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Butzin-Dozier Z, Mertens AN, Tan ST, Granger DA, Pitchik HO, Il'yasova D, Tofail F, Rahman MZ, Spasojevic I, Shalev I, Ali S, Karim MR, Shahriar S, Famida SL, Shuman G, Shoab AK, Akther S, Hossen MS, Mutsuddi P, Rahman M, Unicomb L, Das KK, Yan L, Meyer A, Stewart CP, Hubbard AE, Naved RT, Parvin K, Mamun MMA, Luby SP, Colford JM, Fernald LCH, Lin A. Stress biomarkers and child development in young children in Bangladesh. Psychoneuroendocrinology 2024; 164:107023. [PMID: 38522372 DOI: 10.1016/j.psyneuen.2024.107023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/31/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh. METHODS We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables. RESULTS We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We detected a significant relationship between HPA axis activity and child development, where increased HPA axis activity was associated with poor development outcomes. Specifically, we found that cortisol reactivity (coefficient -0.15, 95% CI (-0.29, -0.01)) and post-stressor levels (coefficient -0.12, 95% CI (-0.24, -0.01)) were associated with CDI comprehension score, post-stressor cortisol was associated with combined EASQ score (coefficient -0.22, 95% CI (-0.41, -0.04), and overall glucocorticoid receptor methylation was associated with CDI expression score (coefficient -0.09, 95% CI (-0.17, -0.01)). We did not detect a significant relationship between SAM activity or oxidative status and child development. CONCLUSIONS Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.
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Affiliation(s)
| | - Andrew N Mertens
- School of Public Health, University of California, Berkeley, CA, USA
| | - Sophia T Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Shahjahan Ali
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sunny Shahriar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Gabrielle Shuman
- School of Public Health, University of California, Berkeley, CA, USA
| | - Abul K Shoab
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salma Akther
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Saheen Hossen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Palash Mutsuddi
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kishor K Das
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kausar Parvin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, CA, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA.
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Lee AC, Cherkerzian S, Tofail F, Folger LV, Ahmed S, Rahman S, Chowdhury NH, Khanam R, Olson I, Oken E, Fichorova R, Nelson CA, Baqui AH, Inder T. Perinatal inflammation, fetal growth restriction, and long-term neurodevelopmental impairment in Bangladesh. Pediatr Res 2024:10.1038/s41390-024-03101-x. [PMID: 38589559 DOI: 10.1038/s41390-024-03101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND There are limited data on the impact of perinatal inflammation on child neurodevelopment in low-middle income countries and among growth-restricted infants. METHODS Population-based, prospective birth cohort study of 288 infants from July 2016-March 2017 in Sylhet, Bangladesh. Umbilical cord blood was analyzed for interleukin(IL)-1α, IL-1β, IL-6, IL-8, and C-reactive protein(CRP). Child neurodevelopment was assessed at 24 months with Bayley-III Scales of Infant Development. We determined associations between cord blood inflammation and neurodevelopmental outcomes, controlling for potential confounders. RESULTS 248/288 (86%) live born infants were followed until 24 months, among whom 8.9% were preterm and 45.0% small-for-gestational-age(SGA) at birth. Among all infants, elevated concentrations (>75%) of CRP and IL-6 at birth were associated with increased odds of fine motor delay at 24 months; elevated CRP was also associated with lower receptive communication z-scores. Among SGA infants, elevated IL-1α was associated with cognitive delay, IL-8 with language delay, CRP with lower receptive communication z-scores, and IL-1β with lower expressive communication and motor z-scores. CONCLUSIONS In rural Bangladesh, perinatal inflammation was associated with impaired neurodevelopment at 24 months. The associations were strongest among SGA infants and noted across several biomarkers and domains, supporting the neurobiological role of inflammation in adverse fetal development, particularly in the setting of fetal growth restriction. IMPACT Cord blood inflammation was associated with fine motor and language delays at 24 months of age in a community-based cohort in rural Bangladesh. 23.4 million infants are born small-for-gestational-age (SGA) globally each year. Among SGA infants, the associations between cord blood inflammation and adverse outcomes were strong and consistent across several biomarkers and neurodevelopmental domains (cognitive, motor, language), supporting the neurobiological impact of inflammation prominent in growth-restricted infants. Prenatal interventions to prevent intrauterine growth restriction are needed in low- and middle-income countries and may also result in long-term benefits on child development.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Sara Cherkerzian
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, 1212, Bangladesh
| | - Lian V Folger
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | | | - Sayedur Rahman
- Projahnmo Research Foundation, Banani, Dhaka, 1213, Bangladesh
| | | | - Rasheda Khanam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ingrid Olson
- Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Emily Oken
- Harvard Medical School, Boston, MA, 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Raina Fichorova
- Harvard Medical School, Boston, MA, 02115, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Charles A Nelson
- Harvard Medical School, Boston, MA, 02115, USA
- Boston Children's Hospital, Boston, MA, 02115, USA
- Harvard Graduate School of Education, Boston, MA, 02138, USA
| | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Terrie Inder
- Center for Neonatal Research, Children's Hospital of Orange County, Orange, CA, 92868, USA
- Department of Pediatrics, University of California Irvine, Irvine, CA, 92697, USA
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Wei R, Sullivan EF, Begum F, Rahman N, Tofail F, Haque R, Nelson CA. Parental communicative input as a protective factor in Bangladeshi families living in poverty: A multi-dimensional perspective. Dev Sci 2024:e13494. [PMID: 38504647 DOI: 10.1111/desc.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 02/03/2024] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
Studies from high-income populations have shown that stimulating, supportive communicative input from parents promote children's cognitive and language development. However, fewer studies have identified specific features of input supporting the healthy development of children growing up in low- or middle-income countries. The current study proposes and tests a multi-dimensional framework for understanding whether and how caregiver communicative input mediates the associations between socio-economic conditions and early development. We also examine how caregiver conceptual scaffolding and autonomy support uniquely and synergistically explain variation in child outcomes. Participants were 71 Bangladeshi families with five-year-olds who were exposed to a range of biological and psychosocial hazards from birth. Caregiver-child interactions during snack sharing and semi-structured play were coded for caregiver conceptual scaffolding, autonomy support, and child engagement. Findings indicate that the two dimensions of input were correlated, suggesting that caregivers who provided richer conceptual scaffolds were simultaneously more supportive of children's autonomy. Notably, conceptual scaffolding and autonomy support each mediated associations between maternal education and child verbal intelligence quotient (IQ) scores. Further, caregivers who supported greater autonomy in their children had children who participated in conversations more actively, and these children in turn had higher performance IQ scores. When considered simultaneously, conceptual scaffolding was associated with verbal IQ over and above autonomy support, whereas autonomy support related to child engagement, controlling for conceptual scaffolding. These findings shed new light on how environmental factors may support early development, contributing to the design of family-centered, culturally authentic interventions. A video abstract of this article can be viewed at https://youtu.be/9v_8sIv7ako RESEARCH HIGHLIGHTS: Studies from high-income countries have identified factors mitigating the impacts of socio-economic risks on development. Such research is scarce in low- and middle-income countries. The present study conceptualized and evaluated caregiver communicative input in Bangladeshi families along two interrelated yet distinct dimensions: conceptual scaffolding and autonomy support. Conceptual scaffolding and autonomy support individually mediated associations between maternal education and child verbal IQ, shedding light on protective factors in families living in poverty. Parents providing richer conceptual scaffolds were simultaneously more supportive of children's autonomy. However, the two dimensions each related to cognition and language through unique pathways.
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Affiliation(s)
- Ran Wei
- Graduate School of Education, Peking University, Beijing, China
| | - Eileen F Sullivan
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, Massachusetts, USA
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Fatema Begum
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, Massachusetts, USA
| | - Navin Rahman
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, Massachusetts, USA
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, Massachusetts, USA
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
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Shama T, O’Sullivan JM, Rahman N, Kakon SH, Tofail F, Hossain MI, Zeilani M, Haque R, Gluckman P, Forrester T, Nelson CA. Multidimensional evaluation of the early emergence of executive function and development in Bangladeshi children using nutritional and psychosocial intervention: A randomized controlled trial protocol. PLoS One 2024; 19:e0296529. [PMID: 38489293 PMCID: PMC10942035 DOI: 10.1371/journal.pone.0296529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Reversing malnutrition-induced impairment of cognition and emotional regulation is a critical global gap. We hypothesize that brain-targeted micronutrient supplemented nutritional rehabilitation in children with moderate acute malnutrition, followed by 2 years micronutrient supplementation will impact on the cognition and emotion regulation of these children. METHODS The primary outcome of this prospective, randomized controlled trial is to study the development of executive functions (EFs) and emotion regulation (ER) in this cohort. Moderate acute malnourished (MAM; WLZ/WHZ <-2 and ≥-3 z-score, and/or 11.5 cm ≤ MUAC < 12.5cm; n = 140)children aged around one year (11m-13m) in Mirpur, Dhaka, Bangladesh will be randomized (1:1) to receive either locally produced Ready to Use Supplementary Food (RUSF) or Enhanced Ready to Use Supplementary Food (E-RUSF) until anthropometric recovery (WLZ/WHZ > -1SD), or for 3 months after enrollment (whichever is earlier). The randomized MAMs groups will be given either Small Quantity Lipid Based Nutrient Supplement (SQLNS) or Enhanced Small Quantity Lipid Based Nutrient Supplement (E-SQLNS), respectively until the end of the 2-year follow up period. Standard psychosocial stimulation will be provided to the MAMs intervention groups. Biological samples will be collected, anthropometric and neurocognitive assessments will be performed at 2 (22m-26m) and 3 (34m-38m) years of age. Two control groups will be recruited: 1), non-malnourished one-year (11m-13m) old children (WLZ/WHZ score>-1SD; n = 70); and 2) three-year (34m-38m) old children (n = 70) with untreated MAM (WHZ <-2 and ≥-3 z-score, and/or 11.5≤MUAC<12.5 cm). The 3-year-old MAM reference group will be assessed once and provided with 2 months of nutritional rehabilitation support (RUSF Nutriset's Plumpy'Sup™).
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Affiliation(s)
- Talat Shama
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Justin M. O’Sullivan
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
- The Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Navin Rahman
- Laboratories of Cognitive Neuroscience, Department of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Shahria H. Kakon
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Md Iqbal Hossain
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mamane Zeilani
- Department of External Research and Nutrition Strategy, Nutriset SAS, Malaunay, France
| | - Rashidul Haque
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Peter Gluckman
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Terrence Forrester
- Faculty of Medical Sciences, UWI Solutions for Developing Countries, The University of the West Indies (UWI), Kingston, Jamaica
| | - Charles A. Nelson
- Laboratories of Cognitive Neuroscience, Department of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard Graduate School of Education, Cambridge, Massachusetts, United States of America
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Hossain SJ, Hamadani JD, Tofail F, Fisher J, Rahman MA, Rahman SM. Factors associated with children's cognitive, language, and motor development in deprived urban settings in Bangladesh. Child Care Health Dev 2024; 50:e13225. [PMID: 38265136 DOI: 10.1111/cch.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 10/30/2023] [Accepted: 12/17/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Children's development is multifactorial. Although there have been several studies exploring the association of children's development with maternal, child, and environmental factors, we are unaware of any study that assessed those factors in children whose mothers were enrolled in a social safety net programme in low- and middle-income countries. This study aimed to identify the factors associated with disadvantaged children's cognitive, language, and motor development at age 6-16 months in deprived settings of urban Bangladesh and to identify relative importance of these factors of children's development. We also explored if there were any gender differences in child development. METHODS This cross-sectional study was conducted in a deprived setting of urban Bangladesh. Bayley III was used for assessing children's cognitive, language, and motor development. Multivariable linear regression model was used to find the factors associated with children's development, and dominance analysis was used to explore the relative importance of the factors. RESULTS Out of the total 599 mother-child dyads, 303 (50.58%) were girls. The factors associated with children's development were length-for-age Z-score (cognitive: B = 1.21 [95% CI = 0.31, 2.11], P = 0.008; language: 1.67 [0.79, 2.55] P < 0.001; motor: 2.15 [1.01, 3.29] P < 0.001) and home environment (cognitive: 0.58 [0.27, 0.89] P < 0.001; language: 0.59 [0.27, 0.92], P < 0.001; motor: 0.44 [0.09, 0.79] P = 0.013). Girls had higher cognitive (1.90 [0.17, 3.6], P = 0.031) and language (2.53 [0.55, 4.51], P = 0.013) development compared with boys. Families with a higher number of under five children within the households had lower language (-1.57 [-2.78, -0.36], P = 0.011) development. Violence against the mother and the families' food security status were not associated with the children's development. Children's length-for-age Z-score (27%) and home stimulation environment (23%) were the most important factors of cognitive development. CONCLUSION Children's nutritional status and home environment are important factors for disadvantaged children's development in deprived urban settings of Bangladesh. Both early child development-focussed parenting and nutrition interventions should be considered when designing child development programmes in urban settings in low- and middle-income countries.
