Developmental risk factors in Vietnamese preschool-age children: Cross-sectional survey

Physical punishment and lifelong outcomes in low‑ and middle‑income countries: a systematic review and multilevel meta-analysis

Research from high-income countries has found negative outcomes associated with physical punishment. Yet, the extent to which such research evidence generalizes to children in low- and middle-income countries (LMICs) is largely unknown. The objective of the current pre-registered study (PROSPERO: CRD42022347346 ) was to conduct a meta-analysis of the associations between childhood physical punishment and individual outcomes in LMICs. We identified eligible articles by searching for keywords related to physical punishment in six languages across 11 databases, with search periods from April to August 2021 and June to July 2024. This process yielded 5,072 unique records, of which 189 studies, comprising 1,490 unique effect sizes and representing 92 LMICs, met our inclusion criteria. Findings from random-effects multilevel meta-analyses indicated that physical punishment was associated with detrimental outcomes, including mental health problems, worse parent-child relationships, substance use, impaired social-emotional development, negative academic outcomes and heightened externalizing behaviour problems, among others. Despite some variation by contextual and study-level characteristics, all subgroup estimates were consistent in direction. Sensitivity checks indicated that these findings were not typical of other non-violent methods of discipline but were specific to physical punishment and psychological aggression. The analysis confirmed that physical punishment is associated with detrimental outcomes for individuals in LMICs. Additional research is needed to inform the design, implementation, and evaluation of policies and interventions to prevent the physical punishment of children and adolescents worldwide.

Food insecurity and early childhood development among children 24-59 months in Nigeria: A multilevel mixed effects modelling of the social determinants of health inequities

Food insecurity (FI) has been identified as a determinant of child development, yet evidence quantifying this association using the newly developed Early Childhood Development Index 2030 (ECDI2030) remains limited. Herein, we provide national estimates of early childhood development (ECD) risks using the ECDI2030 and examined to what extent FI was associated with ECD among children aged 24-59 months in Nigeria. This population based cross-sectional analyses used data from the UNICEF-supported 2021 Multiple Indicator Cluster Survey in Nigeria. The analytic sample comprised children aged 24-59 months (weighted N = 12,112). We measured early childhood development for each child using the ECDI2030, measured across three domains: learning, psychosocial well-being and health. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES), categorized as none/mild, moderate and severe. We fitted mixed-effects multilevel logistic regression models, with random intercepts, to estimate the odds of association between FI status and ECD. A total of 11,494 children aged 24-59 months (mean ± SD age, 43.4 ± 9.9 months), including 5,797 boys (50.2%) and 5,697 girls (49.8%), were included in the study. Approximately 46.4% of children were developmentally off track and about 76% of children lived in food-insecure households. The intercept-only model indicated significant variation in ECD prevalence across communities (τ00 = 0.94, intraclass correlation = 0.22, p < 0.0001), suggesting nonignorable variability in ECD across communities. Adjusting for confounders, we observed no significant association between FI and ECD. However, increasing child's age and disability status appeared as significant risk factors for higher odds of children being developmentally off track. These findings highlight that while FI alone may not explain ECD, a combination of individual and contextual factors plays a crucial role. Future interventions addressing ECD in Nigeria should consider these multidimensional influences to promote optimal child development.

The next 1000 days: building on early investments for the health and development of young children

Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2-5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs. Paper 2 focuses on the cost of inaction and the implications of not investing in the next 1000 days. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. Intervention research in LMICs in the next 1000 days is scarce. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals.

