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Serván-Mori E, Quezada-Sánchez AD, Fuentes-Rivera E, Pineda-Antunez C, Hernández-Chávez MDC, García-Martínez A, García-Feregrino R, Madrigal A, Guerrero B, Medrano G, Schnaas L. Proximal determinants of suboptimal early child development during the first three years of life in socially deprived Mexican contexts. PLoS One 2023; 18:e0291300. [PMID: 37917638 PMCID: PMC10621868 DOI: 10.1371/journal.pone.0291300] [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: 12/20/2021] [Accepted: 08/29/2023] [Indexed: 11/04/2023] Open
Abstract
Assessing the status and determinants of early child development (ECD) requires accurate and regularly updated measurements. Yet, little information has been published on the subject in low- and middle-income countries, particularly regarding the proximal determinants of childhood development in contexts of high social marginalization. This article analyzes the factors that favor or mitigate suboptimal ECD outcomes in Mexico. A cross-sectional study was conducted using recently collected data for 918 children aged 0-38 months from socially marginalized communities in 23 Mexican municipalities. The ECD outcomes of the children were estimated based on indicators of chronic undernutrition and neurodevelopment (normal, lagging and at risk of delay). The distribution of outcomes was described across the ECD proximal determinants analyzed, including the co-occurrence of chronic undernutrition and suboptimal neurodevelopment. Covariate-adjusted prevalence of the ECD outcomes and co-occurrences were calculated as post-estimations from a multiple multinomial logistic regression. The prevalence of chronic undernutrition was 23.5%; 45.9% of children were classified with neurodevelopmental lag, and 11% at risk of neurodevelopmental delay. The prevalence of stunting co-occurring with suboptimal neurodevelopment came to 15.4%. The results of the multinomial logistic regression model indicated that early gestational age, low birth weight, a low household socioeconomic level, being male and having numerous siblings were all associated with the co-occurrence of chronic undernutrition and suboptimal child neurodevelopment. This study identified important predictors of child development in the first three years of life, specifically in two of its principal indicators: nutritional and neurodevelopmental status. Most of the predictors observed can be improved by means of social programs and interventions. Trial registration: ClinicalTrials.gov ID: NCT04210362.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Amado D. Quezada-Sánchez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Evelyn Fuentes-Rivera
- Center for Demographic, Urban and Environmental Studies, El Colegio de Mexico, Mexico City, Mexico
| | - Carlos Pineda-Antunez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Angélica García-Martínez
- Lucy Family Institute for Data and Society, University of Notre Dame, Notre Dame, IN, United States of America
| | - Raquel García-Feregrino
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Abby Madrigal
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Bárbara Guerrero
- Integral Services for Childhood Attention Consulting, Mexico City, Mexico
| | - Gerónimo Medrano
- Integral Services for Childhood Attention Consulting, Mexico City, Mexico
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico
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Serván-Mori E, Fuentes-Rivera E, Quezada AD, Pineda-Antunez C, del Carmen Hernández-Chávez M, García-Martínez A, Madrigal A, García-Feregrino R, Santiago-Angelino T, Hernández-Serrato M, Schnaas L. Early neurological development and nutritional status in Mexican socially deprived contexts. PLoS One 2022; 17:e0270085. [PMID: 35727758 PMCID: PMC9212134 DOI: 10.1371/journal.pone.0270085] [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: 05/03/2021] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Early childhood development (ECD) is a critical stage in the intergenerational process of human development. Targeted interventions depend on accurate and up-to-date ECD measurements. This paper presents estimates for the nutritional and neurodevelopmental status of socially marginalized children in Mexico. We performed a cross-sectional study based on data collected in 2019-2020 during home visits to 1,176 children aged 0-38 months across 24 highly marginalized locations in Oaxaca. We assessed nutritional status according to the World Health Organization 2006 child-growth standards and ECD status using the Child Development Evaluation Test, 2nd Edition. We stratified results by sex. Prevalence of stunting was 5.3 percentage points (p.p.) higher (p = 0.023) in males (25.3%; 95% CI: 20.2%, 31.1%) compared to females (20.0%; 95% CI: 15.0%, 26.1%). Overall prevalence rates stood at 5.7% (95% CI: 4.0%, 8.1%) for underweight, 1.5% (95% CI: 0.9%, 2.7%) for wasting and 3.6% (95% CI: 2.3%, 5.7%) for overweight/obesity, with no significant differences by sex. Prevalence of normal development was 8.3 p.p. lower (p = 0.001) in males (39.3%; 95% CI: 34.5%, 44.4%) compared to females (47.6%; 95% CI: 41.6%, 53.6%). By development area, the highest prevalence of suboptimal outcomes among children with developmental lag or at risk of delay was observed in their gross motor and language skills: 24.1% (95% CI: 20.0%, 28.8%) and 38.6% (95% CI: 34.0%, 43.3%), respectively. The largest difference between the sexes was found in the language area. Our results show that childhood development strategies have been insufficient thus far in the studied population. Programs specifically designed to prevent ECD lags and bridge inequality gaps are urgently needed. Trial registration: ClinicalTrials.gov ID: NCT04210362.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Evelyn Fuentes-Rivera
- Center for Demographic, Urban and Environmental Studies, College of Mexico A.C, Mexico City, Mexico
| | - Amado D. Quezada
- Center for Evaluation and Surveys Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Carlos Pineda-Antunez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Angélica García-Martínez
- Lucy Family Institute for Data and Society, University of Notre Dame, Notre Dame, IN, United States of America
| | - Abby Madrigal
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Raquel García-Feregrino
- Center for Evaluation and Surveys Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Tania Santiago-Angelino
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - María Hernández-Serrato
- Center for Information on Public Health Decisions, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lourdes Schnaas
- Department of Developmental Neurobiology, The National Institute of Perinatology Isidro, Espinosa de los Reyes, Mexico City, Mexico
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