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Jeong J, Ahun MN, Gunaratna NS, Ambikapathi R, Mapendo F, Galvin L, Kieffer MP, Mwanyika-Sando M, Mosha D, O'Malley SF, Verissimo CK, PrayGod G, Yousafzai AK. Effects of engaging fathers and bundling parenting and nutrition interventions on early child development and maternal and paternal parenting in Mara, Tanzania: a factorial cluster-randomized controlled trial. J Child Psychol Psychiatry 2024; 65:694-709. [PMID: 37800367 DOI: 10.1111/jcpp.13897] [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] [Accepted: 07/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Multicomponent interventions are needed to address the various co-occurring risks that compromise early child nutrition and development. We compared the independent and combined effects of engaging fathers and bundling parenting components into a nutrition intervention on early child development (ECD) and parenting outcomes. METHODS We conducted a 2×2 factorial cluster-randomized controlled trial across 80 villages in Mara Region, Tanzania, also known as EFFECTS (Engaging Fathers for Effective Child Nutrition and Development in Tanzania; ClinicalTrials.gov, NCT03759821). Households with children under 18 months of age residing with their mother and father were enrolled. Villages were randomly assigned to one of five groups: a nutrition intervention for mothers, a nutrition intervention for couples, a bundled nutrition and parenting intervention for mothers, a bundled intervention for couples, and a standard-of-care control. Interventions were delivered by trained community health workers through peer groups and home visits over 12 months. Mothers, fathers, and children were assessed at baseline, midline, and endline or postintervention. We used a difference-in-difference approach with intention-to-treat analysis to estimate intervention effects on ECD (Bayley Scales of Infant and Toddler Development, third edition) and maternal and paternal parenting and psychosocial well-being. RESULTS Between October 29, 2018, and May 24, 2019, 960 households were enrolled (n = 192 per arm). Compared to nutrition interventions, bundled interventions improved children's cognitive (β = .18 [95% CI: 0.01, 0.36]) and receptive language development (β = .23 [0.04, 0.41]). There were no differences between interventions for other ECD domains. Compared to nutrition interventions, bundled interventions achieved additional benefits on maternal stimulation (β = .21 [0.04, 0.38]) and availability of home learning materials (β = .25 [0.07-0.43]) and reduced paternal parenting distress (β = -.34 [-0.55, -0.12]). Compared to interventions with mothers only, interventions that engaged fathers improved paternal stimulation (β = .45 [0.27, 0.63]). CONCLUSIONS Jointly bundling parenting components into nutrition interventions while also engaging both mothers and fathers is most effective for improving maternal and paternal parenting and ECD outcomes.
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Affiliation(s)
- Joshua Jeong
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marilyn N Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ramya Ambikapathi
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Global Development, Cornell University, Ithaca, NY, USA
| | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | | | | | - Dominic Mosha
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Savannah Froese O'Malley
- Department of Public Health, Purdue University, West Lafayette, IN, USA
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ahun MN, Ali NB, Hentschel E, Jeong J, Franchett E, Yousafzai AK. A meta-analytic review of the implementation characteristics in parenting interventions to promote early child development. Ann N Y Acad Sci 2024; 1533:99-144. [PMID: 38354095 DOI: 10.1111/nyas.15110] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high-income (62%) and low-and-middle-income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community-based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta-analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low- and middle-income or high-income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale-up of effective interventions to improve child development.