Family play, reading, and other stimulation and early childhood development in five low-and-middle-income countries

This paper used longitudinal data from five studies conducted in Bangladesh, Bhutan, Cambodia, Ethiopia, and Rwanda to examine the links between family stimulation and early childhood development outcomes (N = 4904; Mage = 51.5; 49% girls). Results from random-effects and more conservative child-fixed effects models indicate that across these studies, family stimulation, measured by caregivers' engagement in nine activities (e.g., reading, playing, singing), predicted increments in children's early numeracy, literacy, social-emotional, motor, and executive function skills (standardized associations ranged from 0.05 to 0.11 SD). Study-specific models showed variability in the estimates, with null associations in two out of the five studies. These findings indicate the need for additional research on culturally specific ways in which caregivers may support early development and highlight the importance of promoting family stimulation to catalyze positive developmental trajectories in global contexts. RESEARCH HIGHLIGHTS: Research on the links between family stimulation and early childhood development in low-and-middle-income countries (LMICs) is limited. We used longitudinal data from studies conducted in five LMICs to examine the links between family stimulation and early childhood development outcomes. Results suggest that family stimulation predicted increments in children's numeracy, literacy, social-emotional, motor, and executive function skills. We found variability in the observed estimates, with null associations in two out of the five studies, suggesting the need for additional research in LMICs.

Development and validation of Egyptian developmental screening chart for children from birth up to 30 months

Background

Detecting developmental delay in children is an ongoing world commitment, especially for those below three years. To accurately assess the development of children; a culturally appropriate screening tool must be used. Egypt lacks such tool and multiple studies have shown that western tools are not suitable in other cultures.

Objectives

To develop and validate an easy, rapid, culturally appropriate and applicable screening chart for early detection of developmental delay among Egyptian children from birth up to 30 months and develop a Z-score chart for motor and mental development follow up based on our Egyptian screening chart.

Methods

A cross sectional randomized study was carried out on 1503 Egyptian children of both genders aged from birth up to 30 months assumed to have normal development according to the inclusion and exclusion criteria. They were selected from vaccination centers and well-baby clinics. Developmental milestones from Baroda development screening test (BDST) were applied on them after items were translated and adapted to Egyptian culture. Egyptian children developmental milestones scores were analyzed and carefully prepared in tables and charts. A 97% pass level of developmental achievements represents the threshold below which children are considered delayed. A Z-score chart for motor and mental development follow up was designed by calculating each age group achievement. The developed Egyptian developmental screening chart (EDSC) was validated against Ages and Stages Questionnaires (ASQ-3) as a reference standard in another different sample of 337 children in different age groups.

Results

The developed EDSC is represented in a chart format with two curves 50% and 97% pass level. Children considered delayed when the score below 97% pass level. Results revealed a statistically significant difference between EDSC and BDST at 50% and 97% pass levels. A Z-score chart for motor and mental development follow up was designed by calculating each age group achievement. EDSC sensitivity and specificity were calculated 84.38 (95% CI [67.21%–94.72%]) and 98.36 (95% CI [96.22%–99.47%]) respectively with an overall test accuracy 97.03 (95% CI [94.61%–98.57%]) (p ≤ .001). Agreement between EDSC and ASQ-3 was high (kappa score was 0.827) with negative and positive agreement 98.36 and 84.38, respectively.

Conclusions

Extensive revision of the BDST was needed in order to create and validate a more culturally appropriate Egyptian screening chart. This is the first study to create and validate an Egyptian-specific screening tool, to be rapid and easy to use in Egypt for early detection of developmental delay and enabling early intervention practices. A Z-score curve is reliable for follow up motor and mental development by calculating each age group achievement.

A latent class analysis to identify how patterns of Intimate Partner Violence influence Early Childhood Development outcomes in Honduras

BACKGROUND

Intimate Partner Violence (IPV) against women is a complex phenomenon with long-term consequences for victims and their families.

OBJECTIVE

The goals of this study are two-fold: to identify common patterns of co-occurring and/or successive experiences with IPV; and to study the association between these IPV patterns and outcomes of Early Childhood Development (ECD) among the victim's children.

DATA AND PARTICIPANTS

Data was obtained from the 2011-12 Honduras Demographic Health Survey (DHS).

METHODS

A Latent Class Analysis (LCA) was conducted to define homogeneous patterns of experiences with IPV in terms of the type, severity, timing of the last event, and perpetrator of the violence. Outcomes of interest were binary variables indicating if a child is developmentally on track according to the ECD index and its four domains. LCA with distal outcomes and multivariate logistic regressions were used to measure the association between IPV patterns and ECD outcomes.

