% CI 0.01, 0.37), and overall (adjusted mean difference = 0.25; 95% CI 0.10, 0.41) ASQ-C z-scores after 12 months of the intervention. The intervention cost per child was $50.87, and the costs for increasing the communication, fine motor, and overall ASQ-C scores by one SD were $195.65, $267.74, and $203.48, respectively. Our findings indicate that the integration of a parenting intervention with existing primary health care is a cost-effective way to improve ECD.
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Affiliation(s)
- Huifeng Shi
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xuejun Li
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 168 Litang Road, Changping District, Beijing, 102218, China.
| | - Hai Fang
- China Center for Health Development Studies (CCHDS), Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jingxu Zhang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Sudfeld CR, Bliznashka L, Ashery G, Yousafzai AK, Masanja H. Effect of a home-based health, nutrition and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomised controlled trial in Tanzania. BMJ Glob Health 2021; 6:bmjgh-2021-005086. [PMID: 33906847 PMCID: PMC8088247 DOI: 10.1136/bmjgh-2021-005086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Evidence on the effects of community health worker (CHW) interventions and conditional cash transfers (CCTs) on child growth and development in sub-Saharan Africa remains sparse. Methods We conducted a single-blind, cluster-randomised controlled trial of an integrated home-visiting health, nutrition and responsive stimulation intervention alone and in combination with CCTs to promote antenatal and child clinic attendance from 2017 to 2019 in rural Morogoro Region, Tanzania. Pregnant women and caregivers with a child <1 year of age were enrolled. Twelve villages were randomised to either (1) CHW (n=200 participants), (2) CHW+CCT (n=200) or (3) control (n=193). An intention-to-treat analysis was conducted for the primary trial outcomes of child cognitive, language and motor development assessed with the Bayley Scales of Infant and Toddler Development and child length/height-for-age z-scores (HAZ) at 18 months of follow-up. Results The CHW and CHW+CCT interventions had beneficial effects on child cognitive development as compared with control (standardised mean difference (SMD): 0.15, 95% CI 0.05 to 0.24, and SMD: 0.18, 95% CI 0.07 to 0.28, respectively). The CHW+CCT intervention also had positive effects on language (SMD: 0.08, 95% CI 0.01 to 0.15) and motor (SMD: 0.16, 95% CI 0.03 to 0.28) development. Both CHW and CHW+CCT interventions had no effect on HAZ in the primary analysis; however, there were statistically significant positive effects in multivariable analyses. The CHW+CCT group (mean difference: 3.0 visits, 95% CI 2.1 to 4.0) and the CHW group (mean difference: 1.5 visits, 95% CI 0.6 to 2.5) attended greater number of child health and growth monitoring clinic visits as compared to the control group. Conclusion Integrated CHW home-visiting interventions can improve child cognitive development and may have positive effects on linear growth. Combining CHW with CCT may provide additional benefits on clinic visit attendance and selected child development outcomes. Trial registration number ISRCTN10323949.
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Affiliation(s)
- Christopher R Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA .,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Asnani MR, Francis D, Knight-Madden J, Chang-Lopez S, King L, Walker S. Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial. PLoS One 2021; 16:e0252513. [PMID: 34106974 PMCID: PMC8189456 DOI: 10.1371/journal.pone.0252513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD). DESIGN AND METHODS This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach. RESULTS The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD). CONCLUSION This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.
