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Faridah F, Anies A, Kartasurya MI, Widjanarko B. Online educational intervention: Improving maternal knowledge and attitudes in providing developmental stimulation for stunting toddlers. NARRA J 2024; 4:e591. [PMID: 38798876 PMCID: PMC11125314 DOI: 10.52225/narra.v4i1.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024]
Abstract
Stunting remains a significant public health concern, impacting physical growth and impeding children's development. Mothers, who play a crucial role in stimulating children's development, often encounter barriers in providing effective stimulation, primarily due to limited access to appropriate resources and information. Online education can bridge this gap by offering easily accessible learning. This aim of this study was to determine the effect of online education on maternal knowledge and attitudes in providing developmental stimulation for stunting toddlers. A quasi-experimental research design was employed, comprising a treatment group and a control group, each consisting of 46 mothers with stunting toddlers, sampled purposively. The treatment group received an online developmental stimulation educational intervention through WhatsApp groups for twelve meetings, each lasting 1.5 to 2 hours. Meanwhile, the control group participated in a stunting assistance program provided by the community health centers (Puskesmas). To compare the knowledge and attitudes between groups, Mann-Whitney and independent Student t-test were used. The assessment of intervention effects on knowledge and attitudes was conducted using Wilcoxon and paired Student t-test within each group. Following the educational intervention on developmental stimulation, there was a significant increase in knowledge; however, there was no significant difference in attitudes. The treatment group (mean score 3.9±1.76) had a higher increase in knowledge scores compared to the control group (2.0±2.25) with a p<0.001. Nonetheless, no significant difference in attitudes was observed between the two groups with the mean change scores was 5.8±15.31 in treatment group and 2.5±18.69 for control group, with a p=0.335. This study suggests that providing online education leads to increased knowledge scores but does not impact attitudes significantly. Additional educational approaches should be considered to enhance maternal attitudes.
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Affiliation(s)
- Faridah Faridah
- Doctoral Program of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Anies Anies
- Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Martha I. Kartasurya
- Department of Public Health Nutrition, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
- Department of Health Promotion, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Bagoes Widjanarko
- Department of Health Promotion, Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
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Carrington L, Hale L, Freeman C, Smith D, Perry M. The effectiveness of play as an intervention using International Classification of Functioning outcome measures for children with disabilities - a systematic review and meta-synthesis. Disabil Rehabil 2023:1-22. [PMID: 37750218 DOI: 10.1080/09638288.2023.2259305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Over 240 million children worldwide experience inequities due to disablement/disability. Play is important for children's global development, to enable participation in life, and has been used in therapeutic settings. The purpose of this systematic review is to determine the effectiveness of play used in therapy for children with disabilities, to explore ways that play is used in therapy, and to classify and map outcome measures used in play-based interventions to the International Classification of Functioning. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS The search yielded 22 articles eligible for inclusion. A meta-analysis found significant heterogeneity for play-based intervention outcomes, precluding estimates of effectiveness. Body function and structure outcomes accounted for 61% of reported outcome measures. CONCLUSION There is a trend towards a small positive effect of play used in therapy for children with disabilities, but certainty of the effect is poor, and replication difficult due to heterogeneous reports of how play is used. Research aims and outcome measures focusing on meaningful aspects of activity and participation in addition to body function and structure domains of the International Classification of Functioning should be considered for play-based interventions for children with disabilities.
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Affiliation(s)
- Lizz Carrington
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Leigh Hale
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Claire Freeman
- School of Architecture, Victoria University of Wellington Te Herenga Waka, Wellington, New Zealand
| | - Donna Smith
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Meredith Perry
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
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Giraldo-Huertas J. Parental developmental screening with CARE: A pilot hybrid assessment and intervention with vulnerable families in Colombia. PLoS One 2023; 18:e0287186. [PMID: 37379320 DOI: 10.1371/journal.pone.0287186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Poverty and scarcity of resources make children in low-and-middle-income countries at risk of not reaching their developmental potential. Despite a near-universal interest in risk reduction, effective interventions like enhancing reading skills in parents to diminish developmental delay remain elusive for the great majority of vulnerable families. We undertook a efficacy study for parental use of a booklet called CARE for developmental screening of children between 36 to 60 months old (M = 44.0, SD = 7.5). All participants (N = 50), lived in vulnerable, low-income neighborhoods in Colombia. The study followed a pilot Quasi-Randomised Control Trial design (i.e., control group participants assigned based on non-random criteria) of parent training with a CARE intervention group compared to a control group. Data was analyzed using two-way ANCOVA for sociodemographic variables' interaction with follow-up results and one-way ANCOVA to evaluate the relations between the intervention and post-measurement of developmental delays and cautions and other language related-skills outcomes, while controlling for pre-measurements. These analyses indicated that the CARE booklet intervention enhanced children's developmental status and narrative skills (developmental screening delay items, F(1, 47) = 10.45, p = .002, partial η2 = .182; narrative devices scores, F(1, 17) = 4.87, p = .041, partial η2 = .223). Several limitations (e.g., sample size) and possible implications for the analysis of children's developmental potential are discussed and considered for future research, along with the effects of the COVID-19 pandemic on the closure of preschools and community care centers.