RESULTS

Five patterns of lifetime experiences with IPV were identified: (1)"no violence"; (2)"physical and sexual violence by an ex-partner"; (3)"current emotional violence"; (4)"current controlling, emotional and physical violence"; and (5)"past controlling, emotional and physical violence". Multivariate results show that children were less likely to be developmentally on track if their mothers were exposed to patterns of "physical and sexual violence by an ex-partner" or "current controlling, emotional and physical violence", relative to children whose mothers had not experienced violence. Further analysis of specific ECDI domains suggested that IPV hampers children's socioemotional development, but it is not associated with other domains of ECD.

CONCLUSION

Experiencing a pattern of co-occurrent forms of IPV negatively influences ECD and the socio-emotional development of the victim's children in low and middle-income countries. This study provides initial evidence about the complexity of this phenomenon and its long-lasting sequels.

The association between malnutrition and childhood disability in low- and middle- income countries: systematic review and meta-analysis of observational studies

OBJECTIVE

The aim of this study was to evaluate the association between childhood disability and malnutrition in low- and middle- income countries (LMICs).

METHODS

Articles were identified from 1990 to August 2017 by searching nine electronic databases. Epidemiological studies, undertaken in LMICs that compared the prevalence of malnutrition in children with disabilities to children without disabilities were eligible for inclusion. Titles, abstracts, and full texts were screened by two reviewers, and data were extracted using a structured table for eligible papers. Meta-analyses for the association between childhood disability and undernutrition were performed.

RESULTS

The search generated 4678 results, from which 17 articles were eligible. Fifty-three per cent of these studies showed a positive association between childhood disability and undernutrition. Results varied when disaggregated by type of disability, with positive associations identified for 44% of studies focussed on neurodevelopmental disability, 60% of general disability studies and 67% of studies on hearing impairment. Only four studies were identified that considered overnutrition outcomes, and these showed variable results. Eighteen per cent of eligible studies were considered at low risk of bias, 53% had a medium risk, and 29% had a high risk of bias. Pooled ORs showed that children with disabilities were almost three times more likely to be underweight (OR 2.97, 95% CI 2.33, 3.79), and nearly twice as likely to experience stunting and wasting (Stunting: 1.82, 1.40, 2.36; Wasting: 1.90, 1.32-2.75), compared to controls.

CONCLUSIONS

Children with disabilities may be a vulnerable group for undernutrition in LMICs, which should be reflected in disability and nutritional programming and policy-making.

Mandarin parents' evaluation of developmental status in the detection of delays

BACKGROUND

We examined the parental perception and accuracy of the Mandarin translation of the Parents' Evaluation of Developmental Status, a screening questionnaire for parent concerns about children's various developmental skills.

METHODS

The questionnaire was translated into Mandarin. Upon enrollment, caregivers completed the Mandarin PEDS and answered four questions about its acceptability and usefulness, and its ease of understanding and completion. The Mandarin PEDS was independently evaluated by a pediatrician and a community nurse, and classified as high risk (≥two predictive concerns), medium risk (one predictive concern), low risk (any non-predictive concerns) or no risk (if no concern) for developmental delays. The caregivers repeated Mandarin PEDS at a 2 week interval for test-retest reliability, while the children underwent testing for accuracy using a developmental assessment test.

RESULTS

The majority (≥85%) of the 73 caregivers perceived the Mandarin PEDS as acceptable and useful, as well as easy to understand and complete. Fifteen (20.5%) and 24 responses (33.9%) were classified as high and moderate risk, respectively. The test-retest and inter-rater reliabilities were excellent, with an intra-class correlation coefficient of 0.812 (95% CI: 0.701-0.881, P < 0.001) and a kappa value of 0.870 (P < 0.001), respectively. Mandarin PEDS was 80.0% sensitive and 83.8% specific for those in the high-risk category (adjusted OR, 64.68; 95% CI: 1.33-3,139.72; P = 0.035).

CONCLUSION

Mandarin PEDS was well received by the caregivers, and was reliable and accurate in detecting developmental delays in the Mandarin-speaking subjects. We recommend it for early detection of children with developmental and behavioral problems.