Potential Risk Factors of Developmental Cognitive Delay in the First Two Years of Life

How did the use of the social marketing approach in Egyptian communities succeed in improving breastfeeding practices and infants' growth?

INTRODUCTION

Improving breastfeeding practices does not always link to interventions relying only on improving nutrition awareness and education but needs cultural and behavioral insights .

AIM

This study aimed to evaluate the changes in core breastfeeding indicators as a result of the use of social marketing (SM) approach for improving breastfeeding practices of Egyptian women and the physical growth of infants aged 6 to 12 months. The core breastfeeding indicators were: Early initiation of breastfeeding within one hour of birth, Predominant and exclusive breastfeeding to 6 months (EBF), Bottle feeding with formula, continued breastfeeding to 1 and 2 years, and responsiveness to cues of hunger and satiety.

METHODS

A quasi-experimental longitudinal study with a posttest-only control design was done over 3 years in three phases; the first was in-depth interviews and formative research followed by health education and counseling interventions and ended by measuring the outcome. Motivating mothers' voluntary behaviors toward breastfeeding promotion "feeding your baby like a baby" was done using SM principles: product, price, place, and promotion. The interventions targeted 646 pregnant women in their last trimester and delivered mothers and 1454 women in their childbearing period. The statistical analysis was done by using SPSS program, version 26.

RESULTS

Most mothers showed significantly increased awareness about the benefits of breastfeeding and became interested in breastfeeding their children outside the house using the breastfeeding cover (Gawn) (p < 0.05). Breastfeeding initiation, exclusive breastfeeding under 6 months, frequency of breastfeeding per day, and percentage of children who continued breastfeeding till 2 years, were significantly increased (from 30%, 23%, 56%, and 32% to 62%, 47.3%, 69%, and 43.5% respectively). The girls who recorded underweight results over boys during the first year of life were significantly improved (p < 0.01) after the intervention (from 52.1% to 18.8% respectively). At the same time, girls found to be obese before the intervention (15.6%) became no longer obese.

CONCLUSIONS

Improvement for the majority of the key breastfeeding indicators and physical growth of infants indicates that raising a healthy generation should start by promoting breastfeeding practices that are respectable to societal norms.

Evaluation of apparently healthy Egyptian infants and toddlers on the bayley-III scales according to age and sex

BACKGROUND

Child development is shaped throughout the first years of life through the interaction of genetics and the environment. Bayley-III is valuably used to determine early developmental delay (DD). The aim of this study was to detect the differences in performance of a sample of apparently healthy Egyptian infants and toddlers on the Bayley-III scales in relation to their age and gender.

METHODS

This was a cross-sectional study. Bayley scales were applied to 270 of the 300 recruited children following the inclusion criteria; to avoid potential risk factors affecting development. Assessment included cognitive, language and motor skills. Engaged children aged 18-42 months were divided into 4 age groups with six-month intervals.

RESULTS

Approximately 78.4%, 76.2%, and 72% of the participants had average and above average scores in the cognitive, motor, and language domains, respectively. The language domain was characteristically impacted. The oldest age group (36-42 months) scored the highest means composite scores, while the 2nd group aged 24 - <30 months, scored the lowest means in the three evaluated domains. In general, girls had non-significantly higher composite scores than boys, with a small effect size (d = 0.2-0.4). In the language domain, girls aged 30 to < 36 months scored significantly higher composite scores than boys (p < 0.05), with a medium effect size (d = 0.73).

CONCLUSION

The study indicates that the performance of apparently healthy Egyptian children on the Bayley III evaluation differs in relation to age and sex. The most vulnerable age group at potential risk of DD was children aged 24-30 months. Efforts must be directed to investigate the nutritional, physical, psychological and safety needs of this group. Attention must be paid to early childhood intervention programs that stimulate development, especially language development, and they must be tailored on the basis of age and gender. Gender-specific norms may be needed in the evaluation of language development.