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Affiliation(s)
- Juan Giraldo-Huertas
- Department of Developmental and Educative Psychology, Universidad de la Sabana, Chía, Colombia
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Early child stimulation, linear growth and neurodevelopment in low birth weight infants. BMC Pediatr 2022; 22:586. [PMID: 36209050 PMCID: PMC9547474 DOI: 10.1186/s12887-022-03579-6] [Citation(s) in RCA: 2] [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: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Children with low birth weight (LBW) are at risk of linear growth faltering and developmental deficits. Evidence suggests that early child stimulation and care reflected as responsive caregiving and opportunities for learning can promote development. The current analysis aimed to measure the extent to which linear growth and early child stimulation modify each other’s association with neurodevelopmental outcomes among LBW infants. Methods This is a secondary data analyses from a randomized controlled trial on the effect of community-initiated kangaroo mother care in LBW infants on their neurodevelopment at 12 months of corrected age. Bayley Scales of Infant and Toddler Development was used to assess cognitive, motor and language scores. Stimulation at home was assessed by the Pediatric Review of Children’s Environmental Support and Stimulation (PROCESS) tool. PROCESS scores were categorized into three groups: < Mean-1SD (low stimulation); Mean ± 1 SD (moderate stimulation) and > mean + 1SD (high stimulation). Results A total of 516 infants were available for neurodevelopment assessments. Interactions were observed between length for age z-score (LAZ) and PROCESS score categories. In the low stimulation group, the adjusted regression coefficients for the association between LAZ and cognitive, motor and language scores were substantially higher than in the moderate and high stimulation group. Stimulation was positively associated with neurodevelopmental outcomes in both stunted and non-stunted infants; however, the association was twice as strong in stunted than in non-stunted. Conclusion Moderate to high quality stimulation may alleviate the risk of sub-optimal development in LBW infants with linear growth deficits. Clinical trial registration The primary trial whose data are analysed is registered at clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT02631343). Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03579-6.
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Godoy PBG, Shephard E, Argeu A, Silveira LR, Salomone E, Aldred C, Green J, Polanczyk GV, Matijasevich A. Social communication therapy for children at risk for neurodevelopmental difficulties: Protocol for a clinical trial. Ann N Y Acad Sci 2022; 1514:104-115. [PMID: 35506888 DOI: 10.1111/nyas.14784] [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] [Indexed: 11/30/2022]
Abstract
Exposure to adverse environments are risk factors for neurodevelopmental problems in childhood. Children exposed to such environments may benefit from interventions that target social communication abilities, since these are protective factors for healthy neurodevelopment. This randomized controlled trial will test the efficacy of Paediatric Autism Communication Therapy (PACT) in improving social communication development in young children at risk for neurodevelopmental difficulties living in poverty in Brazil. Participants will be 160 children aged 2-4 years with lower-than-average social communication abilities and their primary caregivers. Child-caregiver dyads will be recruited from public childhood education centers in impoverished urban regions of the city of São Paulo, Brazil. Lower-than-average social communication abilities will be defined by standard scores (≤84) on the socialization and/or communication domains of the Vineland Adaptive Behavior Scales. Child-caregiver dyads will be randomized to receive 12 sessions of the PACT intervention (n = 80) or 5 months of community support as usual plus psychoeducation (n = 80). The primary outcome (parent-child interaction) and secondary outcomes (parent-reported social communication abilities and neurophysiological activity during a live social interaction) will be measured pre- and postintervention. This study may lead to new interventions for vulnerable young children in Brazil and better understanding of the neural mechanisms of PACT.