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Affiliation(s)
- Monika R. Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- * E-mail:
| | - Damian Francis
- School of Health and Human Performance, Georgia College, Milledgeville, Georgia, United States of America
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Chang-Lopez
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Lesley King
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Waldrop J, Baker M, Salomon R, Moreton E. Parenting Interventions and Secondary Outcomes Related to Maternal Mental Health: A Systematic Review. Matern Child Health J 2021; 25:870-880. [PMID: 33905064 PMCID: PMC10916505 DOI: 10.1007/s10995-021-03130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Perinatal mood and anxiety disorders can have far reaching negative impact on both maternal mental health and child growth and development. Multimodal group parenting programs have been shown to improve maternal mental health symptoms however, they are often costly to provide and not accessible to many mothers, especially those mothers suffering from mental health symptoms. Therefore, the authors sought to answer the following question by undertaking a systematic review of the literature: are parenting interventions aimed at improving maternal-child interaction also a way to address mental health symptoms (i.e. depression, anxiety, stress) in mothers? METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. An online platform that supports the systematic review process and quality assessment according to Cochrane guidelines, Covidence, was used in conjunction with an adapted extraction tool to identify relevant studies and extract data for analysis. RESULTS 11 articles were included in the qualitative synthesis. There was great heterogeneity between study interventions and measurement of outcomes for maternal mental health symptoms which precluded meta-analysis. CONCLUSION Studies reviewed did not demonstrate consistent evidence to recommend that parenting interventions leads to improvement in maternal mental health symptoms for depression, anxiety or stress. However, there was evidence that participating in parenting programs does not worsen these symptoms and some encouraging evidence that alternative delivery methods, beyond face to face, could, with more research, lead to more financially feasible and sustainable models of delivery of these types of interventions in the future.
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Affiliation(s)
- Julee Waldrop
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Maureen Baker
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Salomon
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Moreton
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Smith JA, Chang SM, Lopez Boo F, Ferro MDLP, Walker SP. Are Benefits From a Parenting Intervention Delivered Through the Health Services Sustainable? Follow-Up of a Randomized Evaluation in Jamaica. Acad Pediatr 2021; 21:638-645. [PMID: 33434700 DOI: 10.1016/j.acap.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE An innovative low-cost parenting intervention, implemented through health services in Jamaica showed benefits to children's cognitive development at 18 months and parent's attitudes concerning childcare. We assessed the impact of the intervention on child and parent outcomes at 6 years of age. METHODS A cluster randomized trial of 2 parenting interventions was conducted through 20 health centers in Jamaica. Interventions were implemented from age 3 to 18 months and each intervention benefited cognitive development at 18 months (effect size 0.34-0.38 standard deviation). Children were reassessed at 6 years (n = 262, 80.1% of those assessed at 18 months) to determine any benefits to cognition, behavior, and parenting behavior. Loss to follow-up was not significantly different by treatment. Inverse probability weighting and Lee bounds were used to adjust for loss to follow-up, and multilevel regression analyses conducted with random effects at the health center level. RESULTS There were no significant benefits to any child outcomes at age 6 years or to parenting behavior. Results are robust using the wild cluster bootstrap procedure and using Lee bounds for attrition. The initial trial benefits were reproduced with the current sample and methods. CONCLUSION Lack of sustained benefits may be related to the initial effect size and low intensity of the intervention that ended very young at age 18 months. It may also be related to lack of initial impact on home environment and fade-out of effects in a country with near universal preschool. The findings have implications for intervention design and targeting.
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Affiliation(s)
- Joanne A Smith
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica.
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
| | - Florencia Lopez Boo
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Maria de la Paz Ferro
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
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Jeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med 2021; 18:e1003602. [PMID: 33970913 PMCID: PMC8109838 DOI: 10.1371/journal.pmed.1003602] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily E. Franchett
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Clariana V. Ramos de Oliveira
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karima Rehmani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Jeong J, Pitchik HO, Fink G. Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:e004067. [PMID: 33674266 PMCID: PMC7938974 DOI: 10.1136/bmjgh-2020-004067] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Parenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time. METHODS We conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1-3 years after programme completion), medium-term (4-9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children's cognitive and behavioral development by these subgroups of follow-up rounds. RESULTS We identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children's outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time. CONCLUSIONS There have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Switzerland
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Redinger S, Udedi E, Richter LM, Dovel KL, Bruns L, Coates TJ, Rochat TJ. Double benefit? Integrating an early childhood development programme into HIV PMTCT Option B+ services in Malawi. AIDS Care 2021; 33:1595-1602. [PMID: 33615906 DOI: 10.1080/09540121.2021.1876834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
KEY MESSAGES Benefits for mothers and children can be achieved through the successful integration of an early childhood development programme into PMTCT Option B+ services in Malawi.Our study based on in-depth interviews with 62 mothers indicated that such an approach is feasible and acceptable.Participating mothers reported that the integration of the early childhood development component improved their confidence and they believed it improved their parenting;led to improved relationships with health care providers;increased the engagement of fathers and support from others in the family;helped mothers build a new social network and support system through the peer engagement components;reduced the risk of stigmatization in the health care setting.