Factors Affecting Thai Fathers' Self-Efficacy to Support Exclusive Breastfeeding

BACKGROUND

Breastfeeding is the ideal approach for feeding infants and is an important public health consideration. Successful exclusive breastfeeding initiation and duration is influenced by fathers' support. Paternal self-efficacy to support breastfeeding has also been shown to mediate infant feeding practices. The aim of this study was to investigate factors associated with Thai fathers' self-efficacy to support maternal exclusive breastfeeding.

METHODS

We adopted a cross-sectional survey design for this study. In total, 215 Thai fathers who had a partner with a term (37-42 weeks) pregnancy participated in the study. Data were collected from antenatal care clinics at two hospitals in Northern Thailand between June and August 2022. Participants completed a sociodemographic questionnaire, the Fathers' Attitude toward Exclusive Breastfeeding questionnaire, the Fathers' Knowledge about Exclusive Breastfeeding questionnaire, and the Breastfeeding Self-Efficacy Scale (Short-Form). Multiple linear regression and hierarchical regression were used to analyze factors influencing Thai fathers' self-efficacy to support maternal exclusive breastfeeding.

RESULTS

The mean breastfeeding self-efficacy score was 52.94 (SD = 8.58), indicating that fathers were confident they were able to support their partners' breastfeeding. Regression analysis revealed family type, fathers' attitude toward, and fathers' knowledge about exclusive breastfeeding significantly explaining 14.90% of the variance in paternal breastfeeding support self-efficacy. However, fathers' age, education, employment, income, and number of living children were not associated with their self-efficacy.

CONCLUSIONS

The results demonstrated that family type and fathers' attitudes/knowledge about breastfeeding influenced their self-efficacy to support exclusive breastfeeding. Nurses should consider implementing breastfeeding interventions specific to fathers to enhance their attitudes and knowledge about breastfeeding, including increasing fathers' self-efficacy to support maternal exclusive breastfeeding efforts.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

BACKGROUND

Child disability has significant implications on their well-being and healthcare systems.

AIM

This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

METHODS

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

RESULTS

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1-1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2-30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5-6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3-5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1-12.1 & AOR = 3.7, 95% CI: 1.7-7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2-10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

CONCLUSION

The study found a high prevalence of disability among Egyptian children aged 1-6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

Background

Child disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.

Methods

A national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.

Results

The percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1–1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2–30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5–6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3–5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1–12.1 & AOR = 3.7, 95% CI: 1.7–7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2–10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.

Conclusion

The study found a high prevalence of disability among Egyptian children aged 1–6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs

AIM

This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children's future capabilities.

METHODS

Vineland Adaptive Behavior Scales" was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance.

RESULTS

Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18-5.88), male gender (AOR = 1.86; 95% CI: 1.65-2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40-2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34-2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29-1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24-1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24-1.58).

CONCLUSION

The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children's life skills promotion for achieving the most sustainable effects on children's biological and psychological health and well-being.

National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs

Aim

This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children’s future capabilities.

Methods

Vineland Adaptive Behavior Scales” was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance.

Results

Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18–5.88), male gender (AOR = 1.86; 95% CI: 1.65–2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40–2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34–2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29–1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24–1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24–1.58).

Conclusion

The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children’s life skills promotion for achieving the most sustainable effects on children’s biological and psychological health and well-being.

A national screening for the prevalence and profile of disability types among Egyptian children aged 6-12 years: a community-based population study

AIM

This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6-12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors.

METHODS

A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities.

RESULTS

The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5-3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1-2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2-7.1 & AOR = 1.6, 95% CI:1.1-2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%.

CONCLUSION

The study found a high prevalence of disability among Egyptian children aged 6-12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.

A national screening for the prevalence and profile of disability types among Egyptian children aged 6–12 years: a community-based population study

Aim

This study aimed to determine the prevalence of disability domains among Egyptian children in the age group of 6–12 years as well as assess their socio-demographic, epidemiological, and perinatal predictors.

Methods

A national population-based cross-sectional household survey targeting 20,324 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for the identification of disabilities.