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Affiliation(s)
- Priscilla B G Godoy
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Adriana Argeu
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Leticia R Silveira
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Erica Salomone
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Waechter R, Burgen KS, Punch B, Evans R, Blackmon K, Noël T, Fernandes M, Landon B. Improving neurodevelopment in Zika-exposed children: A randomized controlled trial. PLoS Negl Trop Dis 2022; 16:e0010263. [PMID: 35259172 PMCID: PMC8903297 DOI: 10.1371/journal.pntd.0010263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While microcephaly is a significant adverse outcome of prenatal exposure to the Zika virus (ZIKV), subtle malformations of cortical development (MCD) have been observed in Zika-exposed children (ZEC), including delays in language, cognition, and motor domains, and visual acuity deficits. Interventions within the first 1,000 days of life can significantly improve developmental outcomes. This study examined a 12-week Responsive Caregiving Intervention on neurodevelopmental outcomes in 24-30-month-old ZEC. METHODOLOGY/PRINCIPAL FINDINGS A randomized controlled trial was implemented in Grenada, West Indies using an existing ZIKV cohort surveillance study. When children in that study turned 24 months, baseline child neurodevelopmental measures and caregiver interviews were administered. Caregivers who agreed to participate in the 12-week Responsive Caregiving Intervention, implemented when children were 24-30 months of age, were randomly assigned to the Intervention or Waitlist Control group. Children in both groups were re-assessed on the neurodevelopmental measures post-intervention. CONCLUSIONS/SIGNIFICANCE 233 children from the ZIKV surveillance study met inclusion criteria, of which n = 80 declined participation, n = 42 did not complete the Intervention, and n = 72 missed follow-up assessments given strict timelines in the study design. The final sample for analysis was N = 13 children in the Intervention group and N = 26 children in the Control group. A GEE model analysis showed significantly higher language (p = 0.021) and positive behaviour (p = 0.005) scores for children in the Intervention group compared to the Control group. The Intervention had a medium effect on child language (d = 0.66) and a large effect on positive behaviour (d = 0.83). A 12-week Responsive Caregiving Intervention Programme significantly improves language and positive behaviour scores in 30-month-old normocephalic children who were exposed to ZIKV in utero. The programme provides an option for mothers of ZIKV-exposed children who are seeking an evidence-based neurodevelopmental intervention regardless of known impact of the virus on cortical formation. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT04697147).
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Affiliation(s)
- Randall Waechter
- Department of Neuroscience, Physiology, and Behavioral Sciences; School of Medicine; St George’s University; Grenada, West Indies
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
- * E-mail:
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
| | - Bianca Punch
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
| | - Karen Blackmon
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Mayo Clinic; Department of Psychiatry and Psychology; Jacksonville, Florida, United States of America
| | - Trevor Noël
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Office of Research; St. George’s University; Grenada, West Indies
| | - Michelle Fernandes
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Faculty of Medicine; Department of Paediatrics; University Hospitals Southampton; University of Southampton; Southampton, United Kingdom
- Nuffield Department of Women’s & Reproductive Health; John Radcliffe Hospital; University of Oxford; Oxford, United Kingdom
| | - Barbara Landon
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
- School of Graduate Studies; St. George’s University; Grenada, West Indies
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Mwenda V, Makena I, Ogweno V, Obonyo J, Were V. Effectiveness of interactive text messaging and structured psychosocial support groups on developmental milestones of children from adolescent pregnancies in Kenya: a quasi-experimental study (Preprint). JMIR Pediatr Parent 2022; 6:e37359. [PMID: 37126373 DOI: 10.2196/37359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/23/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. OBJECTIVE We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers' knowledge and practices as well as infant growth and development. METHODS This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. RESULTS We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). CONCLUSIONS An interactive text messaging platform improved adolescent mothers' knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse.
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Affiliation(s)
- Valerian Mwenda
- Department of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- Field Epidemiology Society of Kenya, Nairobi, Kenya
| | - Ireen Makena
- Department of Biological Sciences, Chuka University, Chuka, Kenya
| | - Vincent Ogweno
- Department of Pediatrics, University of Nairobi, NAIROBI, Kenya
| | - James Obonyo
- County Department of Health, Homa Bay County, Homa Bay, Kenya
| | - Vincent Were
- Kenya Medical Research Institute-Wellcome trust, Nairobi, Kenya
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Sánchez-Vincitore LV, Castro A. The role of sociodemographic and psychosocial variables in early childhood development: A secondary data analysis of the 2014 and 2019 Multiple Indicator Cluster Surveys in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000465. [PMID: 36962194 PMCID: PMC10021185 DOI: 10.1371/journal.pgph.0000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
The association between sociodemographic factors-poverty, lack of maternal schooling, being male at birth-, childhood developmental delay, and poor educational outcomes has been established in the Dominican Republic (DR). However, family moderating factors present or introduced to buffer sociodemographic factors effects on early childhood development (ECD) are still unknown. We conducted a secondary analysis of the DR's 2014 and 2019 Multiple Indicator Cluster Surveys. We had four study aims: 1) confirm the relationship between socioeconomic position (SP), parenting practices, and ECD; 2) determine if a sociodemographic model predicted ECD; 3) determine if a psychosocial model (family childrearing practices, discipline, and early childhood stimulation) predicted ECD above and beyond the sociodemographic model; 4) explore mothers' beliefs about physical punishment and its relationship with ECD and psychosocial variables. We found that both models predicted ECD significantly, but the psychosocial model explained more variance than the sociodemographic model (6.3% in 2014 and 4.4% in 2019). The most relevant sociodemographic predictors were SP (explaining 21.6% of ECD variance in 2014 and 18.6% in 2019) and mother's education (explaining 13.9% in 2014 and 14.1% in 2019). The most salient ECD psychosocial predictors were: negative discipline, number of children's books at home, stimulating activities at home, and attendance to an early childhood education program. The predicting weights of the independent variables were similar for both years. These results have multiple implications for social programs that aim to improve children's potential in contexts of poverty. Although the results show a protective effect of psychosocial factors, sustainable and large-scale interventions should not be limited to just buffering effects, but to solve the underlying problem, which is that poverty prevents children from reaching their developmental potential and exposes them to life-long greater risk for chronic disease. Addressing delays early in life can therefore contribute to achieving health equity.
