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Rocha HAL, Machado MMT, Santana OMMLD, Rocha SGMO, Aquino CMD, Gomes LGA, Albuquerque LDS, Soares MDDA, Leite ÁJM, Correia LL, Sudfeld CR. Association of Sociodemographic Factors and Maternal Educational Attainment with Child Development among Families Living below the Poverty Line in the State of Ceará, Northeastern Brazil. Children 2023; 10:children10040677. [PMID: 37189926 DOI: 10.3390/children10040677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program “Mais infância”. The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children’s development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6–3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.
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Affiliation(s)
- Hermano A. L. Rocha
- Department of Community Health, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil
| | - Márcia M. T. Machado
- Department of Community Health, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil
| | - Onélia M. M. L. de Santana
- Laboratory of Epidemiology and Data Analysis, University Health Center ABC, Faculdade de Medicina do ABC, Santo André 09060-870, SP, Brazil
- Social Protection Secretariat, Ceará State Government, Fortaleza 60130-160, CE, Brazil
| | - Sabrina G. M. O. Rocha
- Integração Serviço, Escola e Comunidade, Unichristus University Center, Fortaleza 60430-275, CE, Brazil
| | - Camila M. de Aquino
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil
| | - Laécia G. A. Gomes
- Social Protection Secretariat, Ceará State Government, Fortaleza 60130-160, CE, Brazil
| | - Lucas de S. Albuquerque
- Department of Community Health, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil
| | - Maria D. de A. Soares
- Social Protection Secretariat, Ceará State Government, Fortaleza 60130-160, CE, Brazil
| | - Álvaro J. M. Leite
- Laboratory of Epidemiology and Data Analysis, University Health Center ABC, Faculdade de Medicina do ABC, Santo André 09060-870, SP, Brazil
| | - Luciano L. Correia
- Department of Community Health, Federal University of Ceará, Fortaleza 60430-270, CE, Brazil
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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Rocha HAL, Correia LL, Leite ÁJM, Rocha SGMO, Albuquerque LDS, Machado MMT, Campos JS, e Silva AC, Sudfeld CR. Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study. Children (Basel) 2022; 9:children9081246. [PMID: 36010136 PMCID: PMC9406953 DOI: 10.3390/children9081246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
Parenting practices have been identified as a key determinant of children’s developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study included data on 3566 caregiver−child pairs, and the children were aged 0−66 months. Positive parenting behaviors (PPBs) were conceptualized in areas of interactive play, social development, and speech and language interactions. Child development was evaluated using the Brazilian Ages and Stages Questionnaire. Linear regression analysis was used to assess the relationships. We found that a greater number of PPBs was associated with better child development domain scores. Among infants < 1 year, each additional PPB was associated with a 0.32 standardized mean difference (SMD) greater communication (95% CI: 0.24−0.41) and 0.38 SMD greater problem-solving scores (95% CI: 0.24−0.52). Among children aged 4−6 years old, each additional PPB was associated with improved communication (SMD: 0.22; 95% CI: 0.13−0.32), problem solving (SMD: 0.21; 95% CI: 0.10−0.32) and personal−social domain scores (SMD: 0.26; 95% CI: 0.17−0.36). Our findings indicate that PPB were robustly associated with better outcomes across developmental domains among Brazilian children. Programs and interventions that support PPB can contribute to improvements in development outcomes.
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Affiliation(s)
- Hermano A. L. Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
- Correspondence: ; Tel.: +55-85-3366-8044
| | - Luciano L. Correia
- Department of Community Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
| | - Álvaro J. M. Leite
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
| | - Sabrina G. M. O. Rocha
- Department of Community Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
- Integração Saúde Ensino Comunidade, University Center Unichristus, Fortaleza 60020-181, CE, Brazil
| | - Lucas de S. Albuquerque
- Department of Community Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
| | - Márcia M. T. Machado
- Department of Community Health, Federal University of Ceará, Fortaleza 60020-181, CE, Brazil
| | - Jocileide S. Campos
- Integração Saúde Ensino Comunidade, University Center Unichristus, Fortaleza 60020-181, CE, Brazil
| | - Anamaria C. e Silva
- Integração Saúde Ensino Comunidade, University Center Unichristus, Fortaleza 60020-181, CE, Brazil
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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Rocha HAL, Correia LL, Leite ÁJM, Rocha SGMO, Machado MMT, Campos JS, Cunha AJLA, E Silva AC, Sudfeld CR. Undernutrition and short duration of breastfeeding association with child development: a population-based study. J Pediatr (Rio J) 2022; 98:316-322. [PMID: 34508663 PMCID: PMC9432002 DOI: 10.1016/j.jped.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. METHODS The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazil (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. RESULTS A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR 2,08 (1,38-3,12)) was also associated. CONCLUSIONS The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.