Results

The prevalence of children with at least one type of disability was 9.2%. Learning/ comprehension was the most prevalent type (4.2%), followed by speech/communication (3.7%), physical/ mobility and seizures (2.2% for each), intellectual impairment (1.5%), visual (0.7%), and hearing (0.4%). The commonest predictors for disabilities were children who suffered from convulsions or cyanosis after birth and maternal history of any health problem during pregnancy. However, preterm and low birth weight (LBW) babies or being admitted to incubators for more than two days were strong predictors for all disabilities except hearing disability. A history of jaundice after birth significantly carried nearly twice the odds for seizures (AOR = 2.2, 95% CI:1.5–3.4). History of difficult labor was a predictor of intellectual impairment (AOR = 1.5, 95% CI:1.1–2.0). A disabled mother was a strong predictor for all disabilities except seizures, while a disabled father was a predictor for visual and learning/ comprehension disabilities (AOR = 3.9, 95% CI:2.2–7.1 & AOR = 1.6, 95% CI:1.1–2.4 respectively). Meanwhile, both higher maternal and paternal education decreased significantly the odds to have, physical/ mobility and Learning/ comprehension by at least 30%.

Conclusion

The study found a high prevalence of disability among Egyptian children aged 6–12 years. It spotted many modifiable determinants of disability domains. The practice of early screening for disability is encouraged to provide early interventions.

National screening for Egyptian children aged 1 year up to 12 years at high risk of Autism and its determinants: a step for determining what ASD surveillance needs

This study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%-3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8-4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35-2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23-1.89) carried higher odds of being at high risk of ASD.

National screening for Egyptian children aged 1 year up to 12 years at high risk of Autism and its determinants: a step for determining what ASD surveillance needs

This study aimed to provide a national estimate of the prevalence of the high risk of autism spectrum disorder (ASD) and their determinants. A national screening survey was conducted for 41,640 Egyptian children aged 1 to 12 years in two phases. Tools used were Vineland's Adaptive Behavior Scales, Modified Checklist for Autism in Toddlers, Gilliam Autism Rating scale, and Denver II Developmental screening test. The overall prevalence of children at high risk of ASD was 3.3% (95% CI:3.1%–3.5%). Children living without mothers in homes, suffered from convulsions (AOR = 3.67; 95%CI:2.8–4.8), a history of cyanosis after birth (AOR = 1.87; 95% CI:1.35–2.59) or history of LBW babies (AOR = 1.53; 95% CI:1.23–1.89) carried higher odds of being at high risk of ASD.

Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach

Background

Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents’ beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.

Methods

An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan “ enjoy meals like a baby”. The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.

Results

There was marked and significant improvement in the awareness and of the majority of the weaning practices’ indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3–5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the “Minimum Dietary Diversity” (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).

Conclusion

Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.

Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach

BACKGROUND

Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents' beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.

METHODS

An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan " enjoy meals like a baby". The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.

RESULTS

There was marked and significant improvement in the awareness and of the majority of the weaning practices' indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3-5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the "Minimum Dietary Diversity" (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).

CONCLUSION

Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.

Cognitive and Mental Health of Young Mothers' Offspring: A Meta-analysis

BACKGROUND AND OBJECTIVES

The nature and magnitude of the cognitive and mental health risks among the offspring of young mothers is not fully understood. Our objective is to examine the risk of mental disorders in these offspring.

METHODS

Five databases (Medline, Embase, Web of Science, PsycINFO, and CINAHL) were searched from their inceptions until February 2022. Studies were eligible if they assessed offspring of young mothers (&lt;21 years), contained a control group, and assessed any cognitive and/or mental health outcomes. Random-effects meta-analysis was used to generate standardized mean differences (SMDs) in infants (0-3 years), children (4-9), adolescents (10-19), and adults (20+). Methodological bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

51 outcomes were meta-analyzed. Levels of cognitive and learning problems were higher among the infants (SMD = 0.30 [95% confidence interval 0.0-0.55]) and adolescents (SMD = 0.43 [0.24 to 0.62]) of young mothers. Adolescents had more symptoms of delinquency (SMD = 0.24 [0.12 to 0.36]). As adults, they are more often convicted of violent crimes (SMD = 0.36 [0.22 to 0.50]). Internalizing symptoms were higher in these offspring in childhood (SMD = 0.29 [0.14 to 0.45]) and adulthood (SMD = 0.35 [0.34 to 0.36]). This review uses unadjusted data and is thus unequipped to infer causality. Studies have high attrition and rely heavily on self-report.