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Affiliation(s)
- Stephanie Redinger
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn L Dovel
- Partners in Hope, Lilongwe, Malawi.,Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Laurie Bruns
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tamsen J Rochat
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rasheed MA, Mughis W, Elahi KN, Hasan BS. A Family-Centered Intervention to Monitor Children's Development in a Pediatric Outpatient Setting: Design and Feasibility Testing. FRONTIERS IN HEALTH SERVICES 2021; 1:739655. [PMID: 36926480 PMCID: PMC10012677 DOI: 10.3389/frhs.2021.739655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022]
Abstract
The patient experience team at a private tertiary care hospital used the Theory of Change to design a family-centered developmental monitoring intervention, building on an ongoing initiative. The design entailed (i) a monitoring form: Survey of Well-Being of Young Children (SWYC) being an easy parent-report measure; (ii) family support intervention: the Care for Child Development module to enhance parent-child interactions; (iii) timing: utilizing wait time to also enhance families' experience; (iv) the service providers: psychology trainees as volunteers; and (v) reinforcement: by the pediatrician in the regular consultation health visit capitalizing on the established rapport with families. All families with children under 5 years 5 months 31 days of age in selected acute, complex, and developmental care clinics were eligible. Feedback from stakeholders indicated that the monitoring process was useful and imparted important information for parents and pediatricians, while the trainees felt the experience to be significant for their own learning. The authors conclude that the designed intervention model for a family-centric approach was acceptable and feasible. Key recommendations have been presented for further scale-up.
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Affiliation(s)
- Muneera A Rasheed
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Waliyah Mughis
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Kinza Naseem Elahi
- Institute of Professional Psychology, Bahria University, Karachi, Pakistan
| | - Babar S Hasan
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
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Prime H, Andrews K, McTavish J, Harris M, Janus M, Bennett T, Gonzalez A. The application of positive parenting interventions to academic school readiness: A scoping review. Child Care Health Dev 2021; 47:1-14. [PMID: 32959921 DOI: 10.1111/cch.12810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Positive parenting interventions were traditionally developed for use in infant and preschool mental health. However, there is increasing application to a broader range of developmental outcomes. A scoping review was conducted to map the landscape of the diverse applications of positive parenting interventions to academic school readiness. METHODS Positive parenting interventions that took place in the early childhood period (prenatal to 6 years) and included an assessment of academic readiness were eligible (i.e., problem-solving/reasoning, language, executive functions and preacademics). The search strategy included four electronic databases from inception to July 2020 and backward/forward searching of the majority of eligible studies. Data charting was completed by double, independent reviewers and included theoretical frameworks, academic readiness outcomes, parenting behaviour targets, populations serviced and methodological approaches used. The synthesis included quantitative descriptives and tabular/visual representations. RESULTS Ninety-nine studies met eligibility criteria. There has been a steady increase in published studies since 2005, with each academic readiness skill represented in varying proportions. Attachment theory was the most commonly referenced framework for applying interventions to academic readiness, with a more recent shift towards biobehavioural frameworks. The majority of studies included parental responsiveness as a parent behaviour target, whereas behavioural management was more commonly used with older children and/or those with social-emotional/behavioural difficulties. Most studies used a selective prevention approach, with low socioeconomic families being the most frequently studied group. Research gaps were identified in the measurement of follow-up and parenting behaviour. CONCLUSION We discuss changing conceptualizations of academic readiness, applications to public health and practice, and future directions in research.