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Affiliation(s)
- Sheikh Jamal Hossain
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Bangladesh
| | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Bangladesh
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Anisur Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Bangladesh
| | - Syed Moshfiqur Rahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Bangladesh
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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. J Health Popul Nutr 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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Butzin-Dozier Z, Mertens AN, Tan ST, Granger DA, Pitchik HO, Il’yasova D, Tofail F, Rahman MZ, Spasojevic I, Shalev I, Ali S, Karim MR, Shahriar S, Famida SL, Shuman G, Shoab AK, Akther S, Hossen MS, Mutsuddi P, Rahman M, Unicomb L, Das KK, Yan L, Meyer A, Stewart CP, Hubbard A, Tabassum Naved R, Parvin K, Mamun MMA, Luby SP, Colford JM, Fernald LCH, Lin A. Stress Biomarkers and Child Development in Young Children in Bangladesh. medRxiv 2023:2023.09.12.23295429. [PMID: 37745503 PMCID: PMC10516093 DOI: 10.1101/2023.09.12.23295429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh. Methods We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders (hereafter referred to as contrasts) using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables. Results We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We observed 135 primary contrasts of the differences in child development outcomes at the 75th and 25th percentiles of stress biomarkers, where we detected significant relationships in 5 out of 30 contrasts (17%) of HPA axis activity, 1 out of 30 contrasts (3%) of SAM activity, and 3 out of 75 contrasts (4%) of oxidative status. These findings revealed that measures of HPA axis activity were associated with poor development outcomes. We did not find consistent evidence that markers of SAM system activity or oxidative status were associated with developmental status. Conclusions Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.
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Affiliation(s)
| | - Andrew N. Mertens
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Sophia T. Tan
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Helen O. Pitchik
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA USA
| | - Shahjahan Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sunny Shahriar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syeda Luthfa Famida
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gabrielle Shuman
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Abul K. Shoab
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Salma Akther
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Saheen Hossen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Palash Mutsuddi
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kishor K. Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Alan Hubbard
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | | | - Kausar Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Mahfuz Al Mamun
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA USA
| | - John M. Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Lia C. H. Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA USA
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Razzaque A, Huda TMN, Chowdhury R, Haq MA, Sarker P, Akhtar E, Billah MA, Islam MZ, Hoque DME, Ahmed S, Ahmed YH, Tofail F, Raqib R. Factors Associated with Reported COVID-like Symptoms and Seroprevalence Data Matched with COVID-like Symptoms in Slums and Non-Slums of Two Major Cities in Bangladesh. Healthcare (Basel) 2023; 11:healthcare11101444. [PMID: 37239730 DOI: 10.3390/healthcare11101444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES To examine the levels and socio-demographic differentials of: (a) reported COVID-like symptoms; and (b) seroprevalence data matched with COVID-like symptoms. METHODS Survey data of reported COVID-like symptoms and seroprevalence were assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. Survey data of 10,050 individuals for COVID-like symptoms and seroprevalence data of 3205 individuals matched with COVID-like symptoms were analyzed using bivariate and multivariate logistic analysis. RESULTS The odds of COVID-like symptoms were significantly higher for Chattogram city, for non-slum, people having longer years of schooling, working class, income-affected households, while for households with higher income had lower odd. The odds of matched seroprevalence and COVID-like symptoms were higher for non-slum, people having longer years of schooling, and for working class. Out of the seropositive cases, 37.77% were symptomatic-seropositive, and 62.23% were asymptomatic, while out of seronegative cases, 68.96% had no COVID-like symptoms. CONCLUSIONS Collecting community-based seroprevalence data is important to assess the extent of exposure and to initiate mitigation and awareness programs to reduce COVID-19 burden.
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Affiliation(s)
- Abdur Razzaque
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Tarique Mohammad Nurul Huda
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah 52741, Saudi Arabia
| | - Razib Chowdhury
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Md Ahsanul Haq
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Protim Sarker
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Evana Akhtar
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | | | | | - Shehlina Ahmed
- Foreign, Commonwealth & Development Office (FCDO), Dhaka 1212, Bangladesh
| | - Yasmin H Ahmed
- Bangladesh Health Watch, James P Grant School of Public Health, BRAC University, Dhaka 1213, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Rubhana Raqib
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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Rahman M, Jahir T, Akter F, Yeasmin F, Pitchik HO, Hasan R, Das JB, Grant HX, Hossain K, Sultana J, Huda TMN, Shoab A, Khan R, Tofail F, Luby SP, Fernald LCH, Rashid J, Ashrafee S, Leontsini E, Winch PJ. Implementing a group-based multi-component early child development intervention through the government health system in rural Bangladesh: A feasibility study. Int J Health Plann Manage 2023. [PMID: 37132061 DOI: 10.1002/hpm.3647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/28/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
Children in low- and middle-income countries face an increased risk of impaired cognitive development due to contaminated environments, poor nutrition, and inadequate responsive stimulation from caregivers. Implementing multi-component, community-level interventions may reduce these risks; however, there is little evidence supporting implementation of these interventions at scale. We assessed the feasibility of implementing a group-based intervention that included responsive stimulation, maternal and child nutrition, water and sanitation, and childhood lead exposure prevention through the government health system in Chatmohar, Bangladesh. After implementation, we conducted 17 in-depth interviews with frontline health service providers and 12 key informant interviews with their supervisors and managers to explore the facilitators and difficulties implementing such a complex programme within the health system. Factors facilitating implementation included: high quality training and skill level of providers, support from community members, family, and supervisors, positive relationships between providers and participants, and provision of children's toys and books free of cost. Difficulties included increased workload of the providers, complicated group-based yet stage-specific delivery where providers had to manage a large group of mother-child dyads representing many different child age-groups at once, and logistics difficulties in providing toys and books through a centralised health system process. Key informants made suggestions to ensure effective government-level scale-up including engaging relevant NGOs as partners, identifying feasible ways to make toys available, and offering providers meaningful even if non-monetary rewards. These findings can be used to shape the design and delivery of multi-component child development interventions to be delivered through the health system.
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Affiliation(s)
- Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tania Jahir
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Fahmida Akter
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Farzana Yeasmin
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Helen O Pitchik
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Rezaul Hasan
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Jyoti Bhushan Das
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Hannah X Grant
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Khobair Hossain
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Jesmin Sultana
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tarique Md Nurul Huda
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Akm Shoab
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Rizwana Khan
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Jahangir Rashid
- Community Based Health Care (CBHC), Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sabina Ashrafee
- National Newborn Health Program (NNHP) and Integrated Management of Childhood Illness (IMCI) Program, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hossain SJ, Tofail F, Mehrin SF, Hamadani JD. Six-Year Follow-up of Childhood Stimulation on Development of Children With and Without Anemia. Pediatrics 2023; 151:191217. [PMID: 37125884 DOI: 10.1542/peds.2023-060221e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previously, in 30 Bangladeshi villages, 2 groups of children with iron-deficiency anemia (IDA) and nonanemic (NA) iron sufficiency aged 6 to 24 months participated in 2 parallel cluster randomized controlled trials of the effect of psychosocial stimulation on neurodevelopment. The intervention was composed of weekly play sessions at home for 9 months. All children with anemia received iron treatment of 6 months. The intervention improved the mental development of NA but not IDA groups. Six years after end line when the children were aged 8 to 9 years, we aimed to determine if benefits were sustained in the NA group or late-onset benefits emerged in the IDA group. METHODS We relocated 372 (90%) of the initial 412 children from all the clusters (villages), and assessed their IQ with the Wechsler Abbreviated Scale of Intelligence-II, motor development, and school achievement including math, spelling, and reading. Analyses were by intention-to-treat, adjusting for clustering. RESULTS There was a significant interaction between anemia groups (IDA/NA) and intervention on IQ. The intervention benefitted the NA group's Full-Scale IQ (effect size, 0.43 [95% confidence interval, 0.08-0.79]) and Perceptual Reasoning Index (effect size, 0.48 [95% confidence interval, 0.08-0.89]) but did not affect the IDA group's outcomes. No other outcomes were significant. CONCLUSIONS The benefits from early childhood psychosocial stimulation on the NA group's IQ, 6 years after intervention ended, adds to the limited evidence on the sustainability of benefits in low- and middle-income countries. Reasons for lack of effect in children with anemia are unknown.
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Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fahmida Tofail
- Nutrition and Clinical Science Division, icddr,b, Dhaka, Bangladesh
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11
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Tofail F, Islam M, Akter F, Zonji S, Roy B, Hossain SJ, Horaira A, Akter S, Goswami D, Brooks A, Hamadani J. An Integrated Mother-Child Intervention on Child Development and Maternal Mental Health. Pediatrics 2023; 151:191220. [PMID: 37125887 DOI: 10.1542/peds.2023-060221g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To evaluate an integrated, low-cost, facility-based group intervention designed to promote child care, boost maternal mental-wellbeing, reduce harsh discipline, and improve children's health, nutrition, and early development. METHODS In Dhaka, 30 neighborhood clusters of a low-income urban community were randomized to intervention or control groups. Mothers with children between 6 and 24 months (n = 300) who self-reported negative discipline were identified and enrolled. A 1-year group intervention included integration of responsive caregiving, nutritional supplementation, caregivers' mental health, child protection, and health advice. Child outcomes were cognition (primary) and language, motor and behavioral development, growth, and hemoglobin and iron status (secondary). Maternal outcomes were depressive symptoms, self-esteem, negative discipline, and child care knowledge and practices. RESULTS Overall, 222 (74%) mother-child dyads participated in the 1-year follow-up. Intervention and control groups differed on wealth, with no other significant differences. The intervention resulted in a 0.75 SD effect on cognition, 0.77 SD on language, 0.41 SD on motor, and 0.43 to 0.66 SDs on behavior during testing (emotion, cooperation, and vocalization) in the intervention arm. Mothers in the intervention group had fewer depressive symptoms (effect size: -0.72 SD), higher self-esteem (0.62 SD), better child care knowledge (2.02 SD), fewer harsh discipline practices (0.25 SD), and better home stimulation (0.73 SD). The intervention showed no effect on child growth or hemoglobin, but significantly improved serum iron status (-0.36 SD). CONCLUSIONS A comprehensive intervention, delivered through group sessions in health facilities, was effective in promoting child development and reducing maternal depressive symptoms among mothers who reported using negative or harsh discipline.
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Affiliation(s)
| | | | | | - Shekufeh Zonji
- Early Childhood Development Action Network, Washington, DC
| | | | - Sheikh Jamal Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Abdullah Brooks
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jena Hamadani
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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12
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Pitchik HO, Tofail F, Akter F, Shoab AKM, Sultana J, Huda TMN, Rahman M, Winch PJ, Luby SP, Fernald LCH. Concurrent validity of the Ages and Stages Questionnaire Inventory and the Bayley Scales of Infant and Toddler Development in rural Bangladesh. BMC Pediatr 2023; 23:93. [PMID: 36859070 PMCID: PMC9976496 DOI: 10.1186/s12887-022-03800-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/14/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Reliable and valid measurement of early child development are necessary for the design of effective interventions, programs, and policies to improve early child outcomes. One widely used measure in low- and middle-income countries (LMICs) is the Bayley Scales of Infant and Toddler Development III (Bayley-III). Alternatively, the Bangladeshi-adapted Ages and Stages Questionnaire Inventory (ASQ:I) can be administered more quickly, inexpensively, and with less training than the Bayley-III. We aimed to assess the concurrent validity of the Bangladeshi-adapted ASQ:I with the Bayley-III in children 4-27 months old in rural Bangladesh. METHODS The sample was a sub-sample (n = 244) of endline participants from an evaluation of an early child development intervention (July-August 2018). We assessed concurrent validity between internally age-standardized domain-specific and total scores using Pearson correlations both overall and stratified by age and intervention status. We also assessed correlations between scores and variables theoretically related to child development including maternal education and stimulation in the home. RESULTS The overall correlation between ASQ:I and Bayley-III total scores was moderate (r = 0.42 95% CI: 0.30-0.53), with no systematic differences by intervention status. Overall, concurrent validity was highest for the gross motor domain (r = 0.51, 0.40-0.60), and lowest for the fine motor domain (r = 0.20, 0.04-0.33). Total ASQ:I and Bayley-III scores were positively correlated with child stimulation and maternal education. CONCLUSION The Bangladeshi-adapted ASQ:I is a low-cost tool that can be feasibly administered in rural Bangladesh, is moderately correlated with the Bayley-III, and can be used to measure child development when human, time, or financial resources are constrained.
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Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way West, Berkeley, CA, 94720, USA.