CONCLUSIONS

Young mothers' offspring have more cognitive, externalizing, and internalizing problems across the lifespan than individuals born to mothers ≥21 years of age. They may benefit from early detection and support.

A national prevalence and profile of single and multiple developmental delays among children aged from 1 year up to 12 years: an Egyptian community-based study

Objective

This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs’ associated risk and protective factors.

Methods

A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics’ specialists.

Results

The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively).

Conclusions

The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.

A national prevalence and profile of single and multiple developmental delays among children aged from 1 year up to 12 years: an Egyptian community-based study

OBJECTIVE

This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs' associated risk and protective factors.

METHODS

A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics' specialists.

RESULTS

The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively).

CONCLUSIONS

The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.

Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar

Background

Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention.

Methods

Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk.

Results

Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68).

Conclusions

Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00456-x.

A comparison of the performance of normal middle social class Egyptian infants and toddlers with the reference norms of the Bayley Scales -third edition (Bayley III): A pilot study

BACKGROUND

Developmental assessment is an important facility for early detection and intervention of developmental delay in children. Objective: to assess the performance of a sample of middle social class Egyptian infants and toddlers on Bayley Scales of Infant and Toddler Development-third edition (Bayley III), and to compare their cognitive, motor, and communication scores with that of the reference norms.

METHODS

It was a cross-sectional pilot study, included 270 children aged 18-42 months. Mothers filled a questionnaire including questions about family socioeconomic background, perinatal history, and family history. Physical examination and growth assessment of children were performed. Developmental assessment of cognitive, language and motor skills was performed using the Bayley III scales and compared the American norm scores with the Egyptian mean scores.

RESULTS

The mean cognitive, language and motor composite scores were 92.5+18.5, 91.76+ 15.6, and 95.67+18.9 respectively. All were lower than the American mean (100+ 15) with highly significant differences. About one-fourth of the enrolled Egyptian children had below-average composite scores according to the US cutoff point. The ranks of Egyptian children on the American versus the Egyptian percentile curves were significantly different.

CONCLUSION

Mean values of all assessed developmental domains of Egyptian children are within the norm-referenced average of Bayley III, but lower than the recorded American mean. Assessing Egyptian children according to the American norms may result in overestimating developmental delay. This pilot study raised the question about using different cutoff points suitable for the developmental trajectory of Egyptian children. Answering this question needs further studies on Bayley-III after cultural adaptation and standardization, using a larger, more diverse, and representative sample of the Egyptian population.

A comparison of the performance of normal middle social class Egyptian infants and toddlers with the reference norms of the Bayley Scales -third edition (Bayley III): A pilot study

Background

Developmental assessment is an important facility for early detection and intervention of developmental delay in children. Objective: to assess the performance of a sample of middle social class Egyptian infants and toddlers on Bayley Scales of Infant and Toddler Development-third edition (Bayley III), and to compare their cognitive, motor, and communication scores with that of the reference norms.

Methods

It was a cross-sectional pilot study, included 270 children aged 18–42 months. Mothers filled a questionnaire including questions about family socioeconomic background, perinatal history, and family history. Physical examination and growth assessment of children were performed. Developmental assessment of cognitive, language and motor skills was performed using the Bayley III scales and compared the American norm scores with the Egyptian mean scores.