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Affiliation(s)
- Laura V Sánchez-Vincitore
- Neurocognition and Psychophysiology Laboratory, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Arachu Castro
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Emmers D, Jiang Q, Xue H, Zhang Y, Zhang Y, Zhao Y, Liu B, Dill SE, Qian Y, Warrinnier N, Johnstone H, Cai J, Wang X, Wang L, Luo R, Li G, Xu J, Liu M, Huang Y, Shan W, Li Z, Zhang Y, Sylvia S, Ma Y, Medina A, Rozelle S. Early childhood development and parental training interventions in rural China: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:e005578. [PMID: 34417271 PMCID: PMC8381307 DOI: 10.1136/bmjgh-2021-005578] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Inadequate care during early childhood can lead to long-term deficits in skills. Parenting programmes that encourage investment in young children are a promising tool for improving early development outcomes and long-term opportunities in low-income and middle-income regions, such as rural China. METHODS We conducted a systematic review and a meta-analysis to investigate the prevalence of early developmental delays and stimulating parenting practices as well as the effect of parental training programmes on child development outcomes in rural China. We obtained data in English from EconPapers, PubMed, PsycARTICLES, Cochrane Library, Web of Science and Scopus (Elsevier) and in Chinese from China National Knowledge Infrastructure, Wanfang Data and VIP Information. We conducted frequentist meta-analyses of aggregate data and estimated random-effects meta-regressions. Certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS We identified 19 observational studies on the prevalence of developmental delays and stimulating parenting practices for children under 5 years of age (n=19 762) and ten studies on the impact of parental training programmes on early child development (n=13 766). Children's risk of cognitive, language and social-emotional delays in the rural study sites (covering 14 provinces mostly in Central and Western China) was 45%, 46%, and 36%, respectively. Parental training programmes had a positive impact on child cognition, language and social-emotional development. CONCLUSION There is evidence to suggest that early developmental delay and the absence of stimulating parenting practices (ie, reading, storytelling and singing with children) may be prevalent across rural, low-income and middle-income regions in Central and Western China. Results support the effectiveness of parental training programmes to improve early development by encouraging parental engagement. TRIAL REGISTRATION NUMBER This study was registered with PROSPERO (CRD42020218852).