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, Icddr,b, Dhaka, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, Icddr,b, Dhaka, Bangladesh
| | - Abul K M Shoab
- Infectious Diseases Division, Icddr,b, Dhaka, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, Icddr,b, Dhaka, Bangladesh
| | | | | | - Peter J Winch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
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13
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Cavallera V, Lancaster G, Gladstone M, Black MM, McCray G, Nizar A, Ahmed S, Dutta A, Anago RKE, Brentani A, Jiang F, Schönbeck Y, McCoy DC, Kariger P, Weber AM, Raikes A, Waldman M, van Buuren S, Kaur R, Pérez Maillard M, Nisar MI, Khanam R, Sazawal S, Zongo A, Pacifico Mercadante M, Zhang Y, Roy AD, Hepworth K, Fink G, Rubio-Codina M, Tofail F, Eekhout I, Seiden J, Norton R, Baqui AH, Khalfan Ali J, Zhao J, Holzinger A, Detmar S, Kembou SN, Begum F, Mohammed Ali S, Jehan F, Dua T, Janus M. Protocol for validation of the Global Scales for Early Development (GSED) for children under 3 years of age in seven countries. BMJ Open 2023; 13:e062562. [PMID: 36693690 PMCID: PMC9884878 DOI: 10.1136/bmjopen-2022-062562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Children's early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children's early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children's early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate the GSED SF and LF. Secondary aims are to create preliminary reference scores for the GSED SF and LF, validate an adaptive testing algorithm and assess the feasibility and preliminary validity of the GSED PF. METHODS AND ANALYSIS We will conduct the validation in seven countries (Bangladesh, Brazil, Côte d'Ivoire, Pakistan, The Netherlands, People's Republic of China, United Republic of Tanzania), varying in geography, language, culture and income through a 1-year prospective design, combining cross-sectional and longitudinal methods with 1248 children per site, stratified by age and sex. The GSED generates an innovative common metric (Developmental Score: D-score) using the Rasch model and a Development for Age Z-score (DAZ). We will evaluate six psychometric properties of the GSED SF and LF: concurrent validity, predictive validity at 6 months, convergent and discriminant validity, and test-retest and inter-rater reliability. We will evaluate measurement invariance by comparing differential item functioning and differential test functioning across sites. ETHICS AND DISSEMINATION This study has received ethical approval from the WHO (protocol GSED validation 004583 20.04.2020) and approval in each site. Study results will be disseminated through webinars and publications from WHO, international organisations, academic journals and conference proceedings. REGISTRATION DETAILS Open Science Framework https://osf.io/ on 19 November 2021 (DOI 10.17605/OSF.IO/KX5T7; identifier: osf-registrations-kx5t7-v1).
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Affiliation(s)
- Vanessa Cavallera
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life COurse and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Maureen M Black
- International Education, RTI International, Research Triangle Park, North Carolina, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Ambreen Nizar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Arup Dutta
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
| | | | - Alexandra Brentani
- Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Fan Jiang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shangai, People's Republic of China
| | - Yvonne Schönbeck
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Dana C McCoy
- Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Patricia Kariger
- Center for Effective Global Action, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | - Abbie Raikes
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Marcus Waldman
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Stef van Buuren
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, University of Utrecht, Utrecht, Netherlands
| | - Raghbir Kaur
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Michelle Pérez Maillard
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Muhammad Imran Nisar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sunil Sazawal
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
| | - Arsène Zongo
- IPA Côte d'Ivoire, Innovations for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Katelyn Hepworth
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Marta Rubio-Codina
- Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iris Eekhout
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Jonathan Seiden
- Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Rebecca Norton
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jin Zhao
- Department of Developmental and Behavioural Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shangai, People's Republic of China
| | - Andreas Holzinger
- IPA Francophone West Africa, Innovations for Poverty Action, Abidjan, Côte d\'Ivoire
| | - Symone Detmar
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | | | - Farzana Begum
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Said Mohammed Ali
- Institution Head, Public Health Laboratory, Pemba, Zanzibar, Tanzania
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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14
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McCray G, McCoy D, Kariger P, Janus M, Black MM, Chang SM, Tofail F, Eekhout I, Waldman M, van Buuren S, Khanam R, Sazawal S, Nizar A, Schönbeck Y, Zongo A, Brentani A, Zhang Y, Dua T, Cavallera V, Raikes A, Weber AM, Bromley K, Baqui A, Dutta A, Nisar I, Detmar SB, Anago R, Mercadante P, Jiang F, Kaur R, Hepworth K, Rubio-Codina M, Kembou SN, Ahmed S, Lancaster GA, Gladstone M. The creation of the Global Scales for Early Development (GSED) for children aged 0-3 years: combining subject matter expert judgements with big data. BMJ Glob Health 2023; 8:bmjgh-2022-009827. [PMID: 36650017 PMCID: PMC9853147 DOI: 10.1136/bmjgh-2022-009827] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/02/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION With the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early Development (GSED) project aims to provide population and programmatic level measures of ECD for 0-3 years that are valid, reliable and have psychometrically stable performance across geographical, cultural and language contexts. This paper reports on the creation of two measures: (1) the GSED Short Form (GSED-SF)-a caregiver reported measure for population-evaluation-self-administered with no training required and (2) the GSED Long Form (GSED-LF)-a directly administered/observed measure for programmatic evaluation-administered by a trained professional. METHODS We selected 807 psychometrically best-performing items using a Rasch measurement model from an ECD measurement databank which comprised 66 075 children assessed on 2211 items from 18 ECD measures in 32 countries. From 766 of these items, in-depth subject matter expert judgements were gathered to inform final item selection. Specifically collected were data on (1) conceptual matches between pairs of items originating from different measures, (2) developmental domain(s) measured by each item and (3) perceptions of feasibility of administration of each item in diverse contexts. Prototypes were finalised through a combination of psychometric performance evaluation and expert consensus to optimally identify items. RESULTS We created the GSED-SF (139 items) and GSED-LF (157 items) for tablet-based and paper-based assessments, with an optimal set of items that fit the Rasch model, met subject matter expert criteria, avoided conceptual overlap, covered multiple domains of child development and were feasible to implement across diverse settings. CONCLUSIONS State-of-the-art quantitative and qualitative procedures were used to select of theoretically relevant and globally feasible items representing child development for children aged 0-3 years. GSED-SF and GSED-LF will be piloted and validated in children across diverse cultural, demographic, social and language contexts for global use.
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Affiliation(s)
| | - Dana McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | | | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA,RTI International, Research Triangle Park, North Carolina, USA
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iris Eekhout
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Marcus Waldman
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Rasheda Khanam
- Department of International Health, Johns Hopkins, Baltimore, Maryland, USA
| | - Sunil Sazawal
- Center for Public Health Kinetics, New Delhi, New Delhi, India
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Arsène Zongo
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Alexandra Brentani
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Yunting Zhang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China,National Children's Medical Center, Shanghai Children's Medical Center affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tarun Dua
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Vanessa Cavallera
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Abbie Raikes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | - Abdullah Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Imran Nisar
- Paediatrics, Aga Khan University, Karrachi, Pakistan
| | | | - Romuald Anago
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Pacifico Mercadante
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Fan Jiang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China
| | - Raghbir Kaur
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Katelyn Hepworth
- University of Nebraska-Lincoln College of Education and Human Sciences, Lincoln, Nebraska, USA
| | | | - Samuel N Kembou
- Innovations for Poverty Action, Washington, District of Columbia, USA
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15
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Larson LM, Feuerriegel D, Hasan MI, Braat S, Jin J, Tipu SMU, Shiraji S, Tofail F, Biggs BA, Hamadani J, Johnson K, Pasricha SR, Bode S. Supplementation With Iron Syrup or Iron-Containing Multiple Micronutrient Powders Alters Resting Brain Activity in Bangladeshi Children. J Nutr 2023; 153:352-363. [PMID: 36913472 DOI: 10.1016/j.tjnut.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anemia and iron deficiency have been associated with poor child cognitive development. A key rationale for the prevention of anemia using supplementation with iron has been the benefits to neurodevelopment. However, little causal evidence exists for these gains. OBJECTIVES We aimed to examine effects of supplementation with iron or multiple micronutrient powders (MNPs) on brain activity measures using resting electroencephalography (EEG). METHODS Children included in this neurocognitive substudy were randomly selected from the Benefits and Risks of Iron Supplementation in Children study, a double-blind, double-dummy, individually randomized, parallel-group trial in Bangladesh, in which children, starting at 8 mo of age, received 3 mo of daily iron syrup, MNPs, or placebo. Resting brain activity was recorded using EEG immediately after intervention (month 3) and after a further 9-month follow-up (month 12). We derived EEG band power measures for delta, theta, alpha, and beta frequency bands. Linear regression models were used to compare the effect of each intervention with that of placebo on the outcomes. RESULTS Data from 412 children at month 3 and 374 at month 12 were analyzed. At baseline, 43.9% were anemic and 26.7% were iron deficient. Immediately after intervention, iron syrup, but not MNPs, increased the mu alpha-band power, a measure that is associated with maturity and the production of motor actions (iron vs. placebo: mean difference = 0.30; 95% CI: 0.11, 0.50 μV2; P = 0.003; false discovery rate adjusted P = 0.015). Despite effects on hemoglobin and iron status, effects were not observed on the posterior alpha, beta, delta, and theta bands, nor were effects sustained at the 9-month follow-up. CONCLUSIONS The effect size for immediate effects on the mu alpha-band power is comparable in magnitude with psychosocial stimulation interventions and poverty reduction strategies. However, overall, we did not find evidence for long-lasting changes in resting EEG power spectra from iron interventions in young Bangladeshi children. This trial was registered at www.anzctr.org.au as ACTRN12617000660381.
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Affiliation(s)
- Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Daniel Feuerriegel
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Imrul Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sabine Braat
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Jerry Jin
- Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sm Mulk Uddin Tipu
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shamima Shiraji
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Tofail
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Beverley-Ann Biggs
- Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia; The Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jena Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Katherine Johnson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia; Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Diagnostic Haematology and Clinical Haematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Larson LM, Feuerriegel D, Hasan MI, Braat S, Jin J, Tipu SMU, Shiraji S, Tofail F, Biggs BA, Hamadani JD, Johnson KA, Bode S, Pasricha SR. Effects of iron supplementation on neural indices of habituation in Bangladeshi children. Am J Clin Nutr 2023; 117:73-82. [PMID: 36789946 DOI: 10.1016/j.ajcnut.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Iron deficiency and anemia have been associated with poor cognition in children, yet the effects of iron supplementation on neurocognition remain unclear. OBJECTIVE We aimed to examine the effects of supplementation with iron on neural indices of habituation using auditory event-related brain potentials (ERPs). METHODS This substudy was nested within a 3-arm, double-blind, double-dummy, individual randomized trial in Bangladesh, in which 3300 8-mo-old children were randomly selected to receive 3 mo of daily iron syrup (12.5 mg iron), multiple micronutrient powders (MNPs) (including 12.5 mg iron), or placebo. Children were assessed after 3 mo of intervention (mo 3) and 9 mo thereafter (mo 12). The neurocognitive substudy comprised a randomly selected subset of children from the main trial. Brain activity elicited during an auditory roving oddball task was recorded using electroencephalography to provide an index of habituation. The differential response to a novel (deviant) compared with a repeated (standard) sound was examined. The primary outcome was the amplitude of the mismatch response (deviant minusstandard tone waveforms) at mo 3. Secondary outcomes included the deviant and standard tone-evoked amplitudes, N2 amplitude differences, and differences in mean amplitudes evoked by deviant tones presented in the second compared with first half of the oddball sequence at mo 3 and 12. RESULTS Data were analyzed from 329 children at month 3 and 363 at mo 12. Analyses indicated no treatment effects of iron interventions compared with placebo on the amplitude of the mismatch response (iron syrup compared with placebo: mean difference (MD) = 0.07μV [95% CI: -1.22, 1.37]; MNPs compared with placebo: MD = 0.58μV [95% CI: -0.74, 1.90]) nor any secondary ERP outcomes at mo 3 or 12, despite improvements in hemoglobin and ferritin concentrations from iron syrup and MNPs in this nested substudy. CONCLUSION In Bangladeshi children with >40% anemia prevalence, iron or MNP interventions alone are insufficient to improve neural indices of habituation. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12617000660381.
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Affiliation(s)
- Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia.
| | - Daniel Feuerriegel
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Mohammed Imrul Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sabine Braat
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Jerry Jin
- Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sm Mulk Uddin Tipu
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shamima Shiraji
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Tofail
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Beverley-Ann Biggs
- Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, VIC, Australia; The Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jena D Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Katherine A Johnson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Diagnostic Hematology, The Royal Melbourne Hospital, Parkville VIC, Australia; Diagnostic Hematology and Clinical Hematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville VIC, Australia; Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
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17
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Ara G, Sanin KI, Khanam M, Sarker MSA, Tofail F, Nahar B, Chowdhury IA, Boitchi AB, Gibson S, Afsana K, Askari S, Ahmed T. A comprehensive intervention package improves the linear growth of children under 2-years-old in rural Bangladesh: a community-based cluster randomized controlled trial. Sci Rep 2022; 12:21962. [PMID: 36536016 PMCID: PMC9763408 DOI: 10.1038/s41598-022-26269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother-infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.