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Affiliation(s)
- Heather Prime
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jill McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Madeleine Harris
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Magdalena Janus
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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da Rosa Piccolo L, Weisleder A, Mendelsohn AL. Promoting Global Early Child Development Through Play: Two Sustainable, Effective Models. Pediatrics 2020; 146:peds.2020-032433. [PMID: 33148770 DOI: 10.1542/peds.2020-032433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Luciane da Rosa Piccolo
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York; and
| | - Adriana Weisleder
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Alan L Mendelsohn
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York; and
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Grantham-McGregor S, Adya A, Attanasio O, Augsburg B, Behrman J, Caeyers B, Day M, Jervis P, Kochar R, Makkar P, Meghir C, Phimister A, Rubio-Codina M, Vats K. Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT. Pediatrics 2020; 146:peds.2020-002725. [PMID: 33148771 PMCID: PMC7786825 DOI: 10.1542/peds.2020-002725] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Poor early childhood development in low- and middle-income countries is a major public health problem. Efficacy trials have shown the potential of early childhood development interventions but scaling up is costly and challenging. Guidance on effective interventions' delivery is needed. In an open-label cluster-randomized control trial, we compared the effectiveness of weekly home visits and weekly mother-child group sessions. Both included nutritional education, whose effectiveness was tested separately. METHODS In Odisha, India, 192 villages were randomly assigned to control, nutritional education, nutritional education and home visiting, or nutritional education and group sessions. Mothers with children aged 7 to 16 months were enrolled (n = 1449). Trained local women ran the two-year interventions, which comprised demonstrations and interactions and targeted improved play and nutrition. Primary outcomes, measured at baseline, midline (12 months), and endline (24 months), were child cognition, language, motor development, growth and morbidity. RESULTS Home visiting and group sessions had similar positive average (intention-to-treat) impacts on cognition (home visiting: 0.324 SD, 95% confidence interval [CI]: 0.152 to 0.496, P = .001; group sessions: 0.281 SD, 95% CI: 0.100 to 0.463, P = .007) and language (home visiting: 0.239 SD, 95% CI: 0.072 to 0.407, P = .009; group sessions: 0.302 SD, 95% CI: 0.136 to 0.468, P = .001). Most benefits occurred in the first year. Nutrition-education had no benefit. There were no consistent effects on any other primary outcomes. CONCLUSIONS Group sessions cost $38 per child per year and were as effective on average as home visiting, which cost $135, implying an increase by a factor of 3.5 in the returns to investment with group sessions, offering a more scalable model. Impacts materialize in the first year, having important design implications.