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Affiliation(s)
- Dorien Emmers
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Leuven, Belgium
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Qi Jiang
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Yue Zhang
- National Center for Women and Children Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Bin Liu
- Xinhe Foundation, Beijing, China
| | - Sarah-Eve Dill
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Yiwei Qian
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Nele Warrinnier
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Leuven, Belgium
- School of Economics and Finance, Queen Mary University of London, London, UK
| | - Hannah Johnstone
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Jianhua Cai
- Administrators of Training Center of the National Health Commission of the PRC, Beijing, China
| | - Xiaoli Wang
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Lei Wang
- International Business School, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Renfu Luo
- School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Guirong Li
- International Center for Action Research on Education, Henan University School of Education, Kaifeng, Henan, China
| | - Jiajia Xu
- International Center for Action Research on Education, Henan University School of Education, Kaifeng, Henan, China
| | - Ming Liu
- Save the Children International China Program, Beijing, China
| | - Yaqing Huang
- Save the Children International China Program, Beijing, China
| | - Wenjie Shan
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihui Li
- Child Health Advocacy Institute, Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yu Zhang
- Hupan Modou Foundation, Hangzhou, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yue Ma
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Alexis Medina
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
| | - Scott Rozelle
- Stanford Center on China's Economy and Institutions, Freeman Spogli Institute for International Studies & Stanford Institute for Economic Policy Research, Stanford University, Stanford, California, USA
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Jensen SK, Placencio-Castro M, Murray SM, Brennan RT, Goshev S, Farrar J, Yousafzai A, Rawlings LB, Wilson B, Habyarimana E, Sezibera V, Betancourt TS. Effect of a home-visiting parenting program to promote early childhood development and prevent violence: a cluster-randomized trial in Rwanda. BMJ Glob Health 2021; 6:bmjgh-2020-003508. [PMID: 33514591 PMCID: PMC7849888 DOI: 10.1136/bmjgh-2020-003508] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Families living in extreme poverty require interventions to support early-childhood development (ECD) due to broad risks. This longitudinal cluster randomised trial examines the effectiveness of Sugira Muryango (SM), a home-visiting intervention linked to Rwanda’s social protection system to promote ECD and reduce violence compared with usual care (UC). Methods Families with children aged 6–36 months were recruited in 284 geographical clusters across three districts. Cluster-level randomisation (allocated 1:1 SM:UC) was used to prevent diffusion. SM was hypothesised to improve child development, reduce violence and increase father engagement. Developmental outcomes were assessed using the Ages and Stages Questionnaire (ASQ-3) and the Malawi Development Assessment Tool (MDAT) and anthropometric assessments of growth. Violence was assessed using questions from UNICEF Multiple Indicators Cluster Survey (MICS) and Rwanda Demographic and Health Surveys (DHS). Father engagement was assessed using the Home Observation for Measurement of the Environment. Blinded enumerators conducted interviews and developmental assessments. Results A total of 541 SM families and 508 UC families were enrolled and included in the analyses. Study attrition (2.0% children; 9.6% caregivers) was addressed by hot deck imputation. Children in SM families improved more on gross motor (d=0.162, 95% CI 0.065 to 0.260), communication (d=0.081, 95% CI 0.005 to 0.156), problem solving (d=0.101, 95% CI 0.002 to 0.179) and personal-social development (d=0.096, 95% CI −0.015 to 0.177) on the ASQ-3. SM families showed increased father engagement (OR=1.592, 95% CI 1.069 to 2.368), decreased harsh discipline (incidence rate ratio, IRR=0.741, 95% CI 0.657 to 0.835) and intimate partner violence (IRR=0.616, 95% CI:0.458 to 0.828). There were no intervention-related improvements on MDAT or child growth. Conclusion Social protection programmes provide a means to deliver ECD intervention. Trial registration number NCT02510313.
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Affiliation(s)
- Sarah Kg Jensen
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Matias Placencio-Castro
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts, USA
| | - Shauna M Murray
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Robert T Brennan
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA.,Women's Study Research Center, Brandeis University, Waltham, Massachusetts, USA
| | - Simo Goshev
- Academic Research Services, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jordan Farrar
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Briana Wilson
- The World Bank, Washington, District of Columbia, USA
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11
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Mortaji N, Krzeczkowski JE, Boylan K, Booij L, Perreault M, Van Lieshout RJ. Maternal pregnancy diet, postnatal home environment and executive function and behavior in 3- to 4-y-olds. Am J Clin Nutr 2021; 114:1418-1427. [PMID: 34159358 PMCID: PMC8491573 DOI: 10.1093/ajcn/nqab202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal maternal nutrition during pregnancy has been linked to better cognitive and behavioral development in children. However, its influence on the effects of suboptimal postnatal exposures like reduced stimulation and support in the home is not known. OBJECTIVES To examine the effect of maternal pregnancy diet on executive function and/or behavioral development in children raised in suboptimal home environments. METHODS Data were provided by 808 mother-infant dyads from the Canadian Maternal-Infant Research on Environmental Chemicals-Child Development study. Maternal pregnancy diet was self-reported using the Healthy Eating Index 2010 questionnaire. Stimulation and support in the home was assessed using the Home Observation for Measurement of the Environment (HOME) when children were 3-4 y old. Child executive function was reported by mothers at this age using the Behavior Rating Inventory of Executive Functioning-Preschool Edition, and child behavior was assessed using the Behavior Assessment System for Children-2nd Edition. We examined the interaction of maternal pregnancy diet and postnatal HOME scores on child executive function and behavior using linear regression adjusted for maternal education, postpartum depression, prepregnancy BMI, and smoking. RESULTS Maternal pregnancy diet was associated with an increasingly positive association with child working memory (β: 0.21; 95% CI: 0.82, 3.41; P = 0.001), planning (β: 0.17; 95% CI: 0.38, 2.84; P = 0.007), and adaptability (β: -0.13; 95% CI: -1.72, -0.08; P = 0.032) as levels of postnatal stimulation decreased. CONCLUSIONS The positive association of maternal pregnancy diet quality and executive function and adaptability in 3- to 4-y-olds appeared to increase with decreasing levels of postnatal stimulation and support. These results suggest that overall maternal pregnancy diet could be linked to better child neurodevelopment in families experiencing barriers to providing stimulation and support to children in their home.