Results

The mean cognitive, language and motor composite scores were 92.5+18.5, 91.76+ 15.6, and 95.67+18.9 respectively. All were lower than the American mean (100+ 15) with highly significant differences. About one-fourth of the enrolled Egyptian children had below-average composite scores according to the US cutoff point. The ranks of Egyptian children on the American versus the Egyptian percentile curves were significantly different.

Conclusion

Mean values of all assessed developmental domains of Egyptian children are within the norm-referenced average of Bayley III, but lower than the recorded American mean. Assessing Egyptian children according to the American norms may result in overestimating developmental delay. This pilot study raised the question about using different cutoff points suitable for the developmental trajectory of Egyptian children. Answering this question needs further studies on Bayley-III after cultural adaptation and standardization, using a larger, more diverse, and representative sample of the Egyptian population.

Assessing the Effective Communication Channels to Reduce Child and Adolescent Marriage in Rural Communities of Egypt

BACKGROUND: Low levels of scholarly achievement, poverty, and geographical isolation are all known to be linked to early marriage. AIM: This study aimed at identifying the most credible and the best-suited communication channels (CCs) to reach rural communities for motivating them to reduce child and adolescent marriage. METHODS: This study was a community-based cross-sectional systematic formative research. The study targeted 1000 wives who were ever married women in childbearing period aged 15–49 years and their husbands in 21 rural village units of two governorates of Upper Egypt through questionnaires. Decisions concerning the choice of the best-suited CCs were based on their reach, frequency, managerial feasibility, and effectiveness. The investigated CCs included: modern social media (search browser engine/Facebook group and/or twitter/YouTube or messaging through WhatsApp or any mobile app), traditional mass media (T.V/Radio/Reading), and interpersonal communication (talk with religious leaders/partners/friends/doctors/health promoters). Comparisons between different CCs were done using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A vast majority of the surveyed wives (96.6%) were married at an age ranging from 15 to 24 years. The spread of social media through smartphones was limited to only one-third of wives and their husbands through mainly searching on YouTube (31.7% of wives and 27.8% of husbands). Television was the most accessible means of mass media for both wives and husbands (72.5% and 63.3%, respectively). The most credible and the best-suited CCs methods for wives were talking with the health promotors and doctors with 2 times significantly higher (OR = 2.0, CI = 1.7–2.4 for each one) than that with the search on YouTube and 3 times significantly higher (OR = 3.1, CI = 2.5–3.7 and OR = 3.1, CI = 2.6–3.8, respectively) than that for social media using browser engine. For husbands, the odds of the most credible and the best-suited CCs methods were more than 1½ times higher for the talk with the health promotors than the search on You Tube (OR = 1.6, CI = 1.3–2.0) or the search using browser engine (OR = 1.6, CI = 1.3–1.9), Whereas the odds were one and a third higher for the talk with the doctor than the search on You Tube (OR = 1.3, CI = 1.1–1.6) or the search using browser engine (OR = 1.6, CI= 1.1–1.6). Significant difference was detected in favor of the traditional media as the most credible source of information only for wives’ intention to postpone their children early marriage. CONCLUSIONS: Despite the availability of recent social media worldwide, rural communities with high illiteracy have limited access to the internet and limited availability of smartphones. Interpersonal communication is considered their most effective CCs for achieving equity in reducing child marriage. It seems vital during the implementation of any strategies toward reproductive health to use not only the media broadcasts, but also to rely on the channels that are most credible and suitable for the targeted communication to support meeting the unmet need.

Assessing the Effective Communication Channels to Reduce Child and Adolescent Marriage in Rural Communities of Egypt