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Affiliation(s)
- Gulshan Ara
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kazi Istiaque Sanin
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mansura Khanam
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Md. Shafiqul Alam Sarker
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Fahmida Tofail
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Baitun Nahar
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Anika Bushra Boitchi
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sarah Gibson
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Kaosar Afsana
- grid.52681.380000 0001 0746 8691BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sufia Askari
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Tahmeed Ahmed
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
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George CM, Coglianese N, Bauler S, Perin J, Kuhl J, Williams C, Kang Y, Thomas ED, François R, Ng A, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Low dietary diversity is associated with linear growth faltering and subsequent adverse child developmental outcomes in rural Democratic Republic of the Congo (REDUCE program). Maternal & Child Nutrition 2022; 18:e13340. [PMID: 35313062 PMCID: PMC9218309 DOI: 10.1111/mcn.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/05/2022]
Abstract
The objective of this study was to investigate the association between dietary diversity, child growth and child developmental outcomes. This was a prospective cohort study. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6‐month follow‐up visit. Height and weight were measured at baseline and a 6‐month follow‐up. Baseline minimum dietary diversity (MDD) for children 6–23 months old was defined by consumption of five or more of the following food groups: (1) breast milk; (2) grains, roots and tubers; (3) legumes and nuts; (4) dairy products; (5) flesh foods; (6) eggs; (7) vitamin A‐rich fruits and vegetables and (8) other fruits and vegetables. Participants were 117 children 6–23 months of age. Linear growth faltering was defined as a significant decline (p < 0.05) in length‐for‐age Z‐scores (LAZ) between baseline and follow‐up. Regression models were performed. The study was conducted in rural eastern Democratic Republic of the Congo (DRC). MDD was positively associated with change in LAZ (coefficient: 0.87 [95% confidence interval [CI]: 0.33, 1.40]), and a reduced odds of stunting (LAZ < −2) (odds ratio: 0.21 [95% CI: 0.07, 0.61]). MDD was also associated with a significantly higher combined EASQ‐Z‐scores (coefficient: 0.34 [95% CI: 0.003, 0.68], higher communication EASQ‐Z‐scores [0.50 {95% CI: 0.14, 0.85}], and higher personal social EASQ‐Z‐scores [0.46 {95% CI: 0.11, 0.82}]). This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children. Dietary diversity was low among young children in our study setting in rural eastern Democratic Republic of the Congo. Low dietary diversity was associated with linear growth faltering and lower child developmental outcomes. This study provides further evidence demonstrating the need for interventions to improve dietary diversity among young children to improve child health.
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Affiliation(s)
- Christine Marie George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | - Sarah Bauler
- Health Division Food for the Hungry Phoenix Arizona USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Jennifer Kuhl
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Camille Williams
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Yunhee Kang
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Elizabeth D. Thomas
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ruthly François
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Angela Ng
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | | | | | - Fahmida Tofail
- Nutrition Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh
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Raynes-Greenow C, Billah SM, Islam S, Rokonuzzaman SM, Tofail F, Kirkwood EK, Alam A, Chartier R, Ferdous TE, El Arifeen S, Dibley MJ, Homaira N, Hayes A, Thornburg J, Kelly P. Reducing household air pollution exposure to improve early child growth and development; a randomized control trial protocol for the "Poriborton-Extension: The CHANge trial". Trials 2022; 23:505. [PMID: 35710445 PMCID: PMC9205063 DOI: 10.1186/s13063-022-06342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, household air pollution (HAP) is a leading environmental cause of morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on child health outcomes, compared to usual cooking practices in Bangladesh. The primary aim is to evaluate if reduced exposure to HAP through the provision of LPG for cooking from early gestation through to age 2 improves child anthropometry, health, and neuro-cognitive developmental outcomes, compared to children exposed to emissions from usual practice. Methods Two-arm parallel cluster randomized controlled trial (cCRT). We will extend the intervention and follow-up of our existing “Poriborton” trial. In a subset of the original surviving participants, we will supply LPG cylinders and LPG stoves (intervention) compared to usual cooking practices and extend the follow-up to 24 months of age. The expected final sample size, for both (intervention and control) is 1854 children with follow-up to 2 years of age available for analysis. Discussion This trial will answer important research gaps related to HAP and child health and neuro-cognitive developmental outcomes. This evidence will help to understand the impact of a HAP intervention on child health to inform policies for the adoption of clean fuel in Bangladesh and other similar settings. Trial registration The Poriborton: Change trial: Household Air Pollution and Perinatal and early Neonatal mortality is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001214224, original trial registered on 19th July 2018, extension approved on 23rd June 2021. www.anzctr.org.au.
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Affiliation(s)
| | - Sk Masum Billah
- The University of Sydney, School of Public Health, Sydney, Australia.,Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sajia Islam
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Fahmida Tofail
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.,Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Ashraful Alam
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Ryan Chartier
- RTI International, Research Triangle Park, NC, 27707, USA
| | | | | | - Michael J Dibley
- The University of Sydney, School of Public Health, Sydney, Australia
| | | | - Alison Hayes
- The University of Sydney, School of Public Health, Sydney, Australia
| | | | - Patrick Kelly
- The University of Sydney, School of Public Health, Sydney, Australia
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20
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Mehrin SF, Hasan MI, Tofail F, Shiraji S, Ridout D, Grantham-McGregor S, Hamadani JD, Baker-Henningham H. Integrating a Group-Based, Early Childhood Parenting Intervention Into Primary Health Care Services in Rural Bangladesh: A Cluster-Randomized Controlled Trial. Front Pediatr 2022; 10:886542. [PMID: 35783319 PMCID: PMC9245711 DOI: 10.3389/fped.2022.886542] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Over 250 million children globally do not reach their developmental potential. We tested whether integrating a group-based, early childhood parenting program into government healthcare clinics improved children's development, growth, and behavior. Methods We conducted a cluster-randomized controlled trial in 40 community clinics in the Kishorganj district of Bangladesh. We randomly assigned clinics (1:1) to deliver a group-based parenting interventions or to a comparison group that received no intervention. Participants were children aged 5-24 months, with weight-for-age z-score of ≤ -1.5 SDs of the WHO standards, living within a thirty-minute walking distance from the clinic (n = 419 intervention, 366 control). Government health staff facilitated parenting sessions in the clinic with groups of four mother/child dyads fortnightly for one year as part of their routine duties. Primary outcomes measured at baseline and endline were child development assessed using the Bayley scales, child behaviors during the test by tester ratings, and child growth. The trial is registered at ClinicalTrials.gov, NCT02208531. Findings 91% of children were tested at endline (396 intervention, 319 control). Multilevel analyses showed significant benefits of intervention to child cognition (effect size 0.85 SDs, 95% CI: 0.59, 1.11), language (0.69 SDs, 0.43, 0.94), and motor development (0.52 SDs, 0.31, 0.73), and to child behaviors during the test (ranging from 0.36 SDs, 0.14, 0.58, to 0.53 SDs, 0.35, 0.71). There were no significant effects on growth. Conclusion A scalable parenting intervention, integrated into existing government health services and implemented by government health staff, led to significant benefits to child development and behavior.
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Affiliation(s)
- Syeda Fardina Mehrin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Imrul Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shamima Shiraji
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deborah Ridout
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Jena D. Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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21
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Kampouri M, Tofail F, Rahman SM, Gustin K, Vahter M, Kippler M. Gestational and childhood urinary iodine concentrations and children's cognitive function in a longitudinal mother-child cohort in rural Bangladesh. Int J Epidemiol 2022; 52:144-155. [PMID: 35613019 PMCID: PMC9908062 DOI: 10.1093/ije/dyac110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe iodine deficiency adversely affects neurodevelopment; however, evidence regarding the association of non-severe deficiency and child cognitive functioning is inconclusive. METHODS This prospective mother-child cohort study was nested in a population-based nutritional supplementation trial in Bangladesh (Maternal and Infant Nutrition Interventions in Matlab [MINIMat]). Participants with data on cognitive abilities at 5 and 10 years of age (n = 1530) and at least one measurement of urinary iodine concentration (UIC) (gestational week 8, 5, and 10 years) were selected. Cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Wechsler Intelligence Scale for Children (WISC-IV). UICs were measured with inductively coupled plasma mass spectrometry and thereafter adjusted for specific gravity. RESULTS Median UICs in our population: (282 μg/L [pregnancy]; 406 μg/L [5 years]; 294 μg/L [10 years]) indicated that iodine intake corresponded to above 'adequate' or even 'excessive', according to the WHO classification. Maternal 'UIC <150 μg/L' was associated with lower full-scale and verbal scores at 5 and 10 years, although the associations were weakened in the fully adjusted models. A tendency of decreased verbal scores was also observed for maternal 'UIC ≥500 μg/L' but not for the corresponding child iodine category (≥300 μg/L). Child 'UIC <100 μg/L' was associated with lower processing speed (B=-3.1, 95% CI [-6.2, -0.1]; P-value = 0.041) compared with the reference group (100 μg/L≤ UIC <300 μg/L). CONCLUSIONS Current findings add to the growing evidence of a causal association of early-life iodine intake with cognitive development, indicating that low iodine intake during childhood is associated with reduced processing speed and non-optimal gestational iodine intake is weakly associated with slightly poorer verbal development outcomes.
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Affiliation(s)
- Mariza Kampouri
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fahmida Tofail
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh,Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Klara Gustin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Kippler
- Corresponding author. Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77, Stockholm, Sweden. E-mail:
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22
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Raqib R, Sarker P, Akhtar E, Nurul Huda TM, Haq MA, Roy AK, Hosen MB, Haque F, Chowdhury MR, Reidpath DD, Emdadul Hoque DM, Islam Z, Ahmed S, Ahmed T, Tofail F, Razzaque A. Seroprevalence of SARS-CoV-2 infection and associated factors among Bangladeshi slum and non-slum dwellers in pre-COVID-19 vaccination era: October 2020 to February 2021. PLoS One 2022; 17:e0268093. [PMID: 35604947 PMCID: PMC9126397 DOI: 10.1371/journal.pone.0268093] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Seroprevalence studies have been carried out in many developed and developing countries to evaluate ongoing and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data on this infection in marginalized populations in urban slums are limited, which may offer crucial information to update prevention and mitigation policies and strategies. We aimed to determine the seroprevalence of SARS-CoV-2 infection and factors associated with seropositivity in slum and non-slum communities in two large cities in Bangladesh. Methods A cross-sectional study was carried out among the target population in Dhaka and Chattogram cities between October 2020 and February 2021. Questionnaire-based data, anthropometric and blood pressure measurements and blood were obtained. SARS-CoV-2 serology was assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. Results Among the 3220 participants (2444 adults, ≥18 years; 776 children, 10–17 years), the overall weighted seroprevalence was 67.3% (95% confidence intervals (CI) = 65.2, 69.3) with 71.0% in slum (95% CI = 68.7, 72.2) and 62.2% in non-slum (95% CI = 58.5, 65.8). The weighted seroprevalence was 72.9% in Dhaka and 54.2% in Chattogram. Seroprevalence was positively associated with limited years of formal education (adjusted odds ratio [aOR] = 1.61; 95% CI = 1.43, 1.82), lower income (aOR = 1.23; 95% CI = 1.03, 1.46), overweight (aOR = 1.2835; 95% CI = 1.26, 1.97), diabetes (aOR = 1.67; 95% CI = 1.21, 2.32) and heart disease (aOR = 1.38; 95% CI = 1.03, 1.86). Contrarily, negative associations were found between seropositivity and regular wearing of masks and washing hands, and prior BCG vaccination. About 63% of the population had asymptomatic infection; only 33% slum and 49% non-slum population showed symptomatic infection. Conclusion The estimated seroprevalence of SARS-CoV-2 was more prominent in impoverished informal settlements than in the adjacent middle-income non-slum areas. Additional factors associated with seropositivity included limited education, low income, overweight and pre-existing chronic conditions. Behavioral factors such as regular wearing of masks and washing hands were associated with lower probability of seropositivity.
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Affiliation(s)
- Rubhana Raqib
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
- * E-mail:
| | - Protim Sarker
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | - Evana Akhtar
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | | | | | | | - Farjana Haque
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | - Daniel D. Reidpath
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
| | | | | | - Shehlina Ahmed
- Foreign, Commonwealth & Development Office (FCDO), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Abdur Razzaque
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
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23
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George CM, Birindwa A, Beck S, R. Julian T, Kuhl J, Williams C, Coglianese N, D. Thomas E, Bauler S, François R, Ng A, Presence AS, Claude BRJ, Tofail F, Perin J, Mirindi P, Cirhuza LB. Fecal Contamination in Child Play Spaces and on Child Hands Are Associated with Subsequent Adverse Child Developmental Outcomes in Rural Democratic Republic of the Congo: REDUCE Prospective Cohort Study. Am J Trop Med Hyg 2022; 106:1141-1148. [PMID: 35189587 PMCID: PMC8991330 DOI: 10.4269/ajtmh.21-0706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/10/2021] [Indexed: 11/07/2022] Open
Abstract
The objective of the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program is to identify exposure pathways to fecal pathogens that are significant contributors to morbidity among young children in the Democratic Republic of the Congo (DRC), and on developing and evaluating scalable interventions to reduce fecal contamination from these pathways. This prospective cohort study of 270 children under 5 years of age was conducted in rural South Kivu, DRC, to investigate the association between Escherichia coli in hand rinse, soil, food, object, surface, stored water, and water source samples and child developmental outcomes. Child developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up. Children having E. coli present in the soil in their play spaces had significantly lower combined EASQ z scores (coefficient: -0.38 (95% CI: -0.73, -0.03)). E. coli on children's hands was associated with lower communication EASQ z scores (-0.37 (95% CI: -0.0.10, -0.01), and E. coli in stored drinking water was associated with lower gross motor EASQ z scores (-0.40 (95% CI: -0.68, -0.12). In the REDUCE cohort study, E. coli in soil in child play spaces, on children's hands, and in stored drinking water was associated with lower developmental outcome scores (communication, gross motor, fine motor, and problem-solving skills). These results suggest the need for interventions to reduce fecal contamination in the household environment to protect the cognitive development of susceptible pediatric populations in rural DRC.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alves Birindwa
- Food for the Hungry, Nutrition, Washington, District of Columbia
| | - Sara Beck
- Department of Civil Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Bauler
- Food for the Hungry, Nutrition, Washington, District of Columbia
| | - Ruthly François
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Angela Ng
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Child Development Unit, Dhaka, Bangladesh
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick Mirindi
- Food for the Hungry, Nutrition, Washington, District of Columbia
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24
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Khanam R, Applegate J, Nisar I, Dutta A, Rahman S, Nizar A, Ali SM, Chowdhury NH, Begum F, Dhingra U, Tofail F, Mehmood U, Deb S, Ahmed S, Muhammad S, Das S, Ahmed S, Mittal H, Minckas N, Yoshida S, Bahl R, Jehan F, Sazawal S, Baqui AH. Burden and risk factors for antenatal depression and its effect on preterm birth in South Asia: A population-based cohort study. PLoS One 2022; 17:e0263091. [PMID: 35130270 PMCID: PMC8820649 DOI: 10.1371/journal.pone.0263091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Women experience high rates of depression, particularly during pregnancy and the postpartum periods. Using population-based data from Bangladesh and Pakistan, we estimated the burden of antenatal depression, its risk factors, and its effect on preterm birth.