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Affiliation(s)
| | - Akanksha Adya
- Department of Anthropology, Psychology and Sociology, University of West Georgia, Carrollton, Georgia;,Centre for Early Childhood Education and Development at Ambedkar University, Delhi, India
| | - Orazio Attanasio
- Department of Economics, Yale University, New Haven, Connecticut;,Institute for Fiscal Studies, London, United Kingdom;,National Bureau of Economic Research, Cambridge, Massachusetts;,Abdul Latif Jameel Poverty Action Laboratory, Cambridge, Massachusetts
| | | | - Jere Behrman
- Department of Economics and Sociology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bet Caeyers
- Institute for Fiscal Studies, London, United Kingdom
| | - Monimalika Day
- Centre for Early Childhood Education and Development at Ambedkar University, Delhi, India
| | - Pamela Jervis
- Institute for Fiscal Studies, London, United Kingdom;,Department of Industrial Engineering, Universidad de Chile, Chile, South America;,Center for Research in Inclusive Education, Chile
| | - Reema Kochar
- Centre for Early Childhood Education and Development at Ambedkar University, Delhi, India
| | | | - Costas Meghir
- Department of Economics, Yale University, New Haven, Connecticut;,Institute for Fiscal Studies, London, United Kingdom;,National Bureau of Economic Research, Cambridge, Massachusetts;,Abdul Latif Jameel Poverty Action Laboratory, Cambridge, Massachusetts
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Francis T, Baker-Henningham H. Design and Implementation of the Irie Homes Toolbox: A Violence Prevention, Early Childhood, Parenting Program. Front Public Health 2020; 8:582961. [PMID: 33304875 PMCID: PMC7701241 DOI: 10.3389/fpubh.2020.582961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
This paper describes the development of the Irie Homes Toolbox, a violence prevention program targeting parents of children aged two to six years. The intervention was designed to complement an existing, teacher-training, violence prevention program, the Irie Classroom Toolbox, thus promoting an integrated approach across home and school settings. The Irie Homes Toolbox was developed through a four-stage process by integrating data from theory, formative research, and practice to ensure the intervention is acceptable, feasible, relevant, and effective in the context. The perspectives of Jamaican preschool teachers and parents of preschool children, who are the end users, were integrated into the design of the intervention throughout the development process. Stage one involved integrating theory and formative research to inform the initial intervention design. Stages two and three involved iterative cycles of design, implementation and evaluation of the intervention content, process of delivery, structure and materials. Stage four involved a further cycle of learning through a process evaluation conducted as part of a cluster-randomized controlled trial. Data from each of these four stages was used to inform the design and ongoing revisions of the toolbox with the aim of developing a low-cost, scalable and sustainable intervention for the Jamaican context. The resulting program is theory-informed and uses empirically derived content and behavior change principles operationalized for the context in which it will be delivered. The Irie Homes Toolbox is suitable for integration into the existing preschool provision in Jamaica, thus utilizing an existing service and existing staff and increasing the likelihood for wide-scale dissemination.
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Affiliation(s)
- Taja Francis
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Helen Baker-Henningham
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
- School of Psychology, Bangor University, Bangor, United Kingdom
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Clark GF, Kingsley KL. Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years. Am J Occup Ther 2020; 74:7403397010p1-7403397010p42. [PMID: 32365324 DOI: 10.5014/ajot.2020.743001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.
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Affiliation(s)
- Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, FAOTA, is an occupational therapist in private practice, Adel, Iowa;
| | - Karrie L Kingsley
- Karrie L. Kingsley, OTD, OTR/L, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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McCormick BJJ, Caulfield LE, Richard SA, Pendergast L, Seidman JC, Maphula A, Koshy B, Blacy L, Roshan R, Nahar B, Shrestha R, Rasheed M, Svensen E, Rasmussen Z, Scharf RJ, Haque S, Oria R, Murray-Kolb LE. Early Life Experiences and Trajectories of Cognitive Development. Pediatrics 2020; 146:e20193660. [PMID: 32817437 PMCID: PMC7461241 DOI: 10.1542/peds.2019-3660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Stephanie A Richard
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | - Zeba Rasmussen
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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Smith JD, Cruden GH, Rojas LM, Van Ryzin M, Fu E, Davis MM, Landsverk J, Brown CH. Parenting Interventions in Pediatric Primary Care: A Systematic Review. Pediatrics 2020; 146:e20193548. [PMID: 32581000 PMCID: PMC7329253 DOI: 10.1542/peds.2019-3548] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 01/13/2023] Open
Abstract
CONTEXT More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.