BACKGROUND: Low levels of scholarly achievement, poverty, and geographical isolation are all known to be linked to early marriage. AIM: This study aimed at identifying the most credible and the best-suited communication channels (CCs) to reach rural communities for motivating them to reduce child and adolescent marriage. METHODS: This study was a community-based cross-sectional systematic formative research. The study targeted 1000 wives who were ever married women in childbearing period aged 15–49 years and their husbands in 21 rural village units of two governorates of Upper Egypt through questionnaires. Decisions concerning the choice of the best-suited CCs were based on their reach, frequency, managerial feasibility, and effectiveness. The investigated CCs included: modern social media (search browser engine/Facebook group and/or twitter/YouTube or messaging through WhatsApp or any mobile app), traditional mass media (T.V/Radio/Reading), and interpersonal communication (talk with religious leaders/partners/friends/doctors/health promoters). Comparisons between different CCs were done using odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A vast majority of the surveyed wives (96.6%) were married at an age ranging from 15 to 24 years. The spread of social media through smartphones was limited to only one-third of wives and their husbands through mainly searching on YouTube (31.7% of wives and 27.8% of husbands). Television was the most accessible means of mass media for both wives and husbands (72.5% and 63.3%, respectively). The most credible and the best-suited CCs methods for wives were talking with the health promotors and doctors with 2 times significantly higher (OR = 2.0, CI = 1.7–2.4 for each one) than that with the search on YouTube and 3 times significantly higher (OR = 3.1, CI = 2.5–3.7 and OR = 3.1, CI = 2.6–3.8, respectively) than that for social media using browser engine. For husbands, the odds of the most credible and the best-suited CCs methods were more than 1½ times higher for the talk with the health promotors than the search on You Tube (OR = 1.6, CI = 1.3–2.0) or the search using browser engine (OR = 1.6, CI = 1.3–1.9), Whereas the odds were one and a third higher for the talk with the doctor than the search on You Tube (OR = 1.3, CI = 1.1–1.6) or the search using browser engine (OR = 1.6, CI= 1.1–1.6). Significant difference was detected in favor of the traditional media as the most credible source of information only for wives’ intention to postpone their children early marriage. CONCLUSIONS: Despite the availability of recent social media worldwide, rural communities with high illiteracy have limited access to the internet and limited availability of smartphones. Interpersonal communication is considered their most effective CCs for achieving equity in reducing child marriage. It seems vital during the implementation of any strategies toward reproductive health to use not only the media broadcasts, but also to rely on the channels that are most credible and suitable for the targeted communication to support meeting the unmet need.

Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study

BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years. AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village. METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence. RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains. CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.

Determinants Influencing Awareness and Healthy Practices among a Sample of Insulin-dependent Diabetic Egyptian Patients: A Rural Community-based Study

BACKGROUND: The prevalence of diabetes mellitus (DM) is predicted to increase over the coming years. AIM: The objectives of the study were to measure the level of awareness and healthy practices related to five healthy domains and assess the effect of different demographic characteristics, glycated hemoglobin (HbA1c) level, and body mass index (BMI) on these levels among diabetic patients in a rural Egyptian village. METHODS: A cross-sectional study was done on 300 selected insulin-dependent diabetic patients resident in an Egyptian village. Data were collected using a questionnaire covering five domains: General disease awareness and management compliance practice, check-up, foot care, diet, and physical activity. HbA1c and BMI were also measured as an impact of the management adherence. RESULTS: The study found that more than three quarters of the participants (82.0%) were uncontrolled or poorly uncontrolled (HbA1c >8) diabetics and 76.0% were either obese or morbidly obese. Total awareness and practices percentage scores were low (42.4 ± 16.8% and 40.5 ± 12.3%, respectively). The linear regression model showed that high educational level had significantly positive effects on both the total awareness and practice scores as well as their domains. The study found that female participants and those having relatives with DM had significantly higher diet awareness and practice scores (p < 0.05). Younger age had significantly higher scores on foot care and diet awareness scores, physical activity, general disease awareness, and management compliance practices domains. CONCLUSION: The studied awareness and practice domains were inadequate. Their improvement is cornerstones to impact glycemic control of diabetics and control their health risks, especially in rural communities.