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Affiliation(s)
- Marilyn N Ahun
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nazia Binte Ali
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Emily Franchett
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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LaMonica HM, Song YJC, Loblay V, Ekambareshwar M, Naderbagi A, Zahed IUM, Troy J, Hickie IB. Promoting social, emotional, and cognitive development in early childhood: A protocol for early valuation of a culturally adapted digital tool for supporting optimal childrearing practices. Digit Health 2024; 10:20552076241242559. [PMID: 38596404 PMCID: PMC11003334 DOI: 10.1177/20552076241242559] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Objective The Thrive by Five app promotes positive interactions between children and parents, extended family, and trusted community members that support optimal socio-emotional and cognitive development in the early years. This article aims to describe the protocol for a prospective mixed-methods multi-site study evaluating Thrive by Five using surveys, interviews, workshops, audio diaries from citizen ethnographers and app usage data. Methods The study activities and timelines differ by site, with an extensive longitudinal evaluation being conducted at two sites and a basic evaluation being conducted at five sites. The learnings from the more comprehensive evaluations inform the iterative research and development processes while also ensuring ongoing evaluation of usability, acceptability and effectiveness of the app and its content across varying contexts. The study evaluates: (1) the impact of the Thrive by Five content on caregiver knowledge, behaviours, attitudes and confidence; (2) how the content changes relationships at the familial, community and system level; (3) how cultural and contextual factors influence content engagement and effectiveness and (4) the processes that facilitate or disrupt the success of the implementation and dissemination. Results All in-country partners have been identified and data collection has been completed in Indonesia, Malaysia, Afghanistan, Kyrgyzstan, Uzbekistan, Namibia and Cameroon. Conclusions Very few digital health solutions have been trialled for usability and effectiveness in diverse cultural contexts. By combining quantitative, qualitative, process and ethnographic methodologies, this innovative study informs the iterative and ongoing optimisation of the cultural and contextual sensitivity of the Thrive by Five content and the processes supporting implementation and dissemination.
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Affiliation(s)
- Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Yun J. C. Song
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Victoria Loblay
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
- The Australian Prevention Partnership Centre, Sydney, Australia
| | | | - Aila Naderbagi
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Jakelin Troy
- Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Nair S, Sinha H, Holding P. Integrating father involvement into early childhood initiatives delivered at scale: key considerations. Front Public Health 2023; 11:1193974. [PMID: 38169853 PMCID: PMC10758470 DOI: 10.3389/fpubh.2023.1193974] [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] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Early child development (ECD) interventions, usually centered around the mother, exclude fathers from contributing to childcare. Research shows that a father’s involvement in childcare can have a positive impact on the child’s growth. In this light, a trial was conducted in rural India wherein a new program component aimed at enhancing fathers’ engagement in early child was incorporated into an existing childcare intervention. The paper highlights the learnings drawn from the trial to present pathways to change, that is, strategies needed to embed father involvement as a component within the intervention ecosystem.
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Affiliation(s)
- Sapna Nair
- Institute for Financial Management and Research, Krea University, Chennai, India
| | - Harshula Sinha
- Institute for Financial Management and Research, Krea University, Chennai, India
| | - Penny Holding
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Identitea, Nairobi, Kenya
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Gaidhane A, Khatib MN, Telrandhe S, Patil M, Kogade P, Gaidhane S, Choudhari SG, Holding PA, Saxena D, Syed ZQ. Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT. Front Public Health 2023; 11:1165728. [PMID: 38035279 PMCID: PMC10682778 DOI: 10.3389/fpubh.2023.1165728] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/17/2023] [Indexed: 12/02/2023] Open
Abstract
Background To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children. Methods Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months. Findings At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%. Interpretations The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program. Funding The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).
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Affiliation(s)
- Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Manoj Patil
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Priti Kogade
- Global Health Academy, Centre of Early Childhood Development - Stepping Stones Project, Wardha, India
- Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Sonali G. Choudhari
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Penny A. Holding
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Zahiruddin Quazi Syed
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- South Asia Infant Feeding Research Network (SAIFRN), School of Epidemiology and Public Health, Wardha, Maharashtra, India
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Spain AK, Korfmacher J, McCrae JS. Coordination challenges and promising practices for pediatric healthcare-community partnerships: A multi-site study. J Community Psychol 2023; 51:2117-2132. [PMID: 36811161 DOI: 10.1002/jcop.23015] [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] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 06/14/2023]
Abstract
There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic-based screen-and-refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources. We conducted semi-structured interviews with healthcare and community partners at two timepoints (n = 65) to investigate start-up and ongoing implementation experiences, including continuing challenges. Results highlighted common within-clinic and clinic-community coordination challenges across diverse settings as well as promising practices supported by the two frameworks. In addition, we identified ongoing implementation challenges that face efforts to integrate these approaches and to translate screening results into activities that help children and families. Assessing the existing service referral coordination infrastructure of each clinic and community in early implementation is critical to screen-and-refer practice as this influences the continuum of supports available to meet family needs.