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Affiliation(s)
- Hermano A L Rocha
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, United States; Universidade Federal do Ceará, Departamento de Saúde Materno-Infantil, Fortaleza, CE, Brazil; Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil.
| | - Luciano L Correia
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil
| | - Álvaro J M Leite
- Universidade Federal do Ceará, Departamento de Saúde Materno-Infantil, Fortaleza, CE, Brazil
| | - Sabrina G M O Rocha
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil; ISEC, Centro Universitário Unichristus, Fortaleza, CE, Brazil
| | - Márcia M T Machado
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil
| | | | - Antonio J L A Cunha
- Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | | | - Christopher R Sudfeld
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, United States
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Rocha HAL, Sudfeld CR, Leite ÁJM, Machado MMT, Rocha SGMO, Campos JS, Silva ACE, Correia LL. Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study. BMC Pediatr 2021; 21:163. [PMID: 33827507 PMCID: PMC8025508 DOI: 10.1186/s12887-021-02623-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/23/2021] [Indexed: 01/28/2023] Open
Abstract
Background The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children’s developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil. Methods Population-based, cross-sectional study of children aged 0–66 months (0–5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children’s development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores. Findings A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, − 0.02) communication, 0.24 SD lower (95% CI: − 0.44, − 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, − 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05). Conclusion Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.
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Affiliation(s)
- Hermano A L Rocha
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, CE, Brazil.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Álvaro J M Leite
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Márcia M T Machado
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Sabrina G M O Rocha
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil.,ISEC, Unichristus University Center, Fortaleza, CE, Brazil
| | | | | | - Luciano L Correia
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
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Rocha HAL, Sudfeld CR, Leite ÁJM, Rocha SGMO, Machado MMT, Campos JS, E Silva AC, Correia LL. Adverse Childhood Experiences and Child Development Outcomes in Ceará, Brazil: A Population-based Study. Am J Prev Med 2021; 60:579-586. [PMID: 33160797 DOI: 10.1016/j.amepre.2020.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION More than 200 million children fail to reach their full developmental potential in low- and middle-income countries. Adverse childhood experiences, maternal mental health, and intimate partner violence are negatively associated with child development outcomes. The relationship of these risk factors with child communication, gross motor, fine motor, problem-solving, and personal-social development scores in Brazil are assessed. METHODS A population-based, cross-sectional study of preschool children living in the state of Ceará, Brazil, in 2017 was conducted. Child development was assessed with the Ages and Stages Questionnaire. Adverse childhood experiences for children were self-reported by the participants' mothers using the Centers for Disease Control and Prevention Adverse Childhood Experiences Study‒adapted metric. Maternal mental health and intimate partner violence were evaluated using validated questionnaires. Sample-adjusted multivariable generalized linear models with interaction terms were used to determine the association of intimate partner violence, maternal mental health, and adverse childhood experiences with developmental outcomes and identify possible moderators. Data were analyzed between 2019 and 2020. RESULTS Children exposed to ≥3 adverse childhood experiences had -0.12 (95% CI= -0.24, 0) lower communication, -0.25 (95% CI= -0.46, -0.03) lower gross motor, -0.27 (95% CI= -0.47, -0.07) lower fine motor, and -0.17 (95% CI= -0.3, -0.03) lower personal-social domain scores than children with no adverse childhood experiences. Furthermore, the greater number of adverse childhood experiences was linearly associated with lower developmental scores. Maternal mental health and intimate partner violence were also associated with lower development scores. CONCLUSIONS Adverse childhood experiences were independently associated with developmental outcomes in Brazilian children. Community-based interventions to reduce the impact of adverse childhood experiences, intimate partner violence, and maternal mental health may benefits child development outcomes.
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Affiliation(s)
- Hermano A L Rocha
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, Brazil.
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Álvaro J M Leite
- Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, Brazil
| | - Sabrina G M O Rocha
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil; Service, Education and Community Integration, University Center Unichristus, Fortaleza, Brazil
| | - Márcia M T Machado
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
| | - Jocileide S Campos
- Service, Education and Community Integration, University Center Unichristus, Fortaleza, Brazil
| | - Anamaria C E Silva
- Service, Education and Community Integration, University Center Unichristus, Fortaleza, Brazil
| | - Luciano L Correia
- Department of Community Health, Federal University of Ceará, Fortaleza, Brazil
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