The Effect of Parenting Quality on Child Development at 36-48 Months in China's Urban Area: Evidence from a Birth Cohort Study

Environmental exposures, especially parenting quality, are critical for later child development. This study aimed to determine the status of parenting quality and suspected development delay of preschool children in China's urban area and explore the associations between these two factors. The research was based on a birth cohort study conducted in Changsha, Hunan province, China. We used the Parenting Assessment Tool and Ages and Stages Questionnaires, Third Edition (ASQ-3), to measure parenting quality and child development status, respectively. Other data were collected from maternal health manuals and self-administered questionnaires during the follow-up period. The generalized estimating equation was used to examine whether parenting quality was significantly associated with child development outcomes. In the study, good parenting quality was 33.6% measured at 18 months, and suspected development delay was below 10% at 36-48 months among urban China; we observed negative associations between parenting quality scores and child development scores; poor parenting quality had a negative association with suspected development delay [OR and 95% CI: 2.74 (1.17, 6.40)], girls [OR and 95% CI: 0.33 (0.16, 0.69)] and maternal education years (>12 years) [OR and 95% CI: 0.27 (0.12, 0.64)] were protective factors for suspected development delay. Our findings highlighted the importance of good parenting quality among children in urban areas of China through a birth cohort study and may be used to reduce the children at high risk of developmental delay as a future intervention program.

Impact of National Egyptian school feeding program on growth, development, and school achievement of school children

BACKGROUND

School feeding program (SFP) increases access to education and to better health. This study aims to evaluate the effects of SFP on physical growth, cognitive development, psychosocial behavior, and learning achievement of school children.

METHODS

A quasi-experimental study was conducted. The intervention group included 903 pupils in the fifth grade receiving the school meal, while the control group included 886 pupils, matched for age and sex, without meal. The meal consisted of a pie made of flour fortified with vitamins A, B6, B12, C, thiamin, riboflavin, niacin, folate, calcium, iron, zinc, and phosphorus. Socioeconomic position, nutritional status, and dietary behavior were evaluated. Neuropsychological tests were done. Psychosocial behavior was rated and educational achievement was recorded. Post hoc and independent sample t tests were used to detect the association of the studied parameters with the intake of school snack.

RESULTS

Children who took the meal had better scores on visual memory, auditory vigilance tests (9.71 ± 2.80 vs. 7.45 ± 3.25; 25.02 ± 3.36 vs. 10.82 ± 8.92, respectively, P < 0.001), the afternoon attention and working memory test (8.20 ± 2.21vs. 7.75 ± 3.05) (P < 0.001), but less score of externalizing behavior (P < 0.001) than the control group. No significant changes of children's nutritional status were detected between the two groups. School meal was the main predictor of visual memory and auditory vigilance (P < 0.001), and was the strongest predictor of academic achievements when combined with family size and meals' frequency (P < 0.001).

CONCLUSION

School meal improves academic achievements of school children.

The Interaction of Social, Physical and Nutritive Factors in Triggering Early Developmental Language Delay in a Sample of Egyptian Children

BACKGROUND

Language acquisition and child development during the early years of life depend on multiple interacting factors.

AIM

To explore potential factors that can impact language development in 2 groups of Egyptian children, one with normal language development and the second with delayed development. Also, to explore to what extent can the involvement of impaired motor development potentiate the risk of developmental language delay.

METHODS

This cross-sectional case-control study involved Egyptian children belonging to the middle socioeconomic class between 18 and 36 months of age. Children were classified according to their performance on language domain of Bayley Scales of Infant and Toddler Development (Bayley-III) into two groups, infants with the average or above score (control group) and those having below-average scores (cases). Motor development was assessed on the same scale. Factors affecting language development were tested, including socio-demographic, obstetric, and maternal medical factors in addition to Infant Feeding Practices.

RESULTS

The independent factors lowering the language scores were early introduction of complementary food, low family income, history of delivery problems, pregnancy-related diseases of the mother, and maternal education. Impaired motor development appears as a further highly significant risk factor to the previously mentioned factors.

CONCLUSION

In Egyptian children, delayed language development is severely affected by the interaction of medical, social and nutritional factors. Providing adequate maternal health care during pregnancy and childbirth, regular developmental monitoring at each child visit, and screening for such risk factors, can reduce size of the problem and promote child's social and psychological development.