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Affiliation(s)
| | - John E Krzeczkowski
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Maude Perreault
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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12
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Sousa RCRD, Monteiro EMLM, Albuquerque GA, Paula WKAD, Coriolano-Marinus MWDL. NURSING INTERVENTIONS TO PROMOTE CHILD DEVELOPMENT THROUGH BRONFENBRENNER'S BIOECOLOGICAL THEORY. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the benefits and limitations of nursing interventions for the promotion of child development, according to the Bioecological Theory of Human Development, by Bronfenbrenner. Method: an integrative review, from the databases PubMed, Lilacs, CINAHL, Web of Science and Scopus, using the descriptors: "child development" AND "nurses" OR "nursing". No time limit was set for publications. The search was perfomed in September 2019 and update in March 2020. Results: 24 studies were selected for the final sample. The predominant type of study design was the clinical trial (60%). The home visit was the most used strategy (60%). Seven main themes emerged from the outcomes of the interventions: the child, maternal health, parenting skills, relationship between nurse and mother/father, use of social benefits, professional practice, and family violence. The process component was present in all studies, portraying the relevance of proximal interactions in the home environment. Only two interventions had no impact on any outcome. Conclusion: nursing interventions showed benefits in all outcomes, especially in outcomes related to children and parental practices, and improved situations of interaction between caregivers and children, reducing punitive practices and violence against children. It is essential to consider the bioecological perspective, so that nursing interventions, in promoting child development, are more effective.
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13
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Fernandez Rao S, Bentley ME, Balakrishna N, Griffiths P, Creed‐Kanashiro H, Vazir S, Johnson SL. A complementary feeding and play intervention improves the home environment and mental development among toddlers in rural India. MATERNAL & CHILD NUTRITION 2020; 16 Suppl 3:e13066. [PMID: 33347725 PMCID: PMC7752118 DOI: 10.1111/mcn.13066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants (n = 521) were assessed for development (Bayley-II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F(2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales 'Opportunities for Variety in Daily Stimulation' and 'Caregiver Promotion of Child Development' (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F(2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group (P < 0.04); no differences were noted in psychomotor development index (PDI) scores (P = 0.48). The subscales of HOME associated with MDI at 15 months were 'CPCD' and 'Cleanliness of Child' (R2 = 0.076). 'CPCD' was also associated with PDI (R2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months.
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Affiliation(s)
- Sylvia Fernandez Rao
- Behavioral Science Unit, Extension and Training DivisionNational Institute of Nutrition (ICMR)HyderabadIndia
| | - Margaret E. Bentley
- Department of Nutrition and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Paula Griffiths
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | | | - Shahnaz Vazir
- Behavioral Science Unit, Extension and Training DivisionNational Institute of Nutrition (ICMR)HyderabadIndia
| | - Susan L. Johnson
- Children's Eating Laboratory, Department of Pediatrics, Section of NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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14
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Tessema TT, Alamdo AG, Yirtaw TG, Deble FA, Mekonen EB, Abessa TG, Lema TB. The effects of psychosocial stimulation on the development, growth, and treatment outcome of children with severe acute malnutrition age 6-59 months in southern Ethiopia: a parallel group cluster randomized control trial (EPSoSAMC study). BMC Public Health 2019; 19:1610. [PMID: 31791303 PMCID: PMC6889618 DOI: 10.1186/s12889-019-7916-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 01/04/2023] Open
Abstract
Background Severe Acute Malnutrition (SAM) remains a major cause of child mortality. To improve the management and survival of children the World Health Organization (WHO) endorsed the protocol for the management of SAM. The protocol suggested the integration of psychosocial stimulation as part of the medico-nutritional care process to prevent the long-term adverse developmental impact of the SAM. However, there is little scientific evidence behind the recommended stimulation intervention. Method A parallel-group cluster-randomized controlled trial will be conducted among 144 children with SAM age 6–59 months in Southern Ethiopia. The study will have two groups where: children with SAM admitted in the intervention health facilities will receive psychosocial stimulation in addition to the routine inpatient care and for 6 months after discharge. Children with SAM admitted in the SC of the control health facilities will receive the routine inpatient care without psychosocial stimulation and home-based follow up for 6 months after discharge. All mothers/ caregivers will also receive uniform health education on child health-related issues. The primary outcome of the study will be child development while the secondary outcomes will include child growth and treatment outcome. All outcomes will be assessed