Methods
The study uses the following data: maternal depression measured between 24 and 28 weeks of gestation using the 9–question Patient Health Questionnaire (PHQ-9); data on pregnancy including an ultrasound before 19 weeks of gestation; data on pregnancy outcomes; and data on woman’s age, education, parity, weight, height, history of previous illness, prior miscarriage, stillbirth, husband’s education, and household socioeconomic data collected during early pregnancy. Using PHQ-9 cutoff score of ≥12, women were categorized into none to mild depression or moderate to moderately severe depression. Using ultrasound data, preterm birth was defined as babies born <37 weeks of gestation. To identify risk ratios (RR) for antenatal depression, unadjusted and adjusted RR and 95% confidence intervals (CI) were calculated using log- binomial model. Log-binomial models were also used for determining the effect of antenatal depression on preterm birth adjusting for potential confounders. Data were analyzed using Stata version 16 (StataCorp LP).
Results
About 6% of the women reported moderate to moderately severe depressive symptoms during the antenatal period. A parity of ≥2 and the highest household wealth status were associated with an increased risk of depression. The overall incidence of preterm birth was 13.4%. Maternal antenatal depression was significantly associated with the risk of preterm birth (ARR, 95% CI: 1.34, 1.02–1.74).
Conclusion
The increased risk of preterm birth in women with antenatal depression in conjunction with other significant risk factors suggests that depression likely occurs within a constellation of other risk factors. Thus, to effectively address the burden of preterm birth, programs require developing and providing integrated care addressing multiple risk factors.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: (RK); (RB)
| | - Jennifer Applegate
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Imran Nisar
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Arup Dutta
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Sayedur Rahman
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Ambreen Nizar
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | | | | | - Farzana Begum
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Usha Dhingra
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Usma Mehmood
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Saikat Deb
- Center for Public Health Kinetics, Global Division, New Delhi, India
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Abanti, Banani, Dhaka, Bangladesh
| | - Sajid Muhammad
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Sayan Das
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Harshita Mittal
- Center for Public Health Kinetics, Global Division, New Delhi, India
| | - Nicole Minckas
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | | | - Rajiv Bahl
- World Health Organization (MCA/MRD), Geneva, Switzerland
- * E-mail: (RK); (RB)
| | - Fyezah Jehan
- Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan
| | - Sunil Sazawal
- Center for Public Health Kinetics, Global Division, New Delhi, India
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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25
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Mihrshahi S, Ara G, Khanam M, Rasheed S, Agho KE, Kabir AI, Roy SK, Haider R, Derakhshani Hamadani J, Tofail F, Alam A, Dibley MJ. The Shishu Pushti Trial-Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e31475. [PMID: 35129457 PMCID: PMC8861872 DOI: 10.2196/31475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. OBJECTIVE Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. METHODS This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). RESULTS We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. CONCLUSIONS This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. TRIAL REGISTRATION ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31475.
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Affiliation(s)
- Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Gulshan Ara
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mansura Khanam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - S K Roy
- Bangladesh Breastfeeding Foundation, Institute of Public Health, Dhaka, Bangladesh
| | - Rukhsana Haider
- Training and Assistance for Health and Nutrition Foundation, Dhaka, Bangladesh
| | - Jena Derakhshani Hamadani
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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26
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George CM, Perin J, Kuhl J, Williams C, Coglianese N, Thomas ED, Bauler S, François R, Ng A, Kang Y, Presence AS, Jean Claude BR, Tofail F, Mirindi P, Cirhuza LB. Linear Growth Faltering Is Associated with Subsequent Adverse Child Cognitive Developmental Outcomes in the Democratic Republic of the Congo (REDUCE Program). Am J Trop Med Hyg 2022; 106:356-360. [PMID: 34724633 PMCID: PMC8733491 DOI: 10.4269/ajtmh.21-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/30/2021] [Indexed: 01/03/2023] Open
Abstract
Globally, 140 million children under 5 years of age are estimated to be stunted. Previous studies have found an association between stunting and poor cognitive outcomes. However, there is limited evidence of this association in sub-Saharan African settings, such as the Democratic Republic of the Congo (DRC). This prospective cohort study of 286 children under 5 years was conducted in rural DRC to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up visit. Height and weight were measured at baseline and a 6-month follow-up. Diarrhea prevalence was assessed through surveillance visits. Diarrhea prevalence was not associated with follow-up combined EASQ Z-scores at the 6-month follow-up (coefficient: -0.06 [95% CI: -0.29, 0.17]). Each additional standard deviation (SD) increase in height-for-age Z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.22 (95%: 0.14, -0.31) SDs. Each additional SD increase in weight-for-age Z-scores from baseline to the 6-month follow-up increased combined EASQ Z-scores by 0.21 (95%: 0.10, -0.32) SDs. Linear growth faltering and reduced weight gain were associated with reduced cognitive developmental outcomes among children residing in rural DRC. Interventions are urgently needed for this susceptible pediatric population to improve child growth and cognitive developmental outcomes.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205-2103. E-mail:
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Coglianese
- Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Bauler
- Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo
| | - Ruthly François
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Angela Ng
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yunhee Kang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka 1000, Dhaka District, Bangladesh
| | - Patrick Mirindi
- Food for the Hungry, Food for the Hungry, Bukavu, Democratic Republic of the Congo
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27
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George CM, Perin J, Parvin T, Bhuyian MSI, Thomas ED, Monira S, Zohura F, Hasan MT, Alam M, Tofail F. Diarrhea Prevalence and Child Growth Faltering Are Associated with Subsequent Adverse Child Developmental Outcomes in Bangladesh (CHoBI7 Program). Am J Trop Med Hyg 2022; 106:233-238. [PMID: 34724631 PMCID: PMC8733517 DOI: 10.4269/ajtmh.21-0767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/01/2021] [Indexed: 01/03/2023] Open
Abstract
Millions of young children annually are not meeting their developmental potential in low- and middle-income countries. Previous studies have shown that diarrheal diseases during early life are associated with subsequent malnutrition. This prospective cohort study of 576 children under 5 years was conducted in urban Dhaka, Bangladesh, to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Height and weight were measured at baseline and a 12-month follow-up. Diarrhea prevalence was assessed through monthly surveillance visits. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at the 12-month follow-up visit. To assess the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes, linear regression models were fit using generalized estimating equations to account for clustering at the household level and to approximate 95% CIs. Diarrhea prevalence was negatively associated with change in height-for-age (HAZ) Z-scores from baseline to the 12-month follow-up (coefficient -0.85 [95% CI: -1.42, -0.28]). Diarrhea prevalence was a significant predictor of combined EASQ Z-scores with and without baseline stunting included in the model (-0.89 [95% CI: -1.67, -0.09] [baseline stunting included]) and (-0.88 [95% CI: -1.69, -0.07]). Change in HAZ from baseline to the 12-month follow-up was positively associated with follow-up combined EASQ Z-scores (0.28 [95% CI: 0.15, 0.42]). High diarrhea prevalence and linear growth faltering were associated with negative cognitive developmental outcomes among children residing in urban Dhaka, Bangladesh. Furthermore, high diarrhea prevalence was associated with negative child cognitive developmental outcomes with stunting included in the model, suggesting an effect of diarrhea on cognition independent of stunting.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E5535, Baltimore, MD 21205-2103. E-mail:
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Md Sazzadul Islam Bhuyian
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - M. Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh
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Hossain SJ, Roy BR, Sujon HM, Tran T, Fisher J, Tofail F, El Arifeen S, Hamadani JD. Effects of integrated psychosocial stimulation (PS) and unconditional cash transfer (UCT) on children's development in rural Bangladesh: A cluster randomized controlled trial. Soc Sci Med 2021; 293:114657. [PMID: 34942577 DOI: 10.1016/j.socscimed.2021.114657] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/23/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is evidence on benefits of psychosocial stimulation (PS) and cash transfer programmes in low- and middle-income countries on children's development. We integrated PS into an unconditional cash transfer (UCT) programme for poor Bangladeshi mothers to examine the effects on children's development. METHODS This cluster randomized controlled trial was conducted in rural Bangladesh from July 2017 to December 2018 in 33 clusters, with 11 clusters randomly assigned to each of the three arms, namely i) PS + UCT ii) UCT-only and iii) Comparison. We enrolled poor mothers and child (6-16 months) dyads eligible to receive maternity allowance by the Government of Bangladesh. Trained local women imparted training to mothers to provide psychosocial stimulation to their children for one year. Children's cognitive, language and motor development were measured with Bayley-III, behaviour with Wolke's ratings and maternal self-esteem with Rosenberg self-esteem scale. The analysis was intention-to-treat. RESULTS Of the 594 mother-child dyads, 40 (6·8%) were lost to follow-up. Compared to UCT-only, children in the PS + UCT had significant improvement in cognitive (B = 2.96, 95% CI: 0.46-5.47, Effect Size [ES] 0.24SD) and language (2.73, 0.39-5.00, ES 0.21SD) scores and were more responsive to examiner (0.30, 0.06-0.52, ES 0.27SD), while compared to comparison group, they had significantly higher cognitive (3.37, 1.27-6.19, ES 0.32SD), language (2.82, 0.53-5.10, ES 0.24SD) and motor (2.65, 0.24-5.06, ES 0.22SD) scores and were more responsive to examiner (0.30, 0.08-0.52, ES 0.26 SD). The mothers' self-esteem was significantly higher in PS + UCT (2.46, 0.94-3.98, ES 0.48 SD) and UCT-only (1.67, 0.02-3.20, ES 0.32 SD) compared to the comparison group. CONCLUSION PS integrated into an UCT programme benefited children's neurodevelopment and UCT improved mother's self-esteem. UCT programme may be an important platform for child stimulation programmes for rural poor populations.
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Affiliation(s)
- Sheikh Jamal Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh; Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Bharati Rani Roy
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Hasan Mahmud Sujon
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Thach Tran
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Jena Derakshani Hamadani
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
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29
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Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LC, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu L, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr 2021; 114:43S-67S. [PMID: 34590116 PMCID: PMC8560311 DOI: 10.1093/ajcn/nqab277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly N Dentz
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Elizabeth Y Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Patricia Kohl
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Sarker M Parvez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Abu A Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Lee S F Wu
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
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30
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Pasricha SR, Hasan MI, Braat S, Larson LM, Tipu SMMU, Hossain SJ, Shiraji S, Baldi A, Bhuiyan MSA, Tofail F, Fisher J, Grantham-McGregor S, Simpson JA, Hamadani JD, Biggs BA. Benefits and Risks of Iron Interventions in Infants in Rural Bangladesh. N Engl J Med 2021; 385:982-995. [PMID: 34496174 DOI: 10.1056/nejmoa2034187] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent is recommended by the World Health Organization and widely implemented. The functional benefits and safety of these interventions are unclear. METHODS We conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial to assess the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. The primary outcome was cognitive development, as assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance. Secondary outcomes included the cognitive composite score at 9 months after completion of the assigned regimen; behavioral, language, and motor development, as well as growth and hematologic markers, immediately after completion and at 9 months after completion; and safety. RESULTS We randomly assigned 3300 infants to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily. After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo (mean between-group difference in change in score from baseline, -0.30 points; 95% confidence interval [CI], -1.08 to 0.48) or with multiple micronutrient powders as compared with placebo (mean between-group difference in change in score from baseline, 0.23 points; 95% CI, -0.55 to 1.00). No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion. At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo. The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups. CONCLUSIONS In this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo. (Funded by the National Health and Medical Research Council of Australia; BRISC Australian New Zealand Clinical Trials Registry number, ACTRN12617000660381.).