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Affiliation(s)
- Justin D Smith
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | | | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Emily Fu
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew M Davis
- Division of Academic General Pediatrics, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Hamadani JD, Mehrin SF, Tofail F, Hasan MI, Huda SN, Baker-Henningham H, Ridout D, Grantham-McGregor S. Integrating an early childhood development programme into Bangladeshi primary health-care services: an open-label, cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2020; 7:e366-e375. [PMID: 30784637 DOI: 10.1016/s2214-109x(18)30535-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor development in young children in developing countries is a major problem. Child development experts are calling for interventions that aim to improve child development to be integrated into health services, but there are few robust evaluations of such programmes. Previous small Bangladeshi trials that used individual play sessions with mothers and their children (at home or in clinics), which were predominantly run by employed women, found moderate improvements on child development. We aimed to integrate an early childhood development programme into government clinics that provide primary health care and to evaluate the effects of this intervention on child cognition, language, and motor development, growth, and behaviour in a subsample of the children. METHODS In this open-label cluster-randomised controlled trial, we recruited individuals from community clinics in Narsingdi district, Bangladesh. These clinics were randomly selected from a larger sample of eligible clinics, and they were assigned (1:1) to either deliver an intervention of 25 sessions, in which mothers of eligible children were shown how to support their child's development through play and interactions, or to deliver no intervention (control group). Participants were underweight children, defined as a weight-for-age Z score of -2 SDs of the WHO standard, who were aged 5-24 months and who lived near the clinic (defined as a walk of less than 30 min). Government health workers ran these sessions at the clinics as part of their routine work, and mothers and children attended fortnightly in pairs (instead of individual weekly home visits that were specified in the original programme). A subsample of children from each clinic was randomly selected for impact evaluation, and these children were assessed on the Bayley Scales of Infant and Toddler Development for their cognitive, language, and motor performance and for their behaviour with Wolke's ratings, before and after implementation of the intervention. The primary outcomes were the performance of this evaluation subsample on the Bayley and Wolke scales and their anthropometric measurements (weight, length or height, and head circumference) after 1 year of the intervention. This study is registered with ClinicalTrials.gov, number NCT02208531. FINDINGS Between Nov 29, 2014, and April 30, 2015, 12 054 children in 90 clinics were screened, and between six and 25 underweight children were enrolled from each clinic. From the 2423 (20%) underweight children, we excluded 656 (27%) children who lived more than 30-min walking distance from the community clinics, and 30 (1%) children whose mothers did not consent to participate. We therefore enrolled 1737 (72%) children from these 90 clinics. After randomisation, the control group clinics included 878 (51%) children (who all received no intervention) and the intervention group clinics included 859 (49%) children (who all received the child development programme sessions). Eight children from each clinic (360 [41%] children from the control group clinics and 358 [42%] children from the intervention group clinics) were randomly selected for inclusion in the evaluation subsample. Between Feb 24, 2016, and Sept 7, 2016, 344 (96%) children in control group clinics and 343 (96%) children in intervention group clinics were assessed for the primary outcome. 16 (5%) children in the control group clinics and 15 (4%) children in the intervention group clinics did not provide all data and were not included in final analyses. An intention-to-treat analysis showed that the intervention significantly improved children's cognition (effect size 1·3 SDs, 95% CI 1·1 to 1·5; p=0·006), language (1·1 SDs, 0·9 to 1·2; p=0·01), and motor composite scores (1·2 SDs, 1·0 to 1·3; p=0·006) and behaviour ratings (ranging from 0·7 SDs, 0·5 to 0·9; p=0·02; to 1·1 SDs, 1·0 to 1·2; p=0·007), but the intervention had no significant effect on growth (p values ranged from 0·05 to 0·74). Three (1%) children in the intervention group died, but their deaths were not related to the intervention. INTERPRETATION The extent and range of benefits of our intervention are encouraging. Health workers ran most of the sessions effectively and attendance was good, which is promising for scale-up of the intervention model. However, researchers trained and supervised the health workers, and the next step will be to determine whether the Bangladeshi ministry of health can perform these tasks. In future programmes, more attention needs to be paid to the nutrition of the children. FUNDING Grand Challenges Canada (Saving Brains).
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Affiliation(s)
- Jena D Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Syeda F Mehrin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad I Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Deborah Ridout
- UCL Great Ormond Street Institute of Child Health, London, UK
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