four times: at enrollment, upon discharge from the SC, at 3 and 6 months of follow up. The data will be analyzed using STATA Version 15 Statistical Software. The anthropometric Z-scores and percentile of the median will be calculated child using WHO Anthro Version 3.2.2 Statistical Software. To assess the overall effect of the intervention by controlling other potential contributing factors, a generalized linear mixed model will be used. Discussion The present study will have an important contribution in generating supplementary evidence regarding the effect of psychosocial stimulation interventions on the development and growth outcomes of children with SAM. The study will further address the impact of the intervention on treatment outcome indicators that are still under-researched areas requiring new scientific evidence. Trial registration Pan African Clinical Trials Registry -PACTR201901730324304. Registered 25 November 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5739
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Affiliation(s)
- Tesfalem T Tessema
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Andamlak G Alamdo
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tewodrose G Yirtaw
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fana A Deble
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eyoel B Mekonen
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teklu G Abessa
- College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia
| | - Tefera B Lema
- College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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15
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Lloyd‐Fox S, Blasi A, McCann S, Rozhko M, Katus L, Mason L, Austin T, Moore SE, Elwell CE. Habituation and novelty detection fNIRS brain responses in 5- and 8-month-old infants: The Gambia and UK. Dev Sci 2019; 22:e12817. [PMID: 30771264 PMCID: PMC6767511 DOI: 10.1111/desc.12817] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/12/2018] [Accepted: 01/10/2019] [Indexed: 01/17/2023]
Abstract
The first 1,000 days of life are a critical window of vulnerability to exposure to socioeconomic and health challenges (i.e. poverty/undernutrition). The Brain Imaging for Global Health (BRIGHT) project has been established to deliver longitudinal measures of brain development from 0 to 24 months in UK and Gambian infants and to assess the impact of early adversity. Here results from the Habituation-Novelty Detection (HaND) functional near-infrared spectroscopy (fNIRS) task at 5 and 8 months are presented (N = 62 UK; N = 115 Gambia). In the UK cohort distinct patterns of habituation and recovery of response to novelty are seen, becoming more robust from 5 to 8 months of age. In The Gambia, an attenuated habituation response is evident: a larger number of trials are required before the response sufficiently suppresses relative to the response during the first presented trials. Furthermore, recovery of response to novelty is not evident at 5 or 8 months of age. As this longitudinal study continues in The Gambia, the parallel collection of socioeconomic, caregiving, health and nutrition data will allow us to stratify how individual trajectories of habituation and recovery of response to novelty associate with different risk factors and adaptive mechanisms in greater depth. Given the increasing interest in the use of neuroimaging methods within global neurocognitive developmental studies, this study provides a novel cross-culturally appropriate paradigm for the study of brain responses associated with attention and learning mechanisms across early development.
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Affiliation(s)
- Sarah Lloyd‐Fox
- Centre for Brain and Cognitive DevelopmentBirkbeck University of LondonLondonUK
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Anna Blasi
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Samantha McCann
- Medical Research CouncilThe Gambia at the London School of Hygiene and Tropical MedicineLondonUK
| | - Maria Rozhko
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Laura Katus
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Luke Mason
- Centre for Brain and Cognitive DevelopmentBirkbeck University of LondonLondonUK
| | - Topun Austin
- Department of NeonatologyThe Rosie Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sophie E. Moore
- Department of Women and Children’s HealthKings College LondonLondonUK
| | - Clare E. Elwell
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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16
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Argaw A, Huybregts L, Wondafrash M, Kolsteren P, Belachew T, Worku BN, Abessa TG, Bouckaert KP. Neither n-3 Long-Chain PUFA Supplementation of Mothers through Lactation nor of Offspring in a Complementary Food Affects Child Overall or Social-Emotional Development: A 2 × 2 Factorial Randomized Controlled Trial in Rural Ethiopia. J Nutr 2019; 149:505-512. [PMID: 30544211 DOI: 10.1093/jn/nxy202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/25/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The n-3 (ω-3) long-chain polyunsaturated fatty acid (LC-PUFA) docosahexaenoic acid (DHA) is essential for optimal brain development. There is a lack of evidence on the effect of postnatal n-3 LC-PUFA supplementation on child development in low-income countries. OBJECTIVE We evaluated the efficacy of fish-oil supplementation through lactation or complementary food supplementation on the development of children aged 6-24 mo in rural Ethiopia. METHODS We conducted a double-blind randomized controlled trial of n-3 LC-PUFA supplementation for 12 mo using fish-oil