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Affiliation(s)
- Sant-Rayn Pasricha
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - M Imrul Hasan
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Sabine Braat
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Leila M Larson
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - S M Mulk-Uddin Tipu
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Sheikh J Hossain
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Shamima Shiraji
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Andrew Baldi
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Mohammad S A Bhuiyan
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Fahmida Tofail
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Jane Fisher
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Sally Grantham-McGregor
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Julie A Simpson
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Jena D Hamadani
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
| | - Beverley-Ann Biggs
- From the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (S.-R.P., S.B., L.M.L., A.B.), Diagnostic Haematology, Royal Melbourne Hospital (S.-R.P.), Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital (S.-R.P.), the Department of Medical Biology (S.-R.P., A.B.), the Departments of Medicine and Infectious Diseases, Peter Doherty Institute for Infection and Immunity (S.B., L.M.L., B.-A.B.), and the Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health (S.B., J.A.S.), University of Melbourne, and the Victorian Infectious Diseases Service, Royal Melbourne Hospital (B.-A.B.), Parkville, VIC, and the Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC (J.F.) - all in Australia; the International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh (M.I.H., S.M.M.U.T., S.J.H., S.S., M.S.A.B., F.T., J.D.H.); the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia (L.M.L.); and the Institute of Child Health, University College London, London (S.G.-M.)
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Pitchik HO, Tofail F, Akter F, Sultana J, Shoab A, Huda TMN, Forsyth JE, Kaushal N, Jahir T, Yeasmin F, Khan R, Das JB, Khobair Hossain M, Hasan MR, Rahman M, Winch PJ, Luby SP, Fernald LCH. Effects of the COVID-19 pandemic on caregiver mental health and the child caregiving environment in a low-resource, rural context. Child Dev 2021; 92:e764-e780. [PMID: 34490612 PMCID: PMC8653040 DOI: 10.1111/cdev.13651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early child development has been influenced directly and indirectly by the COVID‐19 pandemic, and these effects are exacerbated in contexts of poverty. This study estimates effects of the pandemic and subsequent population lockdowns on mental health, caregiving practices, and freedom of movement among female caregivers of children 6–27 months (50% female), in rural Bangladesh. A cohort (N = 517) was assessed before and during the pandemic (May–June, 2019 and July–September, 2020). Caregivers who experienced more food insecurity and financial loss during the pandemic reported larger increases in depressive symptoms (0.26 SD, 95% CI 0.08–0.44; 0.21 SD, 0.04–0.40) compared to less affected caregivers. Stimulating caregiving and freedom of movement results were inconsistent. Increases in depressive symptoms during the pandemic may have consequences for child development.
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Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Akm Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tarique M N Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Natasha Kaushal
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rizwana Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jyoti B Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Rezaul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
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George CM, Parvin T, Islam Bhuyian MS, Thomas ED, Monira S, Zohura F, Hasan MT, Perin J, Alam M, Tofail F. Child Mouthing of Soil and Contaminated Fomites and Unimproved Sanitation are Associated with Subsequent Poor Child Developmental Outcomes in Urban Bangladesh (CHoBI7 Program). J Pediatr 2021; 235:184-189. [PMID: 33895208 DOI: 10.1016/j.jpeds.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the relationship between mouthing of soil and living in unsanitary conditions and child cognitive development in urban Bangladesh. STUDY DESIGN This prospective cohort study of 224 children under 5 years of age was conducted in urban Dhaka, Bangladesh. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 12-month follow-up visit. RESULTS Children who had caregiver reports of puting soil in their mouths at the majority of surveillance visits had significantly lower combined EASQ Z scores (coefficient, -0.53; 95% CI, -0.83 to -0.22) at the 12-month follow-up visit. Children who had caregiver reports of putting visibly dirty objects in their mouths at the majority of visits had significantly lower combined EASQ Z scores (-0.50; 95% CI, -0.79 to -0.22). Children in households with unimproved sanitation had significantly lower combined EASQ Z scores (-0.63; 95% CI, -1.11 to -0.16). CONCLUSIONS Children found to frequently put soil and visibly dirty objects in their mouths, and those who resided in households using unimproved sanitation, had lower subsequent cognitive developmental outcomes. These findings demonstrate the importance of interventions targeting child mouthing behaviors and sanitation infrastructure to decrease exposure to fecal pathogens and improve child cognitive developmental outcomes.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Hossain SJ, Tofail F, Sujan HM, Arifeen SE, Hamadani J. Factors associated with school achievement of children aged 8-10 years in rural Bangladesh: Findings from a post hoc analysis of a community-based study. PLoS One 2021; 16:e0254693. [PMID: 34320021 PMCID: PMC8318268 DOI: 10.1371/journal.pone.0254693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/25/2021] [Indexed: 01/03/2023] Open
Abstract
Background Education is one of the most important human capitals. Investment in education at early age returns best. A lot of factors influence children’s educational achievement. Studies in developed countries well established the relation of school achievement with its associated variables. But information is lack on what factors play important role for school achievement at early age in low resource settings like Bangladesh. We aimed to find factors associated with school achievement in rural Bangladesh. Method The data were acquired from a long-term follow up study, conducted in 8–10 years old children (n = 372). We used a locally developed school achievement tool based on Wide Range Achievement Test-4 to measure reading, spelling and math computation, Wechsler abbreviated scale of intelligence to measure intelligence Quotient (IQ), Digit span forward and backward for short term memory, and locally available Strength and Difficulties Questionnaire to measure behaviour. Socioeconomic and anthropometric information of the mothers and children were also collected. Multicollinearity of the data was checked. Unadjusted and adjusted multiple linear regression analysis was performed. Findings Years of schooling and short-term memory were positively related to reading, spelling and math computation. For years of schooling it was-reading B = 8.09 (CI 5.84, 10.31), spelling 4.43 (4.33, 8.53) and math computation 5.23 (3.60, 6.87) and for short term memory- reading 3.56 (2.01,5.05), spelling 4.01 (2.56, 5.46) and math computation 2.49 (1.37, 3.62). Older children had lower scores of reading -0.48 (-0.94, -0.02), spelling -0.41 (-0.88, -0.02) and math computation -0.47 (-0.80, -0.14). Children’s IQ predicted reading 0.48 (0.14, 0.81) and spelling 0.50 (0.18, 0.82) skills. Mother and father’s education predicted Spelling 0.82 (0.16, 1.48) and reading 0.68 (0.06, 1.30) capacity respectively. Children enrolled in private schools had higher reading 10.28 (5.05, 15.51) and spelling 6.22 (1.31, 11.13) than those in the government schools. Children with more difficult behaviour tended to have lower scores in reading -0.51 (-0.96, -0.05). Conclusion Children’s school achievement is influenced by their IQ, years of schooling, type of school and parents’ education. Therefore, intervention should be made to focus specifically on these variables and establish the effect of this intervention through robust research design.
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Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
- Department of Women’s and Children’s Health, Faculty of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
- * E-mail: ,
| | - Fahmida Tofail
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | | | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
| | - Jena Hamadani
- Maternal and Child Health Division (MCHD), icddr,b, Dhaka, Bangladesh
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Jahir T, Winch PJ, Leontsini E, Hwang ST, Yeasmin F, Hossain K, Das JB, Amin R, Nurul Huda TM, Sultana J, Khan R, Akter F, Shoab AKM, Hasan R, Pitchik HO, Tofail F, Fernald LCH, Luby SP, Rahman M. Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh. Int J Environ Res Public Health 2021; 18:ijerph18157891. [PMID: 34360185 PMCID: PMC8345337 DOI: 10.3390/ijerph18157891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.
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Affiliation(s)
- Tania Jahir
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
- Correspondence: ; Tel.: +880-1819140900
| | - Peter J. Winch
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (P.J.W.); (E.L.); (S.T.H.)
| | - Elli Leontsini
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (P.J.W.); (E.L.); (S.T.H.)
| | - Sharon T. Hwang
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (P.J.W.); (E.L.); (S.T.H.)
| | - Farzana Yeasmin
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Khobair Hossain
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Jyoti Bhushan Das
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Ruhul Amin
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Tarique Md. Nurul Huda
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Jesmin Sultana
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Rizwana Khan
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Fahmida Akter
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - AKM Shoab
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Rezaul Hasan
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
| | - Helen O. Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh;
| | - Lia C. H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (F.Y.); (K.H.); (J.B.D.); (R.A.); (T.M.N.H.); (J.S.); (R.K.); (F.A.); (A.S.); (R.H.); (M.R.)
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Pitchik HO, Tofail F, Rahman M, Akter F, Sultana J, Shoab AK, Huda TMN, Jahir T, Amin MR, Hossain MK, Das JB, Chung EO, Byrd KA, Yeasmin F, Kwong LH, Forsyth JE, Mridha MK, Winch PJ, Luby SP, Fernald LC. A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh. BMJ Glob Health 2021; 6:bmjgh-2020-004307. [PMID: 33727278 PMCID: PMC7970287 DOI: 10.1136/bmjgh-2020-004307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/13/2021] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale. Trial registration number The trial is registered in ISRCTN (ISRCTN16001234).
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Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Abul Kasham Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tarique Md Nurul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Ruhul Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jyoti Bhushan Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Laura H Kwong
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Peter J Winch
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia Ch Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Ara G, Sanin KI, Khanam M, Sarker MSA, Tofail F, Chowdhury IA, Afsana K, Gibson S, Askari S, Ahmed T. An Intervention Package Including Egg and Milk-Based Snack Improved Growth and Development of U-2 Children in Bangladesh: A Community-Based Randomized Controlled Trial. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab035_007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
We aimed to compare the effect of a comprehensive intervention package focusing on the animal-source protein (egg and milk)-based snack in conjunction with feeding counseling, water sanitation and hygiene, and supplementation with multiple micronutrient powder on linear growth and development of 6‒12-month old children in rural Bangladesh. Primary and secondary outcomes were differences in length-for-age Z score and cognitive development.
Methods
A community-based cluster randomized controlled longitudinal trial included 412 mother-infant pairs from 13 unions (small-administrative-unit) of Harirampur sub-district, allocating to receive treatment (n = 206) or regular health messages (n = 206) as control. The treatment group received monthly food vouchers (30 eggs, 12 L milk, 500 g semolina, 500 mL oil, 500 g sugar) to prepare nutritious children's snacks, micronutrient powder, child feeding and handwashing counseling for 12 months. The Control group received routine health messages from the government. Anthropometry, feeding and morbidity data were collected at baseline, monthly and endpoint. Children's development was assessed only once at an endpoint using Extended Ages and Stages Questionnaire (EASQ), Bayley III and Wolke's behavior rating scales. We used generalized linear regression modelling to conduct intention to treat analysis.
Results
Children's mean weight and length were similar between groups at baseline. At endpoint, compared to the control, treatment children had higher mean length (83.52 and 80.89 cm; difference: 2.62, P < 0.001); higher LAZ score (β: 0.38, CI: 0.24, 0.51); 61% lower rate of stunting (IRR: 0.39, CI: 0.22, 0.67); higher cognitive (β: 4.01, CI: 2.08, 5.94), language (β: 2.94, CI: 0.94, 4.94) and motor (β: 4.53, CI: 1.87, 7.20) scores, all being statistically significant. The intervention also improved developmental EASQ outcomes of the treatment children (gross and fine motor, problem-solving, and socio-emotional scores).
Conclusions
A comprehensive intervention package focusing on egg and milk-based snacks improved child growth and development in poor households in Bangladesh. Reducing the intervention cost and scale-up to larger communities in resource-poor settings merit further research.
Funding Sources
Children Investment Fund Foundation funded the trial.
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Affiliation(s)
| | | | | | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Kaosar Afsana
- BRAC James P Grant School of Public Health, BRAC University
| | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Center for Diarrhoeal Disease Research, Bangladesh
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Larson L, Feuerriegel D, Hasan MI, Jin J, Braat S, Shiraji S, Tofail F, Biggs BA, Pasricha SR, Hamadani J, Johnson K, Bode S. Effects of Supplementation With Iron Syrup or Iron-Containing Multiple Micronutrient Powders on Neural Indices of Cognitive Functioning in Bangladeshi Children. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab045_038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Micronutrients, especially iron, play a critical role in the developing infant brain. Yet, the causal effects of iron supplementation on neurocognitive functioning in a low-income anemic population of children have not been examined. This study sought to evaluate the effects of supplementation with iron syrup and iron-containing multiple micronutrient powders (MNPs) in Bangladeshi children on habituation to familiar sounds, a marker for healthy memory development, using auditory event-related brain potentials (ERPs).
Methods
This study was nested within the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, a double blinded double dummy randomized controlled trial (RCT). At 8 months of age, 3300 children were randomized to receive 3 months of 1) iron syrup + placebo MNPs, or 2)
MNPs (containing iron, retinol, zinc, and Vitamin C) + placebo iron syrup, or 3) placebo iron syrup and placebo MNPs. ERPs in response to an auditory roving oddball paradigm were measured in a random subset of 441 children at 3 months post-intervention (11 months of age) and 595 children after a further 9 months follow-up (20 months of age). ERP measures indexing aspects of habituation included the [deviant minus standard] difference waveform amplitude, N2 waveform amplitude, and the difference in deviant-evoked ERP amplitudes between the first and second half of the paradigm. Intention-to-treat analyses on ERP outcomes using linear models were used at 11 and 20 months of age separately.
Results
Baseline characteristics were balanced between treatment groups. Overall prevalence of anemia was 43.7% and iron deficiency was 28.4%. Intention-to-treat analyses indicated no significant treatment effects of iron or MNPs on the difference waveform amplitude at 11 months of age [mean difference (MD, 95% CI) iron vs placebo 0.24 (–1.03, 1.51); MNP vs placebo 0.59 (–0.70, 1.88)] and 20 months of age [(MD, 95% CI) iron vs placebo 0.50 (–0.62, 1.63); MNP vs placebo 0.24 (–0.89, 1.38)]. There were no differences by treatment arm for the other ERP measures.