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Affiliation(s)
- Angeline K Spain
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Jon Korfmacher
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Julie S McCrae
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
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Hill Z, Zafar S, Soremekun S, Sikander S, Avan BI, Roy R, Aziz S, Kumar D, Parveen N, Saleem S, Verma D, Sharma KK, Skordis J, Hafeez A, Rahman A, Kirkwood B, Divan G. Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan. Front Nutr 2023; 10:1152548. [PMID: 37404854 PMCID: PMC10315833 DOI: 10.3389/fnut.2023.1152548] [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: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction There is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation. Methods and materials We collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors. Results Implementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits. Discussion Programs need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility.
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Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Shamsa Zafar
- Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Siham Sikander
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Bilal Iqbal Avan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Reetabrata Roy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Sarmad Aziz
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Nazia Parveen
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shumaila Saleem
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | | | - Jolene Skordis
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Betty Kirkwood
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mbabazi J, Pesu H, Mutumba R, McCray G, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Effect of Milk Protein and Whey Permeate in Large-Quantity Lipid-Based Nutrient Supplement on Early Child Development among Children with Stunting: A Randomized 2 × 2 Factorial Trial in Uganda. Nutrients 2023; 15:2659. [PMID: 37375563 DOI: 10.3390/nu15122659] [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: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Stunting affects 22% children globally, putting them at risk of adverse outcomes including delayed development. We investigated the effect of milk protein (MP) vs. soy and whey permeate (WP) vs. maltodextrin in large-quantity, lipid-based nutrient supplement (LNS), and LNS itself vs. no supplementation, on child development and head circumference among stunted children aged 1-5 years. We conducted a randomized, double-blind, community-based 2 × 2 factorial trial in Uganda (ISRCTN1309319). We randomized 600 children to one of four LNS formulations (~535 kcal/d), with or without MP (n = 299 vs. n = 301) or WP (n = 301 vs. n = 299), for 12 weeks or to no supplementation (n = 150). Child development was assessed using the Malawi Development Assessment Tool. Data were analyzed using linear mixed-effects models. Children had a median [interquartile range] age of 30 [23; 41] months and mean ± standard deviation height-for-age z-score of -3.02 ± 0.74. There were no interactions between MP and WP for any of the outcomes. There was no effect of either MP or WP on any developmental domain. Although LNS itself had no impact on development, it resulted in 0.07 (95%CI: 0.004; 0.14) cm higher head circumference. Neither dairy in LNS, nor LNS in itself, had an effect on development among already stunted children.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Gareth McCray
- School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Christian Ritz
- The National Institute of Public Health, University of Southern Denmark, 5230 Odense, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere University Hospital, 33520 Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
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Kowalski AJ, Mayen VA, de Ponce S, Lambden KB, Tilton N, Villanueva LM, Palacios AM, Reinhart GA, Hurley KM, Black MM. The Effects of Multiple Micronutrient Fortified Beverage and Responsive Caregiving Interventions on Early Childhood Development, Hemoglobin, and Ferritin among Infants in Rural Guatemala. Nutrients 2023; 15:2062. [PMID: 37432191 DOI: 10.3390/nu15092062] [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: 03/20/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
Undernutrition and a lack of learning opportunities can jeopardize long-term growth and development among infants in low- and middle-income countries. We conducted a 6-month 2 × 2 cluster-randomized trial to assess the effects of multiple micronutrient-fortified beverages and responsive caregiving interventions among infants 6-18 months in 72 community sectors in southwest Guatemala. We administered baseline and endline assessments of childhood development (Bayley Scales of Infant and Toddler Development) and socioemotional development (Brief Infant Toddler Socio-Emotional Assessment) and measured ferritin and hemoglobin on a subsample. The trial was analyzed using linear mixed models. At the baseline, the mean age (SD) was 13.0 (4.6) months, including 49% males, 32% who were stunted, 55% who were anemic, and 58% who were iron deficient. At the endline (n = 328/386, 85% retention), there was no synergistic effect on the fortified beverage and responsive caregiving intervention. Compared to the non-fortified beverage group, socioemotional development improved in the fortified beverage group. There were no intervention effects on other measures of child development, hemoglobin, or ferritin. In a setting with high rates of anemia and iron deficiency, a multiple micronutrient-fortified beverage improved infants' socioemotional development.
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Affiliation(s)
- Alysse J Kowalski
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Victor Alfonso Mayen
- Asociación para la Prevención y Estudio del VIH/Sida, Retalhuleu 11001, Guatemala
| | - Silvia de Ponce
- Asociación para la Prevención y Estudio del VIH/Sida, Retalhuleu 11001, Guatemala
| | - Kaley B Lambden
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Nick Tilton
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21202, USA
| | - Lisa M Villanueva
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
| | - Ana M Palacios
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA
| | - Gregory A Reinhart
- The Mathile Institute for the Advancement of Human Nutrition, Dayton, OH 45414, USA
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- RTI International, Research Triangle Park, NC 27709, USA
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10
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Jiang Z, Liang X, Wang Z, Lin Y, Zhang L. Intrusive parenting in early childhood: A review and meta-analysis. Psych J 2023. [PMID: 36894303 DOI: 10.1002/pchj.637] [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: 12/15/2021] [Accepted: 01/31/2023] [Indexed: 03/11/2023]
Abstract
This systematic review and meta-analysis examines similarities and differences in intrusive parenting between mothers and fathers and relations between intrusive parenting and early childhood development. The authors integrated 55 studies and differentiated cognitive skills and socio-emotional problems as developmental outcomes. The present study employs three-level meta-analyses to reliably estimate effect sizes and examine a range of moderators. It finds a moderate effect size of similarities in intrusive parenting within a family (r = 0.256, confidence interval [CI] = [0.180, 0.329]). No significant differences were observed in intrusiveness level between mothers and fathers (g = 0.035, CI = [-0.034, 0.103]). Intrusive parenting had a significant positive association with children's socio-emotional problems (rmother = 0.098, CImother = [0.051, 0.145]; rfather = 0.094, CI father = [0.032, 0.154]) but was not related to cognitive skills. Moderator analyses suggest that East Asian mothers exhibit higher intrusiveness levels than fathers, whereas Western parents display no significant differences. Overall, these results reveal more similarities than differences in intrusive parenting and that culture likely plays a role in shaping gender-specific parenting behaviors.
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Affiliation(s)
- Zixin Jiang
- Research Center for Child Development, Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Xi Liang
- Research Center for Child Development, Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Zhengyan Wang
- Research Center for Child Development, Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Yige Lin
- Research Center for Child Development, Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Linlin Zhang
- Research Center for Child Development, Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
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Mancini VO, Brook J, Hernandez C, Strickland D, Christophersen CT, D'Vaz N, Silva D, Prescott S, Callaghan B, Downs J, Finlay-Jones A. Associations between the human immune system and gut microbiome with neurodevelopment in the first 5 years of life: A systematic scoping review. Dev Psychobiol 2023; 65:e22360. [PMID: 36811373 PMCID: PMC10107682 DOI: 10.1002/dev.22360] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 01/13/2023]
Abstract
The aim of this review was to map the literature assessing associations between maternal or infant immune or gut microbiome biomarkers and child neurodevelopmental outcomes within the first 5 years of life. We conducted a PRISMA-ScR compliant review of peer-reviewed, English-language journal articles. Studies reporting gut microbiome or immune system biomarkers and child neurodevelopmental outcomes prior to 5 years were eligible. Sixty-nine of 23,495 retrieved studies were included. Of these, 18 reported on the maternal immune system, 40 on the infant immune system, and 13 on the infant gut microbiome. No studies examined the maternal microbiome, and only one study examined biomarkers from both the immune system and the gut microbiome. Additionally, only one study included both maternal and infant biomarkers. Neurodevelopmental outcomes were assessed from 6 days to 5 years. Associations between biomarkers and neurodevelopmental outcomes were largely nonsignificant and small in effect size. While the immune system and gut microbiome are thought to have interactive impacts on the developing brain, there remains a paucity of published studies that report biomarkers from both systems and associations with child development outcomes. Heterogeneity of research designs and methodologies may also contribute to inconsistent findings. Future studies should integrate data across biological systems to generate novel insights into the biological underpinnings of early development.