capsules [maternal intervention: 215 mg DHA + 285 mg eicosapentaenoic acid (EPA)] or a fish-oil-enriched complementary food supplement (child intervention: 169 mg DHA + 331 mg EPA). In total, 360 pairs of mothers and infants aged 6-12 mo were randomly assigned to 4 arms: maternal intervention and child control, child intervention and maternal control, maternal and child intervention, and maternal and child control. Primary outcomes were overall developmental performance with the use of a culturally adapted Denver II test that assesses personal-social, language, fine-motor, and gross-motor domains and social-emotional developmental performance using the Ages and Stages Questionnaire: Social Emotional at baseline and at 6 and 12 mo. We used mixed-effects models to estimate intervention effects on developmental performance over time (intervention × time interaction). RESULTS The evolution in overall and social-emotional developmental performance over time did not differ across study arms (intervention × time: F = 1.09, P = 0.35, and F = 0.61, P = 0.61, respectively). Effects did not change after adjustment for child age, birth order, and nutritional status; maternal age and education; wealth; family size; and breastfeeding frequency. Children's developmental performance significantly decreased during study follow-up (β: -0.03 SDs/mo; 95% CI: -0.04, -0.01 SD/mo; P < 0.01). CONCLUSIONS n-3 LC-PUFA supplementation does not affect overall or social-emotional development of children aged 6-24 mo in a low-income setting. Follow-up of the cohort is recommended to determine whether there are long-term effects of the intervention. This trial was registered at clinicaltrials.gov as NCT01817634.
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Affiliation(s)
- Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC
| | - Mekitie Wondafrash
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Berhanu N Worku
- Department of Psychology, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Teklu G Abessa
- Special Needs and Inclusive Education, College of Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia.,Rehabilitation Research Center (REVAL), Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Kimberley P Bouckaert
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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17
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Yang C, Liu X, Yang Y, Huang X, Song Q, Wang Y, Zhou H. Quality of care and suspected developmental delay among children aged 1-59 months: a cross-sectional study in 8 counties of rural China. BMC Pediatr 2019; 19:41. [PMID: 30704443 PMCID: PMC6354395 DOI: 10.1186/s12887-019-1406-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/16/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The data about quality of care of more than 70 countries were available from UNICEF but little was known about China. We examined the status about quality of care and explored its associations with developmental outcomes in Chinese children. METHODS A cross-sectional study with probability proportional to size sampling method was conducted in 8 counties of rural China. A total 1927 children were assessed on development status using Ages and Stages Questionnaires-Chinese (ASQ-C) based on Chinese normative data. Nutritional status was derived from the anthropometric method following WHO guidelines. Caregivers were interviewed through household questionnaires from UNICEF's 5th Multiple Indicator Cluster Survey to understand the quality of care, including the status of availability of children's books, availability of playthings, support for learning, fathers' support for learning and inadequate care. Moreover, quality of care was explored to be categorized into three levels (poor, medium and good) for overall assessment. Multivariable logistic regression model was applied to estimate the odds ratios and 95% confidence intervals between quality of care and suspected developmental delay (SDD) after adjustment for potential confounding variables. RESULTS The proportions of availability of children's books, playthings, support for learning, fathers' support for learning and inadequate care were 36.8, 91.3, 83.1, 16.4 and 4.9%, respectively. When compared to available data of more than 70 countries and areas, the quality of care in rural China was in the middle to upper level. After adjustment for potential confounding variables, multivariable analysis showed that SDD in overall ASQ remained negatively associated with availability of children's books (odds ratio [OR] and 95% confidence interval [CI]: 1.64 [1.27-2.12]), playthings (OR and 95% CI: 2.23 [1.52-3.27]) and support for learning (OR and 95% CI: 1.81 [1.06-3.10]). When compared with children under good quality of care, children under medium and poor quality of care had higher prevalence of SDD in overall ASQ (OR and 95% CI: 1.59 [1.21-2.07]; 3.05 [1.96-4.74]). CONCLUSIONS Quality of care in rural China still had scope for improvement. Better quality of care had negative associations with SDD.
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Affiliation(s)
- Chenlu Yang
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiaoli Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuning Yang
- United Nations International Children's Emergency Fund China, No. 12 Sanlitun Road, Chaoyang District, Beijing, 100600, China
| | - Xiaona Huang
- United Nations International Children's Emergency Fund China, No. 12 Sanlitun Road, Chaoyang District, Beijing, 100600, China
| | - Qiying Song
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yan Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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