Conclusions
Results from a rigorous prospectively powered sub-study of an RCT in an iron deficient population indicated no significant effects of supplementation with iron or MNPs on neural indices of habituation.
Funding Sources
NHMRC and The University of Melbourne.
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Affiliation(s)
| | | | | | | | | | - Shamima Shiraji
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Jena Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Yeasmin F, Winch PJ, Hwang ST, Leontsini E, Jahir T, Das JB, Amin MR, Hossain MK, Huda TMN, Akter F, Shoab AKM, Tofail F, Mridha MK, Sultana J, Pitchik H, Fernald LCH, Luby SP, Rahman M. Exploration of Attendance, Active Participation, and Behavior Change in a Group-Based Responsive Stimulation, Maternal and Child Health, and Nutrition Intervention. Am J Trop Med Hyg 2021; 104:1586-1595. [PMID: 33534769 PMCID: PMC8045643 DOI: 10.4269/ajtmh.20-0991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
Delivery of interventions through group sessions allows for in-depth discussions and creates opportunities for group members to work together to identify and solve common problems. However, low attendance may limit impact. We explored factors affecting attendance, active participation, and behavior change in an integrated group-based child development and maternal and child health intervention in Bangladesh. Community health workers (CHWs) facilitated two sessions a month including material on child stimulation; water, sanitation, and hygiene; nutrition, maternal depression, and lead exposure prevention. Sessions were conducted with 320 pregnant women and mothers with children younger than 24 months, in 16 villages in Kishoreganj district. After 4 and 9 months of intervention, we conducted focus group discussions and in-depth interviews with mothers (n = 55 and n = 48) to identify determinants of attendance and behavior change, and to examine potential for intervention scale-up. Recruiting family members to assist with childcare resulted in improved attention during sessions. Adopting a storytelling format for presentation of session materials resulted in more engaged participation during courtyard sessions. Session attendance and behavior change, especially purchasing decisions, were difficult for participants without the support of male heads of the household. Selecting a rotating leader from among the group members to remind group members to attend sessions and support CHWs in organizing the sessions was not successful. Facilitating self-appraisals and planning for water and sanitation allowed participants to identify areas for improvement and track their progress. Key determinants of a participant’s attendance were identified, and the resulting intervention shows promise for future implementation at scale.
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Affiliation(s)
- Farzana Yeasmin
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Peter J Winch
- 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sharon T Hwang
- 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elli Leontsini
- 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tania Jahir
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Jyoti B Das
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mohammad R Amin
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Md K Hossain
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Tarique Md Nurul Huda
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Fahmida Akter
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Abul K M Shoab
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Fahmida Tofail
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Malay K Mridha
- 3James P. Grant School of Public Health, Dhaka, Bangladesh
| | - Jesmin Sultana
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Helen Pitchik
- 4School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lia C H Fernald
- 4School of Public Health, University of California, Berkeley, Berkeley, California
| | | | - Mahbubur Rahman
- 1Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
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Hamadani JD, Hasan MI, Baldi AJ, Hossain SJ, Shiraji S, Bhuiyan MSA, Mehrin SF, Fisher J, Tofail F, Tipu SMMU, Grantham-McGregor S, Biggs BA, Braat S, Pasricha SR. Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series. Lancet Glob Health 2020; 8:e1380-e1389. [PMID: 32857955 PMCID: PMC7447230 DOI: 10.1016/s2214-109x(20)30366-1] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh. METHODS An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic. RESULTS Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99·9%, 95% CI 99·6-99·9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321 (96·0%, 95·2-96·7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1·90 per day rose from five (0·2%, 0·0-0·5) of 2422 to 992 (47·3%, 45·2-49·5) of 2096 (p<0·0001 comparing baseline with lockdown period). Before the pandemic, 136 (5·6%, 4·7-6·6) of 2420 and 65 (2·7%, 2·1-3·4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881 (36·5%, 34·5-38·4) of 2417 and 371 (15·3%, 13·9-16·8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51·7% (48·1-55·4; p<0·0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown. INTERPRETATION COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families. FUNDING National Health and Medical Research Council, Australia.
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Affiliation(s)
| | | | - Andrew J Baldi
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | | | - Shamima Shiraji
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | - Jane Fisher
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Fahmida Tofail
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | - Beverley-Ann Biggs
- Department of Medicine, Peter Doherty Institute, The University of Melbourne, Parkville, VIC, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sabine Braat
- Department of Medicine, Peter Doherty Institute, The University of Melbourne, Parkville, VIC, Australia; School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia; Diagnostic Haematology, Royal Melbourne Hospital, Parkville, VIC, Australia; Clinical Haematology at the Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, VIC Australia.
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40
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Akter F, Rahman M, Pitchik HO, Winch PJ, Fernald LCH, Nurul Huda TM, Jahir T, Amin R, Das JB, Hossain K, Shoab AK, Khan R, Yeasmin F, Sultana J, Luby SP, Tofail F. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. Int J Environ Res Public Health 2020; 17:ijerph17176233. [PMID: 32867253 PMCID: PMC7503282 DOI: 10.3390/ijerph17176233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022]
Abstract
Supporting caregivers’ mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar–April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children <24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of “unhealthy thoughts” in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting.
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Affiliation(s)
- Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
- Correspondence: ; Tel.: +880-17-16449655
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Helen O. Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Peter J. Winch
- Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Lia C. H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Tarique Mohammad Nurul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Ruhul Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Jyoti Bhushan Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Abul Kashem Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Rizwana Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (M.R.); (T.M.N.H.); (T.J.); (R.A.); (J.B.D.); (K.H.); (A.K.S.); (R.K.); (F.Y.); (J.S.)
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh;
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Hossain SJ, Roy BR, Hossain AT, Mehrin F, Tipu SMMU, Tofail F, Arifeen SE, Tran T, Fisher J, Hamadani J. Prevalence of Maternal Postpartum Depression, Health-Seeking Behavior and Out of Pocket Payment for Physical Illness and Cost Coping Mechanism of the Poor Families in Bangladesh: A Rural Community-Based Study. Int J Environ Res Public Health 2020; 17:ijerph17134727. [PMID: 32630173 PMCID: PMC7370050 DOI: 10.3390/ijerph17134727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022]
Abstract
The burden of depression is high globally. Maternal depression affects the mother, the child, and other family members. We aimed to measure the prevalence of maternal postpartum depressive (PPD) symptoms having a child aged 6–16 months, health-seeking behavior for general illness of all family members, out of pocket (OOP) payments for health care and cost coping mechanisms. We conducted a cross sectional study with 591 poor families in rural Bangladesh. The survey was conducted between August and October, 2017. Information was collected on maternal depressive symptoms using the Self Reporting Questionnaire (SRQ-20), health-seeking behavior, and related costs using a structured, pretested questionnaire. The prevalence of depressive symptoms was 51.7%. Multiple logistic regression analysis showed that PPD symptoms were independently associated with maternal age (p = 0.044), family food insecurity (p < 0.001) and violence against women (p < 0.001). Most (60%) ill persons sought health care from informal health providers. Out of pocket (OOP) expenditure was significantly higher (p = 0.03) in the families of depressed mothers, who had to take loan or sell their valuables to cope with expenditures (p < 0.001). Our results suggest that postpartum depressive symptoms are prevalent in the poor rural mothers. Community-based interventions including prevention of violence and income generation activities for these economically disadvantaged mothers should be designed to address risk factors. Health financing options should also be explored for the mothers with depressive symptoms
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Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
- Correspondence: or ; Tel.: +880-1712191414
| | - Bharati Rani Roy
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - Fardina Mehrin
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - SM Mulk Uddin Tipu
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - Fahmida Tofail
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
| | - Thach Tran
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (T.T.); (J.F.)
| | - Jane Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (T.T.); (J.F.)
| | - Jena Hamadani
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; (B.R.R.); (A.T.H.); (F.M.); (S.M.U.T.); (F.T.); (S.E.A.); (J.H.)
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Hamadani JD, Mehrin SF, Tofail F, Hasan MI, Huda SN, Baker-Henningham H, Ridout D, Grantham-McGregor S. Integrating an early childhood development programme into Bangladeshi primary health-care services: an open-label, cluster-randomised controlled trial. Lancet Glob Health 2020; 7:e366-e375. [PMID: 30784637 DOI: 10.1016/s2214-109x(18)30535-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor development in young children in developing countries is a major problem. Child development experts are calling for interventions that aim to improve child development to be integrated into health services, but there are few robust evaluations of such programmes. Previous small Bangladeshi trials that used individual play sessions with mothers and their children (at home or in clinics), which were predominantly run by employed women, found moderate improvements on child development. We aimed to integrate an early childhood development programme into government clinics that provide primary health care and to evaluate the effects of this intervention on child cognition, language, and motor development, growth, and behaviour in a subsample of the children. METHODS In this open-label cluster-randomised controlled trial, we recruited individuals from community clinics in Narsingdi district, Bangladesh. These clinics were randomly selected from a larger sample of eligible clinics, and they were assigned (1:1) to either deliver an intervention of 25 sessions, in which mothers of eligible children were shown how to support their child's development through play and interactions, or to deliver no intervention (control group). Participants were underweight children, defined as a weight-for-age Z score of -2 SDs of the WHO standard, who were aged 5-24 months and who lived near the clinic (defined as a walk of less than 30 min). Government health workers ran these sessions at the clinics as part of their routine work, and mothers and children attended fortnightly in pairs (instead of individual weekly home visits that were specified in the original programme). A subsample of children from each clinic was randomly selected for impact evaluation, and these children were assessed on the Bayley Scales of Infant and Toddler Development for their cognitive, language, and motor performance and for their behaviour with Wolke's ratings, before and after implementation of the intervention. The primary outcomes were the performance of this evaluation subsample on the Bayley and Wolke scales and their anthropometric measurements (weight, length or height, and head circumference) after 1 year of the intervention. This study is registered with ClinicalTrials.gov, number NCT02208531. FINDINGS Between Nov 29, 2014, and April 30, 2015, 12 054 children in 90 clinics were screened, and between six and 25 underweight children were enrolled from each clinic. From the 2423 (20%) underweight children, we excluded 656 (27%) children who lived more than 30-min walking distance from the community clinics, and 30 (1%) children whose mothers did not consent to participate. We therefore enrolled 1737 (72%) children from these 90 clinics. After randomisation, the control group clinics included 878 (51%) children (who all received no intervention) and the intervention group clinics included 859 (49%) children (who all received the child development programme sessions). Eight children from each clinic (360 [41%] children from the control group clinics and 358 [42%] children from the intervention group clinics) were randomly selected for inclusion in the evaluation subsample. Between Feb 24, 2016, and Sept 7, 2016, 344 (96%) children in control group clinics and 343 (96%) children in intervention group clinics were assessed for the primary outcome. 16 (5%) children in the control group clinics and 15 (4%) children in the intervention group clinics did not provide all data and were not included in final analyses. An intention-to-treat analysis showed that the intervention significantly improved children's cognition (effect size 1·3 SDs, 95% CI 1·1 to 1·5; p=0·006), language (1·1 SDs, 0·9 to 1·2; p=0·01), and motor composite scores (1·2 SDs, 1·0 to 1·3; p=0·006) and behaviour ratings (ranging from 0·7 SDs, 0·5 to 0·9; p=0·02; to 1·1 SDs, 1·0 to 1·2; p=0·007), but the intervention had no significant effect on growth (p values ranged from 0·05 to 0·74). Three (1%) children in the intervention group died, but their deaths were not related to the intervention. INTERPRETATION The extent and range of benefits of our intervention are encouraging. Health workers ran most of the sessions effectively and attendance was good, which is promising for scale-up of the intervention model. However, researchers trained and supervised the health workers, and the next step will be to determine whether the Bangladeshi ministry of health can perform these tasks. In future programmes, more attention needs to be paid to the nutrition of the children. FUNDING Grand Challenges Canada (Saving Brains).
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Affiliation(s)
- Jena D Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Syeda F Mehrin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad I Hasan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Deborah Ridout
- UCL Great Ormond Street Institute of Child Health, London, UK
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Berens AE, Kumar S, Tofail F, Jensen SKG, Alam M, Haque R, Kakon SH, Petri WA, Nelson CA. Cumulative psychosocial risk and early child development: validation and use of the Childhood Psychosocial Adversity Scale in global health research. Pediatr Res 2019; 86:766-775. [PMID: 31103019 PMCID: PMC6859196 DOI: 10.1038/s41390-019-0431-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence suggests that cumulative early psychosocial adversity can influence early child development (ECD). The Childhood Psychosocial Adversity Scale (CPAS) is a novel measure of cumulative risk designed for use in global ECD research. We describe its development and assess validity from its first application in Bangladesh, where it predicts cognitive development scores among young children. METHODS Items were generated from literature review and qualitatively assessed for local relevance. Two-hundred and eighty-five mother-child dyads from an urban slum of Dhaka completed the CPAS at child ages 18, 24, 48, and/or 60 months. The CPAS was assessed for internal consistency, retest reliability, and convergent, incremental, and predictive validity. RESULTS The CPAS includes subscales assessing child maltreatment, caregiver mental health, family conflict, domestic violence, and household/community psychosocial risks. In Bangladesh, subscales had good internal consistency (Cronbach's α > 0.70). Full-scale score had good 2-week test-retest reliability (intra-class correlation coefficient = 0.89; F(38,38) = 8.45, p < 0.001). Using multivariate regression, 48-month CPAS score significantly predicted 60-month intelligence quotient, accounting for more variance than socioeconomic status or malnutrition. CONCLUSIONS The CPAS is a novel tool assessing cumulative childhood psychosocial risk. Evidence supports validity of its use in ECD research in Bangladesh, and ongoing work is applying it in additional countries.
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Affiliation(s)
- Anne E Berens
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Swapna Kumar
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Sarah K G Jensen
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Masud Alam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shahria H Kakon
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Harvard Graduate School of Education, Cambridge, MA, USA.
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Naheed A, Islam MS, Hossain SW, Ahmed HU, Uddin MMJ, Tofail F, Hamadani JD, Hussain AHME, Munir K. Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh. Autism Res 2019; 13:284-297. [PMID: 31647184 DOI: 10.1002/aur.2227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
This cross-sectional study examined the burden of depression and quality of life (QoL) among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. All consenting mothers were 18 years of age and older and met criteria for major depressive disorder (MDD) on the Structured Interview for DSM-V-TR Research Version-non patient edition administered by trained raters. QoL was assessed by the EuroQol five-dimensional standardized questionnaire. MDD was diagnosed in 45% of mothers and was proportionally higher among those who did not work outside the home, had no childcare support at home, expressed low level of satisfaction with the quality of providers when they had sought care for their children with ASD, and reported being recipient of negative attitudes from neighbors toward their children with ASD. QoL was negatively associated with MDD, mothers' illness, and low satisfaction with the health care providers for children with ASD, as well as experiencing a negative attitude by neighbors toward their children. QoL was positively associated with the reported family monthly income and improvement of the children with ASD on school attendance. The prevalence of MDD among mothers of children with ASD was high and associated with poor QoL. Integrating mental health services and supports for mothers in the ASD care of children is likely to address the high burden of depression they face, and improve their overall quality of life. Autism Res 2020, 13: 284-297. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The levels of depression were assessed among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. Almost one in two mothers was found to have major depression. The quality of life of these mothers was generally poor. Integrating mental health services for mothers with ASD care in children is likely to address the burden of depression among the mothers of children with ASD and improve overall quality of life.
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Affiliation(s)
- Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saimul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Helal Uddin Ahmed
- National Institute of Mental Health, Bangladesh (NIMH,B), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - M M Jalal Uddin
- National Institute of Neurosciences & Hospital, Bangladesh (NINS,B), Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Fahmida Tofail
- NCSD Administration, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jena Derakhshani Hamadani
- Maternal and Neonatal Health, Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A H M Enayet Hussain
- Planning and Development, Director General of Health Services (DGHS), Dhaka, Bangladesh
| | - Kerim Munir
- Division of Developmental Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Developmental Medicine, Boston Children's Hospital and Department and Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Sania A, Sudfeld CR, Danaei G, Fink G, McCoy DC, Zhu Z, Fawzi MCS, Akman M, Arifeen SE, Barros AJD, Bellinger D, Black MM, Bogale A, Braun JM, van den Broek N, Carrara V, Duazo P, Duggan C, Fernald LCH, Gladstone M, Hamadani J, Handal AJ, Harlow S, Hidrobo M, Kuzawa C, Kvestad I, Locks L, Manji K, Masanja H, Matijasevich A, McDonald C, McGready R, Rizvi A, Santos D, Santos L, Save D, Shapiro R, Stoecker B, Strand TA, Taneja S, Tellez-Rojo MM, Tofail F, Yousafzai AK, Ezzati M, Fawzi W. Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries. BMJ Open 2019; 9:e026449. [PMID: 31585969 PMCID: PMC6797384 DOI: 10.1136/bmjopen-2018-026449] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs). DESIGN Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data. DATA SOURCES We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study. ANALYSES Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses. RESULTS We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs. CONCLUSIONS Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.
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Affiliation(s)
- Ayesha Sania
- ICAP and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York city, New York, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Goodarz Danaei
- Deaprtment of Global Health and Population, and Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Günther Fink
- Household Economics and Health System Research Unit, Schweizerisches Tropen- und Public Health-Institut, Basel, Switzerland
| | - Dana C McCoy
- Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA
| | - Zhaozhong Zhu
- Departments of Epidemiology and Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mehmet Akman
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Shams E Arifeen
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - David Bellinger
- Department of Neurology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alemtsehay Bogale
- Nutrition and Scientific Affairs, The Nature's Bounty Co, Ronkonkoma, New York, USA
| | - Joseph M Braun
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Nynke van den Broek
- Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Verena Carrara
- Department of Maternal and Child Health, Shoklo Malaria Research Unit, Mae Sot, Thailand
| | - Paulita Duazo
- Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Christopher Duggan
- Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Lia C H Fernald
- Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Melissa Gladstone
- Women and Children's Health, University of Liverpool, Institute of Translational Medicine, Liverpool, UK
| | - Jena Hamadani
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Alexis J Handal
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Siobán Harlow
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Melissa Hidrobo
- Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Chris Kuzawa
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway
| | - Lindsey Locks
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Karim Manji
- Department of Pediatrics and Child Health, Muhibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brasil
| | - Christine McDonald
- Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital, Oakland, California, USA
| | - Rose McGready
- Faculty of Tropical Medicine, Mahidol University, Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjumand Rizvi
- Pediatrics and Child Health, Aga Khan Medical University, Karachi, Pakistan
| | - Darci Santos
- Department of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
| | - Leticia Santos
- Department of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
| | - Dilsad Save
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Roger Shapiro
- Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Barbara Stoecker
- Department of Nutritional Sciences, Oklahoma State University College of Human Environmental Sciences, Stillwater, Oklahoma, USA
| | - Tor A Strand
- Department of Laboratory Medicine, Sykehuset Innlandet Helseforetaket, Brumunddal, Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Fahmida Tofail
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Wafaie Fawzi
- Deaprtment of Global Health and Population, Epidemiology, and Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Larson L, Hasan MI, Feuerriegel D, Shiraji S, Shabnab S, Tofail F, Braat S, Biggs BA, Pasricha SR, Hamadani J, Bode S, Johnson K. Using a Developmental Test and Electroencephalography to Examine Child Cognition and Its Predictors in Bangladesh (P13-024-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz036.p13-024-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
The majority of global health studies use behavioural assessments to measure early child development. Few studies have examined neural indices of cognition using electroencephalography (EEG) in low-income settings. Using data from the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, we examined cognitive development and neural indices of memory and attention in 11 month-old Bangladeshi children and their environmental, socio-demographic, and biological predictors.
Methods
At 8 months of age, 3300 children were randomized to iron syrup, multiple micronutrient supplementation, or placebo for 3 months. The main trial outcomes include child development measured using the Bayley Scales of Infant and Toddler Development (BSID)-III, anthropometry, haemoglobin, morbidity, and iron indices. EEG is being conducted to measure event-related brain potentials (ERPs) in a random subset of 250 children at 11 months of age. ERPs are measured in response to auditory and visual stimuli, using roving oddball and attention orienting tasks. Generalized linear mixed models estimated the predictors of BSID-derived cognitive development and EEG-derived neural indices of memory and attention. Potential predictors include psychosocial stimulation, anthropometry, haemoglobin, socio-economic status, food security, sex, and parental education. Additionally, we examined correlations between the BSID cognitive scores and EEG-derived neural indices of cognition.
Results
Preliminary BSID data up to December 2018 indicates that 1749 children have completed measurements at 11 months of age. Psychosocial stimulation was significantly associated with BSID cognitive development scores. ERPs in children at 11 months of age are expected to be completed by May 2019 and relevant results will be presented.
Conclusions
This study is the first to acquire ERP data in children at 11 months of age in rural Bangladesh. Our findings will identify significant predictors of cognitive functioning measured using the BSID (a well-established developmental test) and using EEG (a sensitive neurophysiological approach) in young children in this setting. Results will indicate the agreement between child cognition outcomes using the BSID and EEG.
Funding Sources
NHMRC and The University of Melbourne.
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Affiliation(s)
| | | | | | - Shamima Shiraji
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Samiha Shabnab
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Jena Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Ruan-Iu L, Pendergast LL, Rasheed M, Tofail F, Svensen E, Maphula A, Roshan R, Nahar B, Shrestha R, Williams B, Schaefer BA, Scharf R, Caulfield LE, Seidman J, Murray-Kolb LE. Assessing Early Childhood Fluid Reasoning in Low- and Middle-Income Nations: Validity of the Wechsler Preschool and Primary Scale of Intelligence Across Seven MAL-ED Sites. Journal of Psychoeducational Assessment 2019. [DOI: 10.1177/0734282919850040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An adapted version of the Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III) was administered to assess cognitive functioning among 1,253 5-year-old children from the Malnutrition and Enteric Disease (MAL-ED) study—an international, multisite study investigating multiple aspects of child development. In this study, the factor structure and invariance of the WPPSI-III were examined across seven international research sites located in Bangladesh, Brazil, India, Nepal, Pakistan, South Africa, and Tanzania. Using a multiple indicator multiple cause (MIMIC) modeling approach, the findings supported the validity of a fluid reasoning dimension (comprised of block design, matrix reasoning, and picture completion subscales) across each of the seven sites, although the scores were noninvariant. Accordingly, these scores are recommended for research purposes and understanding relationships between variables but not for mean comparisons or clinical purposes.
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Affiliation(s)
| | | | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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48
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Hamadani JD, Baker-Henningham H, Tofail F, Mehrin SF, Grantham-McGregor S. Learning opportunities and responsive caregiving. Lancet Glob Health 2019; 7:e709. [PMID: 31097274 DOI: 10.1016/s2214-109x(19)30191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jena D Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh.
| | | | - Fahmida Tofail
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
| | - Syeda F Mehrin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
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Milner KM, Bhopal S, Black M, Dua T, Gladstone M, Hamadani J, Hughes R, Kohli-Lynch M, Manji K, Ponce Hardy V, Radner J, Sharma S, Tofail F, Tann C, Lawn JE. Counting outcomes, coverage and quality for early child development programmes. Arch Dis Child 2019; 104:S13-S21. [PMID: 30885962 PMCID: PMC6557221 DOI: 10.1136/archdischild-2018-315430] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/04/2022]
Abstract
Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada®-funded Saving Brains® ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a 'theory of change' based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind.
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Affiliation(s)
- Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Sunil Bhopal
- Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle upon Tyne, UK
| | - Maureen Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jena Hamadani
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rob Hughes
- Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, UK
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Cally Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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50
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Hossain SJ, Roy BR, Salveen NE, Hasan MI, Tipu SMMU, Shiraji S, Tofail F, Hamadani JD. Effects of adding psychosocial stimulation for children of lactating mothers using an unconditional cash transfer platform on neurocognitive behavior of children in rural Bangladesh: protocol for a cluster randomized controlled trial. BMC Psychol 2019; 7:13. [PMID: 30836984 PMCID: PMC6402152 DOI: 10.1186/s40359-019-0289-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background There is sufficient evidence that psychosocial stimulation (PS) benefits children’s neurocognitive behavior, however, there is no information on how it works when delivered through an Unconditional Cash Transfer (UCT) platform for poor rural population in developing countries. The objective of this study is to measure effects of adding PS for children of lactating mothers enrolled to receive UCT with health education (HE) on neurocognitive behavior of children in rural Bangladesh. Methods The study will be conducted at 11 unions of Ullapara sub-district in Bangladesh. The study is a cluster randomized controlled trial with three-arms; (i) PS and UCT with HE (ii) UCT with HE and iii) Comparison arm. The cluster will be considered as an old Ward of a Union, the lowest tier of local government system in rural Bangladesh. There are three old Wards in a union. These three clusters will be randomized to one of the three arms. Similarly, randomization will be done for each 11 Unions and then 11 clusters will be assigned to an arm. Eighteen participants will be recruited from each cluster randomly (n = 196 in each arm). The intervention designed for one year includes UCT with HE for the poor as a safety net program in rural Bangladesh with or without PS. An age-based curriculum of PS is already available for Bangladeshi children and this will be administered by trained local women; play leaders (PL) in intervention clusters. The government of Bangladesh is providing UCT of taka 500 ($6.25) as maternity allowance per month with HE. The primary outcomes will be cognitive, motor and language composite scores measured by Bayley-III and behavior using Wolke’s behavior rating scale. The secondary outcomes will be children and mothers’ growth, family food security status, health seeking behavior, mothers’ depressive symptoms and self-esteem and violence against mothers. Discussion The study will provide a unique opportunity to assess an integrated early childhood development intervention using UCT platform to mitigate developmental delays in poor vulnerable children of rural Bangladesh. Trial registration number ClinicalTrials.gov NCT03281980, registered on September 13, 2017.
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Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
| | - Bharati Rani Roy
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Nur-E Salveen
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Imrul Hasan
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - S M Mulk Uddin Tipu
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Shamima Shiraji
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Fahmida Tofail
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Jena D Hamadani
- Maternal and Child Health Division (MCHD), Internationational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
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