Child development in rural Ghana: Associations between cognitive/language milestones and indicators of nutrition and stimulation of children under two years of age

Reading, singing, and storytelling: the impact of caregiver-child interaction and child access to books and preschool on early childhood development in Ghana

Optimal early childhood development (ECD) is crucial in shaping future academic and economic accomplishments. Recognising its profound influence, the United Nations has included a specific target and indicator related to ECD in the Sustainable Development Goals to ensure universal access to high-quality ECD for all preschoolers by 2030. This study investigated whether caregiver-child engagements, early stimulation, and learning opportunities are associated with ECD among children aged 36-59 months. Data on 6752 children were pooled from the 2011 and 2017 Ghana Multiple Indicator Cluster Surveys. The ECD outcomes of interest were literacy-numeracy, social-emotional, learning-cognitive, and physical development, measured with UNICEF's Early Childhood Development Index (ECDI). Binary logistic regression assessed the effects of various caregiver-child engagements and early learning opportunities on the ECD outcomes. We found that most children were developmentally on track in the physical (95.0%) and learning-cognitive (86.4%) domains, but fewer were on track in the literacy-numeracy (36.7%) and social-emotional (68.6%) domains. Reading to or with a child (aOR 1.72; 95% CI 1.35-2.19), telling them stories (aOR 1.61; 95% CI 1.26-2.04), counting or drawing with them (aOR 1.63; 95% CI 1.30-2.04) and a child's attendance at preschool (aOR 4.62; 95% CI 3.34-6.38) were associated with a higher odds for on track literacy-numeracy development. Playing with a child was associated with higher odds of on-track social-emotional development (aOR 1.29; 95% CI 1.04-1.59), physical development (aOR 1.61; 95% CI 1.01-2.55), and learning-cognitive development (aOR 1.51; 95% CI 1.14-2.00). However, singing songs to or with a child (aOR 0.78; 95% CI 0.62-0.89) and taking a child outside the home (aOR 0.78; 95% CI 0.64-0.95) were associated with lower odds for on track social-emotional development. Access to children's books at home was associated with higher odds for on track literacy-numeracy and social-emotional development. In subgroup analysis, some observed associations varied depending on a child's residence (urban or rural). Our findings confirmed that caregiver-child  interaction and early learning opportunities could increase a child's likelihood of achieving early developmental milestones.

The home language environment in rural China: variations across family characteristics

BACKGROUND

A rich language environment is an important element of a nurturing home environment. Despite their proven importance, vocabulary and conversation have been shown to vary widely across households-even within the same socio-economic class. One significant gap in the existing literature is its nearly exclusive geographic focus on Western and developed settings, with little attention given to poorer communities in lower/middle income countries. The purpose of this study was to empirically illustrate the characteristics of the home language environment in the low SES, non-Western cultural setting of rural China.

METHODS

Using Language Environment Analysis (LENA) automated language-analysis system, this study measured the home language environment of 38 children aged 20-27 months in Northwest rural China. Our primary measures of the home language environment were Adult Word Count (AWC), Conversational Turn Count (CTC) and Child Vocalization Count (CVC). Multivariate linear regression models were used to examine the association between home language environment and family/child characteristics, and language skills (Measured by MacArthur-Bates Communicative Developmental Inventory score).

RESULTS

In this paper, by comparison, we found that the home language environment of our rural sample fell far behind that of urban households. We also identify significant, positive correlations between language skills and both AWC and CTC. Our analysis finds no significant correlations between home language environment and family/child characteristics.

CONCLUSION

In this paper, we present the first ever findings using the LENA system to measure the home language environment of young children from poor rural communities in China. We found that the home language environment of lower-SES household was significantly worse than high-SES households, and demonstrated the importance of the home language environment to language skills, pointing to a need for more high-quality studies of the home language environment in rural China to better understand possible mechanisms behind low levels of parent-child language engagement and ways to improve the home language environment.

Family medicine residency training in Ghana after 20 years: resident attitudes about their education

Objective

In addition to assessing educational needs of family medicine trainees in Ghana, we sought to assess whether those entering the training programme aimed to pursue an academic career.

Design

A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan.

Setting

The family medicine postgraduate trainees and the most recent graduates in the three training sites, Accra, Kumasi and Mampong, as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018.

Participants

Second and third year family medicine residents, fellows (known as senior residents in Ghana) and recent graduates were invited to participate in this study. Thirty-five of 77 eligible subjects provided responses (46% response rate), but five records were eliminated due to incomplete data to yield a survey completion rate of 39% (30/77).

Result

Participants were mostly men (n=19), and the average age of respondents was 37 years old. The participants indicated the residency programmes needed more faculty 97% (n=29), supervision during outpatient care 87% (n=26) and lectures 83% (n=25). The main reason provided by respondents for entering residency programme in family medicine, which is currently not required for practising primary care in Ghana, was to obtain more education 93% (n=28). Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency (p <0.001).

Conclusion

The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme. These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.

Relationships between dietary diversity and early childhood developmental outcomes in rural China

The period from birth to 2years of age is highly sensitive with respect to the relationship between nutrition and neurodevelopment, but data regarding the association between dietary diversity and early childhood neurodevelopment are limited. We sought to examine the association of two feeding indicators-minimum dietary diversity (MDD) and minimum meal frequency (MMF)-with the neurodevelopment of children aged 6-23 months, using data from a cross-sectional survey conducted in six rural counties in China. Data on 1,534 children were analysed using logistic regression to explore the associations between dietary diversity and early neurodevelopment, with adjustments for the age, sex and prematurity of the child; the age, sex and educational level of the caregiver; and family size, income and simulative care practices and resources. We found that 32.4% of children had suspected developmental delays based on the Chinese version of the Ages and Stages Questionnaires Version 3, whereas 77.0% and 39.2% failed to meet the MDD and MMF, respectively. Meeting the MDD was associated with a 39% lower risk of developmental delays (AOR = 0.61, 95% CI [0.43, 0.86]). There was a significant association between MDD and reduced likelihood of developmental delays in gross motor, fine motor, problem-solving and personal social subscales, whereas MMF was only associated with a lower risk of developmental delays in the gross motor subscale (AOR = 0.63, 95% CI [0.42, 0.94]). We observed an inverse dose-response relationship between the number of food groups consumed and the risk of developmental delays (P < .001).

Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2⁻6 Years of Age

In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2⁻6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio > 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions.