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Bandal A, Hernández S, Mustafa R, Choy K, Edwards N, Guarchaj M, Mejía Alvarez M, Sane A, Tschida S, Maliye C, Miller A, Raut A, Srinivasan R, Turner M, Wagenaar BH, Ertem I, Grazioso MDP, Gupta SS, Krishnamurthy V, Rohloff P. Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework. Glob Health Action 2024; 17:2338324. [PMID: 38726569 PMCID: PMC11089920 DOI: 10.1080/16549716.2024.2338324] [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: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 05/15/2024] Open
Abstract
There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021-2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.
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Affiliation(s)
- Amruta Bandal
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Sara Hernández
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Revan Mustafa
- Department of Pediatrics, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Karyn Choy
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Namrata Edwards
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Magdalena Guarchaj
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | | | - Anushree Sane
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Scott Tschida
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
| | - Chetna Maliye
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Ann Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Abhishek Raut
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Roopa Srinivasan
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Morgan Turner
- Department of Global Health, University of Washington, Seattle, USA
| | - Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Ilgi Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Subodh S. Gupta
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | - Vibha Krishnamurthy
- Early Childhood Development and Disabilities, Ummeed Child Development Centre, Mumbai, India
| | - Peter Rohloff
- Center for Indigenous Health Research, Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA
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Oh J, Ordoñez ELT, Velasquez E, Mejía M, Grazioso MDP, Rohloff P, Smith BA. Early full-day leg movement kinematics and swaddling patterns in infants in rural Guatemala: A pilot study. PLoS One 2024; 19:e0298652. [PMID: 38422106 PMCID: PMC10903813 DOI: 10.1371/journal.pone.0298652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Tools to accurately assess infants' neurodevelopmental status very early in their lives are limited. Wearable sensors may provide a novel approach for very early assessment of infant neurodevelopmental status. This may be especially relevant in rural and low-resource global settings. METHODS We conducted a longitudinal observational study and used wearable sensors to repeatedly measure the kinematic leg movement characteristics of 41 infants in rural Guatemala three times across full days between birth and 6 months of age. In addition, we collected sociodemographic data, growth data, and caregiver estimates of swaddling behaviors. We used visual analysis and multivariable linear mixed models to evaluate the associations between two leg movement kinematic variables (awake movement rate, peak acceleration per movement) and infant age, swaddling behaviors, growth, and other covariates. RESULTS Multivariable mixed models of sensor data showed age-dependent increases in leg movement rates (2.16 [95% CI 0.80,3.52] movements/awake hour/day of life) and movement acceleration (5.04e-3 m/s2 [95% CI 3.79e-3, 6.27e-3]/day of life). Swaddling time as well as growth status, poverty status and multiple other clinical and sociodemographic variables had no impact on either movement variable. CONCLUSIONS Collecting wearable sensor data on young infants in a rural low-resource setting is feasible and can be used to monitor age-dependent changes in movement kinematics. Future work will evaluate associations between these kinematic variables from sensors and formal developmental measures, such as the Bayley Scales of Infant and Toddler Development.
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Affiliation(s)
- Jinseok Oh
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | | | | | | | | | - Peter Rohloff
- Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Beth A. Smith
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
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Wanjari D, Raut AV, Meher S, Bandal A, Vaishampayan A, Gupta SS. Effect of Inclusive Early Childhood Development (IECD) on Growth and Development of Children in the Rural Part of the Central India: A Cohort Study. Indian J Pediatr 2024:10.1007/s12098-023-04979-x. [PMID: 38282106 DOI: 10.1007/s12098-023-04979-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/06/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES To compare the difference between the growth and developmental status of the children who were residing in the area where Inclusive Early Childhood Development (IECD) project was being implemented and who had received interventions through trained Anganwadi workers (Frontline workers) under Integrated Child Development Services (ICDS) scheme with the children who had not received the Inclusive ECD project interventions. METHODS It was a mixed method cohort study, nested in an ongoing project in a medical college in which Inclusive ECD was used as an intervention through International Guide for Monitoring Child Development (GMCD) which is a tool for both monitoring and assessment with the help of existing government structures and personnel such as Anganwadi workers, Anganwadi supervisors and their contact points with communities. A sample of 200 children was selected; 100 each from intervention group (IECD cohort) and comparison group (Usual care cohort) and were followed till the child became 2 y of age. RESULTS IECD intervention showed statistically significant effect on weight (p = 0.04) and height (p = 0.03) of the IECD cohort. Overall developmental assessment showed that the identified developmental issues (Concerns + Delays) were approximately half in IECD cohort (9.67% + 5.37% = 15.04%) as compared to usual care cohort (17.20% + 11.82% = 29.02%). The results from binomial logistic regression performed for developmental outcomes were statistically significant (p = 0.04) suggesting that children with IECD intervention have lower odds of developing developmental issues. CONCLUSIONS The study indicates that it is possible to implement IECD interventions through frontline workers, which significantly improves the growth and development of the children.
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Affiliation(s)
- Devyani Wanjari
- Dr. Sushila Nayar School of Public Health incorporating the Department of Community Medicine, MGIMS, Sevagram, Maharashtra, India.
| | - Abhishek V Raut
- Dr. Sushila Nayar School of Public Health incorporating the Department of Community Medicine, MGIMS, Sevagram, Maharashtra, India
| | - Sonu Meher
- State Nutrition Bureau, Nagpur, Maharashtra, India
| | - Amruta Bandal
- Dr. Sushila Nayar School of Public Health incorporating the Department of Community Medicine, MGIMS, Sevagram, Maharashtra, India
- Inclusive ECD Project, MGIMS, Sevagram, Wardha, India
| | | | - Subodh S Gupta
- Dr. Sushila Nayar School of Public Health incorporating the Department of Community Medicine, MGIMS, Sevagram, Maharashtra, India
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Ozalp Akin E, Bingoler Pekcici B. Monitoring and supporting development in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024. [PMID: 38270231 DOI: 10.1002/ppul.26876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Each child on home invasive mechanical ventilation is unique with different diagnoses, co-morbidities, families, environment, needs, and developmental conditions. While studies mostly focused on survival and morbidities of these children, every child on home invasive mechanical ventilation has the right to reach his/her optimal developmental potential. OBJECTIVES This can be achieved by monitoring and supporting child development holistically, especially in the early childhood period when brain development is happening rapidly and plasticity is highest. MATERIALS AND METHODS Key theory-based frameworks should be used as universal principles to address child development. These are bioecological theory, family-centered care, World Health Organisation International Classification of Functioning Disability and Health framework, monitoring approach, child-friendly healthcare approach, and transdisciplinary care. RESULTS Monitoring and supporting the development of children on home invasive mechanical ventilation aims to support children in reaching their own full developmental potential, to keep track of children's development, know and support the child's and family's strengths and vulnerabilities over time, address risk factors, support the child's development with the family, use specialized services when needed. CONCLUSIONS When all these principles are put together for children on home invasive mechanical ventilation, monitoring and supporting child development should be a standard approach urgently and holistically in cognitive, receptive, and expressive language, fine and gross motor, relating, play and self help domains, while committing to strengths-based family-centered care, functionality, participation in life, avoidance of stigma, and providing transdisciplinary follow-up.
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Affiliation(s)
- Ezgi Ozalp Akin
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Bahar Bingoler Pekcici
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Maqbool S, Brown N, Farid A, Ali A, Iftikhar K, Bari A, Ullah E, Hafeez S. Construction and validation of ShaMaq developmental screening tool. Child Care Health Dev 2024; 50:e13123. [PMID: 37153970 DOI: 10.1111/cch.13123] [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: 03/09/2021] [Revised: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources. AIM The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children. METHOD ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8 weeks (Group 1), 6-10 months (Group 2), 18-24 months (Group 3), 3-3.5 years (Group 4), and 4.5-5.5 years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6 weeks to 5.5 years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach's alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician's final diagnosis as the gold standard. RESULTS Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity. CONCLUSION SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validity.
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Affiliation(s)
- Shazia Maqbool
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Nick Brown
- International Maternal Child Health Department, Kvinnors och barns hälsa, Uppsala University, Uppsala, Sweden
- Department of Child Health, Aga Khan University, Karachi, Pakistan
- Barn och ungdoms avdelning, Länssjukhuset Gävleborg, Gävle, Sweden
| | - Aisha Farid
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Anam Ali
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Kamila Iftikhar
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Attia Bari
- Department of Pediatric Medicine, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Ehsan Ullah
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Shahid Hafeez
- Department of Developmental & Behavioural Paediatrics, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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Petrowski N, de Castro F, Davis-Becker S, Gladstone M, Lindgren Alves CR, Becher Y, Grisham J, Donald K, van den Heuvel M, Kandawasvika G, Maqbool S, Tofail F, Xin T, Zeinoun P, Cappa C. Establishing performance standards for child development: learnings from the ECDI2030. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:140. [PMID: 38087377 PMCID: PMC10717755 DOI: 10.1186/s41043-023-00483-2] [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: 04/24/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Standards of early childhood development (ECD) are needed to determine whether children living in different contexts are developmentally on track. The Early Childhood Development Index 2030 (ECDI2030) is a population-level measure intended to be used in household surveys to collect globally comparable data on one of the indicators chosen to monitor progress toward target 4.2 of the Sustainable Development Goals: The proportion of children aged 24-59 months who are developmentally on track in health, learning and psychosocial well-being. METHODS To define performance cut-scores for the ECDI2030 we followed a criterion-referenced standard setting exercise using the modified Angoff method. The exercise gauged the expectations from 15 global experts in ECD and was informed by representative population data collected in Mexico and the State of Palestine. The final calibrated age-specific performance cut-scores were applied to these data to estimate the proportion of children developmentally on track, disaggregated by background characteristics, including the child's sex and attendance to early childhood education. RESULTS Through a process of standard setting, we generated robust performance standards for the ECDI2030 by establishing five age-specific cut-scores to identify children as developmentally on track. CONCLUSIONS This paper demonstrated how the standard setting methodology, typically applied to measures in the health and education fields, could be applied to a measure of child development. By creating robust criterion-referenced standards, we have been able to ensure that the cut-scores related to age for the ECDI2030 are based on performance standards set by global experts in the ECD field for defining on and off track development.
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Affiliation(s)
- Nicole Petrowski
- UNICEF, Data and Analytics Section, 3 UN Plaza, New York, NY, 10017, USA.
| | - Filipa de Castro
- Formerly with UNICEF, Data and Analytics Section, 3 UN Plaza, New York, NY, 10017, USA
| | - Susan Davis-Becker
- ACS Ventures, 11035 Lavender Hill Drive #160-433, Las Vegas, NV, 89135, USA
| | - Melissa Gladstone
- Department of Women and Children's Health, Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Place, Liverpool, L3 5QA, UK
| | | | - Yvonne Becher
- The Child Development Centre, 4/F Prime Mansion, 183-187 Johnston Road, Wan Chai, Hong Kong
| | - Jennifer Grisham
- Early Childhood Laboratory, University of Kentucky, 621 S. Limestone, Lexington, KY, 40506-0657, USA
| | - Kirsten Donald
- Division of Developmental Pediatrics, Red Cross War Memorial Children's Hospital and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Meta van den Heuvel
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Gwendoline Kandawasvika
- Primary Health Sciences Department, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP167, Harare, Zimbabwe
| | - Shazia Maqbool
- Developmental-Behavioral Pediatrics Department, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, GPO Box 128, Dhaka, 1000, Bangladesh
| | - Tao Xin
- National Assessment Center for Education Quality, Ministry of Education, Beijing, China
| | | | - Claudia Cappa
- UNICEF, Data and Analytics Section, 3 UN Plaza, New York, NY, 10017, USA
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Rah SS, Jung M, Lee K, Kang H, Jang S, Park J, Yoon JY, Hong SB. Systematic Review and Meta-analysis: Real-World Accuracy of Children's Developmental Screening Tests. J Am Acad Child Adolesc Psychiatry 2023; 62:1095-1109. [PMID: 36592715 DOI: 10.1016/j.jaac.2022.12.014] [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: 12/20/2021] [Revised: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This review presents a list of developmental screening tests used in clinical settings worldwide and provides a broad estimate of their accuracy (PROSPERO: CRD42021236474). METHOD Following the PRISMA Diagnostic Test Accuracy (DTA) guidelines, this review involved searching PubMed, PsycINFO, Cochrane, EMBASE, CINAHL, and Google Scholar (for manual searching). Inclusion criteria included studies published in English through 2020 that compared the accuracy of developmental screening tests against developmental diagnostic tests among children under 13 years of age. Six researchers, in pairs, independently selected the studies and extracted the data. A hierarchical model was applied to meta-analyze the diagnostic accuracy of the tests, and meta-regression was used to identify the moderators using R 4.1.3 software. RESULTS The meta-analysis included 56 studies (17 screening tests and 61 outcomes). The most frequently used screening tests were the Ages and Stages Questionnaire (ASQ), Denver Developmental Screening Test (DDST), and Parent's Evaluation of Developmental Status (PEDS). The pooled sensitivity and specificity were 0.75 (95% CI = 0.69-0.80) and 0.76 (95% CI = 0.71-0.80), and the overall diagnostic accuracy of the total outcomes (area under the curve) was 0.80. High heterogeneity was observed between the included studies with various thresholds of the tests. Participants' developmental concerns at the baseline significantly moderated the accuracy of the screening tests, resulting in double the positive predictive value and prevalence compared to those without the concerns. CONCLUSION We recommend a standardized process of validation studies for diagnostic accuracy, to ensure the effectiveness of developmental screening tests in clinical settings. STUDY PREREGISTRATION INFORMATION Accuracy of Developmental Screening Tools among Children in Real World: a Systematic Review and Meta Analysis; https://www.crd.york.ac.uk/; CRD42021236474.
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Affiliation(s)
- Sung Sil Rah
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minho Jung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungmin Lee
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Hannah Kang
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Soyoung Jang
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Junghyun Park
- Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Soon-Beom Hong
- Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Mukherjee SB, Meghana S, Singh AK, Sharma S, Kapoor D. Diagnostic Accuracy of the Government of India Mother and Child Protection Card for Developmental Screening of Indian Children Aged 2–36 Months: A Hospital-based Mixed Method Study. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Büyükavcı MA, Dundar I. Comparison of developmental outcomes in children with permanent and transient congenital hypothyroidism. J Pediatr Endocrinol Metab 2023; 36:364-370. [PMID: 36794655 DOI: 10.1515/jpem-2022-0539] [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: 10/22/2022] [Accepted: 01/29/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Congenital hypothyroidism (CH) is still one of the most common causes of preventable cognitive impairment in children, and its early detection and treatment prevent irreversible neurodevelopmental delay. Depending on the underlying cause, cases with CH may be transient or permanent. This study aimed to compare the developmental evaluation results of transient and permanent CH patients and to reveal any differences. METHODS A total of 118 patients with CH, who were followed up jointly in pediatric endocrinology and developmental pediatrics clinics, were included. The patients' progress was evaluated per the International Guide for Monitoring Child Development (GMCD). RESULTS Of the cases, 52 (44.1%) were female, and 66 (55.9%) were male. While 20 (16.9%) cases were diagnosed with permanent CH, 98 (83.1%) were diagnosed with transient CH. According to the results of the developmental evaluation made with GMCD, the development of 101 (85.6%) children was compatible with their age, while 17 (14.4%) children had delays in at least one developmental area. All 17 patients had a delay in expressive language. Developmental delay was detected in 13 (13.3%) of those with transient CH and 4 (20%) with permanent CH. CONCLUSIONS There is difficulty in expressive language in all cases of CH with developmental delay. No significant difference was found between the developmental evaluations of permanent and transient CH cases. The results revealed the importance of developmental follow-up, early diagnosis and interventions in those children. GMCD is thought to be an important guide to help monitoring the development of patients with CH.
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Affiliation(s)
- Mehmet Akif Büyükavcı
- Department of Developmental Pediatrics, Faculty of Medicine, Inonu University, Malatya, Türkiye
| | - Ismail Dundar
- Department of Pediatric Endocrinology, Faculty of Medicine, Inonu University, Malatya, Türkiye
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Fernandes M, Bassani D, Albernaz E, Bertoldi AD, Silveira MF, Matijsevich A, Anselmi L, Cruz S, Halal CS, Tovo-Rodrigues L, Cruz GIN, Metgud D, Santos IS. Construction and validation of the Oxford Neurodevelopment Assessment (OX-NDA) in 1-year-old Brazilian children. BMC Pediatr 2022; 22:733. [PMID: 36564728 PMCID: PMC9783969 DOI: 10.1186/s12887-022-03794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Over 250 million children under 5 years, globally, are at risk of developmental delay. Interventions during the first 2 years of life have enduring positive effects if children at risk are identified, using standardized assessments, within this window. However, identifying developmental delay during infancy is challenging and there are limited infant development assessments suitable for use in low- and middle-income (LMIC) settings. Here, we describe a new tool, the Oxford Neurodevelopment Assessment (OX-NDA), measuring cognition, language, motor, and behaviour, outcomes in 1-year-old children. We present the results of its evaluation against the Bayley Scales of Infant Development IIIrd edition (BSID-III) and its psychometric properties. METHODS Sixteen international tools measuring infant development were analysed to inform the OX-NDA's construction. Its agreement with the BSID-III, for cognitive, motor and language domains, was evaluated using intra-class correlations (ICCs, for absolute agreement), Bland-Altman analyses (for bias and limits of agreement), and sensitivity and specificity analyses (for accuracy) in 104 Brazilian children, aged 12 months (SD 8.4 days), recruited from the 2015 Pelotas Birth Cohort Study. Behaviour was not evaluated, as the BSID-III's adaptive behaviour scale was not included in the cohort's protocol. Cohen's kappas and Cronbach's alphas were calculated to determine the OX-NDA's reliability and internal consistency respectively. RESULTS Agreement was moderate for cognition and motor outcomes (ICCs 0.63 and 0.68, p < 0.001) and low for language outcomes (ICC 0.30, p < 0.04). Bland-Altman analysis showed little to no bias between measures across domains. The OX-NDA's sensitivity and specificity for predicting moderate-to-severe delay on the BSID-III was 76, 73 and 43% and 75, 80 and 33% for cognition, motor and language outcomes, respectively. Inter-rater (k = 0.80-0.96) and test-rest (k = 0.85-0.94) reliability was high for all domains. Administration time was < 20 minutes. CONCLUSION The OX-NDA shows moderate agreement with the BSID-III for identifying infants at risk of cognitive and motor delay; agreement was low for language delay. It is a rapid, low-cost assessment constructed specifically for use in LMIC populations. Further work is needed to evaluate its use (i) across domains in populations beyond Brazil and (ii) to identify language delays in Brazilian children.
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Affiliation(s)
- Michelle Fernandes
- grid.5491.90000 0004 1936 9297MRC Lifecourse Epidemiology Centre and Human Development & Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.4991.50000 0004 1936 8948Nuffield Department of Women’s and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Diego Bassani
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health & Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Canada ,grid.42327.300000 0004 0473 9646Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Elaine Albernaz
- grid.411221.50000 0001 2134 6519Maternal and Child Department, Faculty of Medicine, Federal University of Pelotas, Pelotas, RS Brazil
| | - Andrea D. Bertoldi
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Mariangela F. Silveira
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Alicia Matijsevich
- grid.11899.380000 0004 1937 0722Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP Brazil
| | - Luciana Anselmi
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Suélen Cruz
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Camila S. Halal
- Conceição Hospital Group, Hospital Criança Conceição, Porto Alegre, RS Brazil
| | - Luciana Tovo-Rodrigues
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Gloria Isabel Nino Cruz
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil
| | - Deepa Metgud
- grid.411053.20000 0001 1889 7360Department of Paediatric Physiotherapy, KLE Institute of Physiotherapy, JN Medical College, KLE University, Belagavi, India
| | - Ina S. Santos
- grid.411221.50000 0001 2134 6519Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS Brazil ,grid.412519.a0000 0001 2166 9094Post-graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS Brazil
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Uchitel J, Alden E, Bhutta ZA, Cavallera V, Lucas J, Oberklaid F, Patterson J, Raghavan C, Richter L, Rikard B, Russell RR, Mikati MA. Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association. J Dev Behav Pediatr 2022; 43:e546-e558. [PMID: 35980036 DOI: 10.1097/dbp.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.
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Affiliation(s)
- Julie Uchitel
- Department of Paediatrics, University of Cambridge, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Errol Alden
- International Pediatric Association, Uniformed Services of Health Sciences, Bethesda, MD
| | - Zulfiqar A Bhutta
- International Pediatric Association; Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Jane Lucas
- Consultant in International Health and Child Development to UNICEF and the World Health Organization, New York, NY
| | - Frank Oberklaid
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Australia
| | - Janna Patterson
- Global Child Health and Life Support, American Academy of Pediatrics, Chicago, IL
| | - Chemba Raghavan
- Early Childhood Development Specialist/Acting Chief, UNICEF, New York, NY
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Blaire Rikard
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Robert Ross Russell
- European Board of Paediatrics, European Academy of Paediatrics; Paediatric Respiratory Paediatrics, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mohamad A Mikati
- Early Childhood Development Standing Advisory Group, International Pediatrics Association; Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine Duke University Medical Center, Durham, NC
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Russell AL, Hentschel E, Fulcher I, Ravà MS, Abdulkarim G, Abdalla O, Said S, Khamis H, Hedt-Gauthier B, Wilson K. Caregiver parenting practices, dietary diversity knowledge, and association with early childhood development outcomes among children aged 18-29 months in Zanzibar, Tanzania: a cross-sectional survey. BMC Public Health 2022; 22:762. [PMID: 35428252 PMCID: PMC9012040 DOI: 10.1186/s12889-022-13009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar’s Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD) following the Nurturing Care Framework within an integrated maternal and child healthcare package. Using program baseline data, we explored home environment, caregivers’ parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar. Methods We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI), with higher scores representing higher levels of child development. We analyzed CREDI scores, along with MICS questions on parenting knowledge, practices, and characteristics of the home environment. We developed multivariate regression models to assess associations between caregiver-child interactions, knowledge of dietary diversity, and ECD. Results Ten percent of children had overall CREDI z-scores 2 standard deviations [SD] or more below the global reference population mean, with 28% of children at risk of developmental delay with z-scores 1 SD or more below the mean. Cognitive and language domains were of highest concern (10.2 and 12.7% with z-score < − 2 SD). In 3-day recall, 75% of children engaged in ≥4 early stimulating activities with all caregivers averaging 3 total hours of play. CREDI scores were positively associated with greater frequency of caregivers’ engagement (β = 0.036, p = 0.002, 95%CI = [0.014, 0.058]), and dietary diversity knowledge (β = 0.564, p < 0.001, 95%CI = [0.281, 0.846]). Conclusions Our findings demonstrate a positive association between both the frequency of caregiver child interactions and knowledge of adequate dietary diversity, and ECD outcomes. This aligns with global evidence that promoting early stimulation, play and learning opportunities, and dietary diversity can improve developmental outcomes. Further study is needed to establish causal relationships and assess the impact of ECD programming in Zanzibar. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13009-y.
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Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, Squires JK, Pajek JA, Wolf RB, Slaughter KS, Broughton AS, Gerndt KL, Mlodoch BJ, Lipkin PH. Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics 2022; 149:184748. [PMID: 35132439 PMCID: PMC9680195 DOI: 10.1542/peds.2021-052138] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
The Centers for Disease Control and Prevention's (CDC) Learn the Signs. Act Early. program, funded the American Academy of Pediatrics (AAP) to convene an expert working group to revise its developmental surveillance checklists. The goals of the group were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages. Subject matter experts identified by the AAP established 11 criteria for CDC milestone checklists, including using milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages and those that are easily observed in natural settings. A database of normative data for individual milestones, common screening and evaluation tools, and published clinical opinion was created to inform revisions. Application of the criteria established by the AAP working group and adding milestones for the 15- and 30-month health supervision visits resulted in a 26.4% reduction and 40.9% replacement of previous CDC milestones. One third of the retained milestones were transferred to different ages; 67.7% of those transferred were moved to older ages. Approximately 80% of the final milestones had normative data from ≥1 sources. Social-emotional and cognitive milestones had the least normative data. These criteria and revised checklists can be used to support developmental surveillance, clinical judgment regarding additional developmental screening, and research in developmental surveillance processes. Gaps in developmental data were identified particularly for social-emotional and cognitive milestones.
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Affiliation(s)
- Jennifer M. Zubler
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;,Eagle Global Scientific, LLC, San Antonio, Texas
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle M. Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Toni M. Whitaker
- Division of Developmental Pediatrics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Judith S. Shaw
- Vermont Child Health Improvement Program, Department of Pediatrics, Larner College of Medicine, The University of Vermont, Burlington, Vermont
| | - Jane K. Squires
- Center on Human Development (Professor Emerita), University of Oregon, Eugene, Oregon
| | - Julie A. Pajek
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Rebecca B. Wolf
- National Center on Birth Defects and Developmental Disabilities (retired), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karnesha S. Slaughter
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amber S. Broughton
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Paul H. Lipkin
- Kennedy Krieger Institute, Baltimore, Maryland;,Johns Hopkins School of Medicine, Baltimore, Maryland
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Ozalp Akin E, Bingoler Pekcici EB, Ozturk Ertem I. Rates and Correlates of Stigmatization Expressed by Parents of Young Children with Developmental Difficulties in a Middle-Income Country. J Dev Behav Pediatr 2022; 43:e61-e69. [PMID: 34086634 DOI: 10.1097/dbp.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Information on stigmatization of young children with developmental difficulties (DDs) in low- and middle-income countries (LMICs), where most children reside, is crucial to combat stigma globally. We aimed to identify rates and correlates of stigmatization of young children with DDs in a middle-income country, Turkey. METHOD In this cross-sectional study, parents of children aged 0 to 42 months attending Ankara University School of Medicine, Department of Pediatrics, Developmental-Behavioral Pediatrics Division for their first visit were recruited consecutively. Parents responded to the written open-ended stigma questions of the Expanded Guide for Monitoring Child Development. Stepwise logistic regression analysis was used to determine factors associated with stigmatization. RESULTS The sample comprised 306 children (60.8% boys) with DDs (72.9% with chronic illness/disability and 27.1% with isolated language delay). Most of the mothers (61.1%) and fathers (60.7%) had less than high school education. Stigmatization was reported by 102 (33.3%) families. Child's sex, age, and health condition were not, but 5 of 9 environmental/contextual factors examined were statistically significantly associated with stigmatization. In the logistic regression model, not receiving support from relatives/friends (odds ratio [OR] = 4.97, 95% confidence interval [CI] = 2.16-11.48) and feelings of depression in the mother were independent factors associated with stigmatization (OR = 2.16, 95% CI = 1.04-4.50). CONCLUSION In a referred sample from Turkey and likely other LMICs, a large proportion of parents of young children with DDs report having experienced stigmatization at their first developmental assessment. Interventions that aim to address stigmatization in this early period must focus on support from family/friends and maternal mental health, which are independent strong correlates of stigma.
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Affiliation(s)
- Ezgi Ozalp Akin
- Department of Pediatrics, Developmental-Behavioral Pediatrics Division, Ankara University School of Medicine, Ankara, Turkey
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Shekhawat DS, Gupta T, Singh P, Sharma P, Singh K. Monitoring tools for early identification of children with developmental delay in India: an update. Child Neuropsychol 2022; 28:814-830. [DOI: 10.1080/09297049.2021.2022113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Tanu Gupta
- Clinical Psychologist Department of Psychiatry, All India Institute of Medical Sciences Jodhpur, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences Jodhpur, India
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16
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Ozalp Akin E, Akbas A, Atasoy SC, Kanatli MC, Ince Acici S, Mustafayev R, Karaaslan BT, Ertem HD, Bingoler Pekcici B, Ertem I. Applicability of the Guide for Monitoring Child Development as a Telehealth Delivered Intervention During the Pandemic. Front Pediatr 2022; 10:884779. [PMID: 35722494 PMCID: PMC9204056 DOI: 10.3389/fped.2022.884779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early intervention delivered through telehealth is critically needed during crises, particularly for children in low and middle-income countries (LMICs). We aimed to determine the applicability of the international Guide for Monitoring Child Development (GMCD) intervention delivered through telehealth during the COVID-19 lockdown in Turkey. METHODS Using a mixed-methods longitudinal design, we recruited children with developmental difficulties aged 0-42 months with an appointment during the first lockdown at Ankara University Developmental Pediatrics Division and seen face-to-face only once before. Developmental pediatricians applied the GMCD intervention during a single telephone call. As a novel intervention component, caregivers were asked to record and send back videos of the child's development when there were doubts about the child's functioning. Caregivers were called 1 year later by blinded independent researchers and a semi-structured interview on applicability was conducted. Applicability of the caregiver recorded video component of the intervention was assessed by a blinded observer using the GMCD Video Observation Tool. RESULTS Of 122 children that received the telehealth delivered GMCD intervention, 114 (93.4%) were included in the 1-year outcome study. Most were boys (51.8%); median age was 16.5 (IQR: 10.0-29.0) months, 51.0% had chronic health conditions, and 66.7% had developmental delay. All caregivers that received the intervention were mothers; 75.4% had at least high school education. The intervention was reported as applicable by 80.7% with high levels of satisfaction. On multivariate regression analysis, absence of chronic health related conditions was significantly associated with applicability (OR = 2.87, 95% CI = 1.02-8.09). Of 31 caregivers that were asked for videos, 19 sent back 93 videos that were technically observable. One or more developmental domains were observed in all videos; in 52.6%, caregivers provided early learning opportunities. CONCLUSIONS The findings of this study imply that the telehealth delivered GMCD intervention for children with developmental difficulties is applicable during the pandemic. The intervention content and frequency needs to be augmented for children with chronic health conditions. Further research is required to examine applicability and effectiveness of the GMCD intervention in other settings, particularly in LMICs.
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Affiliation(s)
- Ezgi Ozalp Akin
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Aysen Akbas
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Sidika Canan Atasoy
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Merve Cicek Kanatli
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Selin Ince Acici
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Revan Mustafayev
- Department of Pediatrics, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Bedriye Tugba Karaaslan
- Department of Child Development, Faculty of Health Sciences, Izmir Katip Çelebi University, Izmir, Turkey
| | - Hilmi Deniz Ertem
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Bahar Bingoler Pekcici
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ilgi Ertem
- Developmental Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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17
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Early Childhood Development: A Paradigm Shift From Developmental Screening and Surveillance to Parent Intervention Programs. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Srinivasan R, Marathe A, Krishnamurthy V. Providing Services for Children With Developmental Difficulties, Delay or Disability — Early Diagnosis and Interventions at the Community Level. Indian Pediatr 2021. [PMCID: PMC8606274 DOI: 10.1007/s13312-021-2360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper describes two programs using the recommended tiered approach — World Health Organization’s (WHO) Nurturing Care Framework (NCF), viz., Early Childhood Champions (ECC) program and Child Development Aide (CDA) program delivered by Ummeed Child Development Center, a non-governmental organization in Mumbai. The ECC program builds capacity in community health workers (CHWs) employed by community based organizations in urban, semi-urban and rural areas to deliver the responsive caregiving and early learning components of WHO-NCF framework to all children (universal services) and those with or at risk for disabilities (targeted and indicated services). The CDA program trains CHWs to become disability workers in communities where rehabilitation services are scarce or nonexistent. ECC and CDA programs integrate ECD services into the existing work of established CHWs in the communities and have preliminary evidence of reach, effectiveness and acceptability. Till date, the 145 CHWs trained by the ECC program have reached 7073 children, of whom 835 (7.4%) have been identified with developmental delays. The ECC program meets the well-recognized need for training packages on responsive caregiving and early learning components of WHO NCF framework.
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Affiliation(s)
- Roopa Srinivasan
- Developmental Pediatrics and Early Childhood Development and Disability (ECDD) Services, Ummeed Child Development Center, Ground Floor, Mantri Pride 1-B, 1/62, N.M. Joshi Marg, Subhash Nagar, Lower Parel, Mumbai, 400 011 Maharashtra India
| | - Ashwini Marathe
- Developmental Pediatrics and Early Childhood Development and Disability (ECDD) Services, Ummeed Child Development Center, Ground Floor, Mantri Pride 1-B, 1/62, N.M. Joshi Marg, Subhash Nagar, Lower Parel, Mumbai, 400 011 Maharashtra India
| | - Vibha Krishnamurthy
- Developmental Pediatrics and Early Childhood Development and Disability (ECDD) Services, Ummeed Child Development Center, Ground Floor, Mantri Pride 1-B, 1/62, N.M. Joshi Marg, Subhash Nagar, Lower Parel, Mumbai, 400 011 Maharashtra India
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Kautz MM. Applications of psychoneuroimmunology models of toxic stress in prevention and intervention efforts across early development. Brain Behav Immun Health 2021; 16:100322. [PMID: 34589810 PMCID: PMC8474171 DOI: 10.1016/j.bbih.2021.100322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Although evidence supporting psychoneuroimmunology (PNI) models of toxic stress have emerged over the past decade, the PNI field has struggled to integrate these important findings into real-world practical applications. There is great potential for these models to reduce the societal burden of childhood adversity by facilitating early detection and prevention with those children and adolescents at greatest risk for stress-related physical and psychological disorders. But further research is needed to validate and scale developmentally appropriate interventions with specific immune and endocrine mechanism-based targets that are developmentally sensitive. The allostatic load and additive PNI models of toxic stress exposure in youth are summarized. These models highlight the importance of integrating a standardized screening of environmental and interpersonal risk factors with stable and scalable cognitive and biological markers of risk. PNI models of toxic stress illustrate the need for intervention delivery as early as possible to prevent negative health outcomes in youth and comprehensive screening efforts would facilitate the deployment of community and family level interventions. This review discusses practical applications of toxic stress models that are currently under investigation, clarifies key obstacles, such as research gaps and scalability, and provides potential solutions, including cross-disciplinary partnerships.
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Affiliation(s)
- Marin M Kautz
- Department of Psychology, Temple University Psychology, 1701 N. 13th St., Weiss Hall, Philadelphia, PA, 19122, United States
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20
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Giraldo-Huertas J, Schafer G. Agreement and Reliability of Parental Reports and Direct Screening of Developmental Outcomes in Toddlers at Risk. Front Psychol 2021; 12:725146. [PMID: 34650483 PMCID: PMC8505716 DOI: 10.3389/fpsyg.2021.725146] [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: 06/15/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Developmental screening is a practice that directly benefits vulnerable and low-income families and children when it is regular and frequently applied. A developmental screening tool administered by parents called CARE is tested. CARE contains a compilation of activities to report and enhance development at home. Hundred and fifty-seven families in Bogotá (Colombia) initially responded to a call to participate in developmental screening tools' validation and reliability study. All children (Average: 42.7 months old; SD: 9.4; Min: 24, Max: 58) were screened directly by trained applicants using a Spanish version of the Denver Developmental Screening test [i.e., the Haizea-Llevant (HLL) screening table]. After a first screening, 61 dyads were positive for follow-up and received a second HLL screening. Fifty-two out of 61 dyads use and returned CARE booklet after 1-month screening at home. The comparative analysis for parent reports using CARE and direct screening observation included (a) the effects of demographic variables on overall and agreement, (b) agreement and congruence between the CARE report classification and direct screening classification ("At risk" or "Not at risk"), (c) receiver operating characteristic analysis, (d) item-Level agreement for specific developmental domains, and (e) acceptability and feasibility analysis. Results and conclusions show the parental report using the CARE booklet as a reliable screening tool that has the potential to activate alerts for an early cognitive delay that reassure clinicians and families to further specialized and controlled developmental evaluations and act as a screen for the presence of such delay in four developmental dimensions.
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Affiliation(s)
- Juan Giraldo-Huertas
- Department of Psychology of Development and Education, Universidad de la Sabana, Chía, Colombia
| | - Graham Schafer
- The School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala. J Acad Nutr Diet 2021; 122:432-444. [PMID: 33962902 DOI: 10.1016/j.jand.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo' Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo' (ie, "egg" in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu' Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization's infant and young child feeding indicators. The results of the Saqmolo' Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.
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Bingoler Pekcici EB, Gumus Dogan D, Ozalp Akin E, Buyukavci A, Akpinar F, Hayran G, Arslan N, Doganay B, Ozturk Ertem I. Referral Trends in Two Pioneering Developmental-Behavioral Pediatric Centers in Turkey. J Dev Behav Pediatr 2021; 42:227-233. [PMID: 33093303 DOI: 10.1097/dbp.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To inform professionals pioneering developmental-behavioral pediatrics (DBP) services in low- and middle-income countries (LMICs), we aimed to examine referral trends in 2 pioneering DBP centers at different locations in Turkey and to ascertain whether the official establishment of DBP as a subspecialty affected these trends. METHOD This longitudinal observational study included all children referred to Ankara (AUDPD) and Inonu (IUDPD) Universities' Developmental Pediatrics Divisions between 2010 and 2018. We examined the sources of referrals and the independent effects of time and the establishment of DBP as a subspecialty on referral volume using Negative Binomial Regression (NBR) models. RESULTS Of 8,051 children, most were boys (58%) and under 24 months of age (72%). Most referrals were from the pediatric and pediatric surgery department clinics (85%); less than 1% were from child and adolescent psychiatry, and none were from family physicians. The NBR models showed that yearly, the referral volume increased significantly, 1.18-fold (95% confidence interval [CI] = 1.09-1.28) and 1.48-fold (95% CI = 1.20-1.82) for AUDPD and IUDPD, respectively. Compared with the trend of referrals before, the trend after the establishment of DBP as a subspecialty increased significantly at AUDPD, but not IUDPD. CONCLUSION The increase in referrals to DBP over time is encouraging to professionals working to advance DBP services and training in LMICs even if DBP is not officially established as a subspecialty. Additional efforts may be needed to improve recognition and use of DBP services by community physicians and allied disciplines that provide services to children.
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Affiliation(s)
- Emine Bahar Bingoler Pekcici
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gumus Dogan
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Ezgi Ozalp Akin
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Akif Buyukavci
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Funda Akpinar
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Gamze Hayran
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Necati Arslan
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Inonu University School of Medicine, Malatya, Turkey
| | - Beyza Doganay
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ilgi Ozturk Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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23
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Bingöler Pekcici EB, Özalp Akin E, Akpinar F, Hayran G, Keleş C, Yağbasan B, Kurşun N, Ertem İ. Family-centeredness of services for young children with Down syndrome: an observational study from Turkey. Turk J Med Sci 2021; 51:246-255. [PMID: 33155788 PMCID: PMC7991864 DOI: 10.3906/sag-2009-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background/aim Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methods In a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness. Results All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5–38.0) months. The MPOC-20 subscale scores were highest for the “respectful and supportive care (RSC)” (median 6.0; IQR: 4.8–6.8) and lowest for the “providing specific information” (median 3.0; IQR: 4.4–6.5) subscales. On univariate analyses, maternal education <high school was associated with scores ≤4 on the RSC (OR = 6.75; 95%CI = 1.77–25.64) and “enabling and partnership” subscales (OR = 3.10; 95%CI = 1.06–9.05); income ≤ minimum wage (OR=3.94; 95%CI=1.10-14.02) was associated with scores ≤4 on the RSC. In the multivariate logistic regression model, maternal education ≤ high school was independently associated with RSC scores ≤4 (OR = 5.13; 95%CI = 1.26–20.84). Conclusion Our findings imply that limitations in family-centeredness of community service for young children with Down syndrome. Deficiencies of services particularly for children with less educated mothers need to be urgently resolved.
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Affiliation(s)
- Emine Bahar Bingöler Pekcici
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ezgi Özalp Akin
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Funda Akpinar
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gamze Hayran
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cansu Keleş
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Betül Yağbasan
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazmiye Kurşun
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İlgi Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
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24
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Raut A, Mustafayev R, Srinivasan R, Chary A, Ertem I, Grazioso MDP, Gupta S, Krishnamurthy V, Lu C, Maliye C, Miller AC, Wagenaar BH, Rohloff P. Hybrid type 1 effectiveness/implementation trial of the international Guide for Monitoring Child Development: protocol for a cluster-randomised controlled trial. BMJ Paediatr Open 2021; 5:e001254. [PMID: 34604546 PMCID: PMC8444252 DOI: 10.1136/bmjpo-2021-001254] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION More than 40% of children under 5 years of age in low-income and middle-income countries are at risk of not reaching their developmental potential. The international Guide for Monitoring Child Development (GMCD) early intervention package is a comprehensive programme to address developmental difficulties using an individualised intervention plan for young children and their families. We will conduct a hybrid type 1 effectiveness-implementation evaluation of the GMCD intervention in rural India and Guatemala. METHODS AND ANALYSIS Using a cluster-randomised design, 624 children aged 0-24 months in 52 clusters (26 in India, 26 in Guatemala) will be assigned to usual care or the GMCD intervention plus usual care delivered by frontline workers for 12 months. After 12 months, the usual care arm will cross over to the intervention, which will continue for 12 additional months (24 total). The intervention will be delivered using a digital mobile device interface. Effectiveness will be assessed for developmental functioning (Bayley Scales of Infant Development, 3rd edition) and nurturing care (Home Observation for Measurement of the Environment Scale) outcomes. Implementation will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Explanatory qualitative analysis guided by the Consolidated Framework for Implementation Research will explore determinants between clusters with high versus low implementation effectiveness. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Boards of Brigham and Women's Hospital, Mahatma Gandhi Institute of Medical Sciences and Maya Health Alliance; and by the Indian Council of Medical Research/Health Ministry Screening Committee. Key study findings will be published in international open-access journals. TRIAL REGISTRATION NUMBER NCT04665297, CTRI/2020/12/029748. PROTOCOL VERSION 1.0 (12 November 2020).
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Affiliation(s)
- Abhishek Raut
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Revan Mustafayev
- Department of Pediatrics, Acibadem Maslak Private Hospital, Istanbul, Turkey
| | | | - Anita Chary
- Center for Indigenous Health Research, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala
| | - Ilgi Ertem
- Developmental-Behavioral Pediatrics Division, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Subodh Gupta
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | | | - Chunling Lu
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Chetna Maliye
- Department of Community Medicine, Dr. Sushila Nayar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Ann C Miller
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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25
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White M, Feucht UD, Duffley E, Molokoane F, Durandt C, Cassol E, Rossouw T, Connor KL. Does in utero HIV exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa. Pilot Feasibility Stud 2020; 6:192. [PMID: 33308322 PMCID: PMC7730756 DOI: 10.1186/s40814-020-00725-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 11/11/2020] [Indexed: 03/08/2023] Open
Abstract
Background As mother-to-child transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is a growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life. Methods In a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n = 20) and not on ART (n = 20) and new mothers without HIV (n = 20) through our clinics to study the effects of HEU on growth and immune- and neurodevelopment in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16 and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8–16 weeks). Results We recruited 33 women living with HIV on ART and 22 women living without HIV within 4 days of delivery from June to December 2016. Twenty-one women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU. Conclusions Our small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects of suboptimal nutrition in utero and postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.
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Affiliation(s)
- Marina White
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Ute D Feucht
- Paediatrics, University of Pretoria, Pretoria, GP 0002, South Africa.,Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, GP 0002, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, South Africa
| | - Eleanor Duffley
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Felicia Molokoane
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, GP 0002, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Council, Pretoria, South Africa.,Obstetrics and Gynaecology, University of Pretoria, Pretoria, GP, 0002, South Africa
| | - Chrisna Durandt
- South African Medical Research Council Extramural Unit for Stem Cell Research and Therapy, University of Pretoria, Pretoria, GP 0002, South Africa.,Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, GP 0002, South Africa
| | - Edana Cassol
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Theresa Rossouw
- Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, GP 0002, South Africa
| | - Kristin L Connor
- Department of Health Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada.
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26
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Torun EG, Ertugrul A, Tekguc DC, Bostanci I. Sleep Patterns and Development of Children with Atopic Dermatitis. Int Arch Allergy Immunol 2020; 181:871-878. [PMID: 32772024 DOI: 10.1159/000509402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic inflammatory disease that begins in early childhood. Sleep problems have increased in children with AD. The aim of this study was to evaluate sleep patterns and the development of children with AD at an early age. METHODS This is a cross-sectional study consisting of a total of 80 children aged 0-36 months with AD. Patients were evaluated by the Brief Infant Sleep Questionnaire and International Guide for Monitoring Child Development. RESULTS The median age (IQR) of the patients was 6 (4.25-9) months, 63.7% of them were male and 50% of them had sleep problems. Male sex (OR: 3.78, p = 0.024, 95% CI, 0.083-0.837), patients with AD who were in the first 3 months after diagnosis (OR: 3.56; 95% CI, 1.220-10.43, p = 0.020), and moderate-severe AD (OR: 5.09; 95% CI, 1.649-15.748, p = 0.005) were determined as risk factors for sleep problems. In all, 12.5% of the patients needed support for one or more developmental areas (gross motor skills, expressive language and communication, receptive language, fine motor skills, relationship, and play). Developmental delay was higher in patients with sleep problems (p = 0.037). Multiple siblings (OR: 14.381; 95% CI, 1.557-132.871, p = 0.019) and the presence of sleep problems (OR: 8.011; 95% CI, 1.764-36.387, p = 0.024) were found to be risk factors for developmental delay. CONCLUSION Boys with moderate-severe AD within the first 3 months of diagnosis were at increased risk for sleep problems. Children with AD who have multiple siblings and sleep problems should be evaluated for developmental delay and monitored closely.
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Affiliation(s)
- Emine Gulsah Torun
- Department of Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Aysegul Ertugrul
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey,
| | - Doga Ceren Tekguc
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Ilknur Bostanci
- Pediatric Allergy and Immunology Department, Health Sciences University Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
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Fernandes M, Villar J, Stein A, Staines Urias E, Garza C, Victora CG, Barros FC, Bertino E, Purwar M, Carvalho M, Giuliani F, Wulff K, Abubakar AA, Kihara M, Cheikh Ismail L, Aranzeta L, Albernaz E, Kunnawar N, Di Nicola P, Ochieng R, Sandells T, Savini S, Temple S, Murray E, Ohuma EO, Gravett MG, Pang R, Jaffer YA, Noble JA, Winsey A, Lambert A, Papageorghiou AT, Bhutta Z, Kennedy S. INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study. BMJ Open 2020; 10:e035258. [PMID: 32513882 PMCID: PMC7282399 DOI: 10.1136/bmjopen-2019-035258] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe the construction of the international INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) standards for child development at 2 years by reporting the cognitive, language, motor and behaviour outcomes in optimally healthy and nourished children in the INTERGROWTH-21st Project. DESIGN Population-based cohort study, the INTERGROWTH-21st Project. SETTING Brazil, India, Italy, Kenya and the UK. PARTICIPANTS 1181 children prospectively recruited from early fetal life according to the prescriptive WHO approach, and confirmed to be at low risk of adverse perinatal and postnatal outcomes. PRIMARY MEASURES Scaled INTER-NDA domain scores for cognition, language, fine and gross motor skills and behaviour; vision outcomes measured on the Cardiff tests; attentional problems and emotional reactivity measured on the respective subscales of the preschool Child Behaviour Checklist; and the age of acquisition of the WHO gross motor milestones. RESULTS Scaled INTER-NDA domain scores are presented as centiles, which were constructed according to the prescriptive WHO approach and excluded children born preterm and those with significant postnatal/neurological morbidity. For all domains, except negative behaviour, higher scores reflect better outcomes and the threshold for normality was defined as ≥10th centile. For the INTER-NDA's cognitive, fine motor, gross motor, language and positive behaviour domains these are ≥38.5, ≥25.7, ≥51.7, ≥17.8 and ≥51.4, respectively. The threshold for normality for the INTER-NDA's negative behaviour domain is ≤50.0, that is, ≤90th centile. At 22-30 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (<10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges. CONCLUSIONS From this large, healthy and well-nourished, international cohort, we have constructed, using the WHO prescriptive methodology, international INTER-NDA standards for child development at 2 years of age. Standards, rather than references, are recommended for population-level screening and the identification of children at risk of adverse outcomes.
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Affiliation(s)
- Michelle Fernandes
- Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, Oxfordshire, UK
| | - Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | | | - Cutberto Garza
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fernando C Barros
- Post-Graduate Program in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell' Adolescenza, SCDU Neonatologia, Universita di Torino, Torino, Piemonte, Italy
| | - Manorama Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Francesca Giuliani
- Ospedale Infantile Regina Margherita, Sant'Anna Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Katharina Wulff
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
| | - Amina A Abubakar
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Michael Kihara
- Department of Psychology, United States International University, Nairobi, Kenya
| | | | - Luis Aranzeta
- Centro de Tecnologıa e Innovacion, Mexico City, Mexico
| | - Elaine Albernaz
- Faculty of Medicine, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Naina Kunnawar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - Paola Di Nicola
- Ospedale Infantile Regina Margherita, Sant'Anna Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | - Tamsin Sandells
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Sandy Savini
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Sophie Temple
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Elizabeth Murray
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael G Gravett
- Departments of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, Washington, USA
| | - Ruyan Pang
- School of Public Health, Peking University, Beijing, China
| | - Yasmine A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Oman
| | | | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, Oxfordshire, UK
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, Oxfordshire, UK
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28
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Dea C, Gauvin L, Fournier M, Goldfeld S. Does Place Matter? An International Comparison of Early Childhood Development Outcomes between the Metropolitan Areas of Melbourne, Australia and Montreal, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162915. [PMID: 31416243 PMCID: PMC6720425 DOI: 10.3390/ijerph16162915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/17/2022]
Abstract
There is strong consensus about the importance of early childhood development (ECD) for improving population health and closing the health inequity gap. Environmental features and public policies across sectors and jurisdictions are known to influence ECD. International comparisons provide valuable opportunities to better understand the impact of these ecological determinants on ECD. This study compared ECD outcomes between metropolitan Melbourne (Australia) and Montreal (Canada), and contrasted disparities across demographic and socioeconomic characteristics. Methods: Population wide surveys using the Early Development Instrument (EDI) were conducted among 4–6 years-old children in both Montreal and Melbourne in 2012, measuring five domains of ECD: 1-Physical Health/Well-Being (PHYS); 2-Social Competence (SOC); 3-Emotional Maturity (EMOT); 4-Language/Cognitive Development (COGN); and 5-Communication Skills/General Knowledge (COMM). Descriptive analyses of summary EDI indicators and domain indicators (including median scores and interquartile ranges) were compared between metropolitan areas, using their respective 95% confident intervals (CIs). Analyses were performed using Stata software (v14). Results: The proportion of children developmentally vulnerable in at least one domain of ECD was 26.8% (95% CIs: 26.2, 27.3) in Montreal vs. 19.2% (95% CIs: 18.8, 19.5) in Melbourne. The Melbourne advantage was greatest for EMOT and COGN (11.5% vs. 6.9%; 13.0% vs. 5.8%). In both Montreal and Melbourne, boys, immigrants, children not speaking the language of the majority at home, and those living in the most deprived areas were at greater risk of being developmentally vulnerable. Relative risks as a function of home language and area-level deprivation subgroups were smaller in Montreal than in Melbourne. Conclusion: This study shows that Melbourne’s children globally experience better ECD outcomes than Montreal’s children, but that inequity gaps are greater in Melbourne for language and area-level deprivation subgroups. Further research is warranted to identify the environmental factors, policies, and programs that account for these observed differences.
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Affiliation(s)
- Catherine Dea
- Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montréal, QC H3N 1X9, Canada
- Direction Régionale de Santé Publique, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Lise Gauvin
- Department of Social & Preventive Medicine, École de santé publique, Université de Montréal, Montréal, QC H3N 1X9, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada
| | - Michel Fournier
- Direction Régionale de Santé Publique, Centre Intégré Universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, & Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne VIC 3052, Australia.
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