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Affiliation(s)
- Vincent O Mancini
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Juliet Brook
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Christian Hernandez
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Deborah Strickland
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Claus T Christophersen
- WA Human Microbiome Collaboration Centre, School of Molecular and Life Sciences, Curtin University, Bentley, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nina D'Vaz
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Desiree Silva
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan Prescott
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Bridget Callaghan
- Brain and Body Lab, University of California, Los Angeles, Los Angeles, California, USA
| | - Jenny Downs
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Amy Finlay-Jones
- Early Neurodevelopment and Mental Health, Telethon Kids Institute, Nedlands, Western Australia, Australia
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12
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Outhwaite LA. App-based support for parental self-efficacy in the first 1,000 days: A randomized control trial. Front Psychol 2023; 13:998170. [PMID: 36710829 PMCID: PMC9878327 DOI: 10.3389/fpsyg.2022.998170] [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] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Parental self-efficacy is key for guiding parents' interactions with their child and is an important target for early intervention. This study reports a pilot randomized control trial (RCT) of a parenting application (app) with 79 parents of children aged 0-6 months in the United Kingdom. The app includes 1,026 daily age-appropriate activities across eight areas of child development, using resources accessible at home. While controlling for pre-test scores, parents who used the parenting app (Treatment Group) had significantly higher parental self-efficacy, after the 4-week intervention period, compared to the Active Control Group. Partial correlation analyses indicated that higher frequency of self-reported use of the parenting app was associated with greater parental self-efficacy outcomes. This evidence establishes proof of concept that parenting apps can have significant benefits on parental self-efficacy in early childhood. Limitations to the interpretation and generalization of the findings, as well as directions for future research are discussed.
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13
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Bromley J, Sherrard S, Atkinson D, Marley JV, Henderson‐Yates L, Griffiths E. Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting. Aust J Rural Health 2022; 30:860-869. [PMID: 35802805 PMCID: PMC10083997 DOI: 10.1111/ajr.12900] [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] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Supporting Early Childhood Development (ECD) is an Australian national priority. Aboriginal children in Western Australia's Kimberley region have much higher rates of developmental concerns at school entry than non-Aboriginal children. We aimed to describe ECD practices in the participating service; document follow-up of identified developmental concerns; and identify barriers and enablers to incorporating ECD practices into clinic activity. DESIGN Mixed-method design incorporating clinical audit and staff interviews. SETTING An Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region. PARTICIPANTS A total of 176 children receiving primary health care through the participating ACCHS; interviews with five ACCHS staff members. MAIN OUTCOME MEASURES Frequency of developmental enquiry by age and domain; follow-up of identified developmental concerns; and barriers and enablers to ECD practices. RESULTS Developmental enquiry was documented for 114 of 176 eligible children (65%), including in 80% of ACCHS child health assessments. Standardised ECD assessments were less common. Staff were aware of the importance of developmental enquiry, however, barriers to increasing ECD practices included a lack of resources and structured staff education, time pressures and a lack of role clarity between the ACCHS and government community health clinic. CONCLUSIONS This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.
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Affiliation(s)
- Jane Bromley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Stephanie Sherrard
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - David Atkinson
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
| | - Julia V. Marley
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
| | | | - Emma Griffiths
- Rural Clinical School of Western AustraliaThe University of Western AustraliaBroomeWAAustralia
- Kimberley Aboriginal Medical ServicesBroomeWAAustralia
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14
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Turunç G, Kisbu-Sakarya Y. Parents' Attitudes Toward Domestic Violence as a Risk Factor for Early Childhood Development: Testing an Actor-Partner Interdependence Model Using UNICEF MICS. J Interpers Violence 2022; 37:NP21476-NP21501. [PMID: 34865554 DOI: 10.1177/08862605211058212] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: While the importance of domestic violence has been examined in relation to parenting behaviors and child development, less is known about the link between justifying attitudes toward wife beating and parenting, especially in low- and middle-income countries (LMIC). This study employs an actor-partner interdependence mediation model to examine how parents' justifying attitudes toward violence against women relate to their own (actor effects) and their partners' (partner effects) level of parental involvement, which then influence their preschool children's early development. Method: Using data from mothers, fathers, and children in 16,010 families residing in LMIC that participated in UNICEF's Multiple Indicator Cluster Survey Waves 4-5-6 and a dyadic mediation modeling approach, we have examined the associations between maternal and paternal justification of violence against women, parental involvement, and children's early development. Results: Results revealed that mothers' greater justification of violence against themselves were associated with decreased level of maternal (actor effect) and paternal (partner effect) involvement, while fathers' greater justification of violence against their wives was related to decreased paternal involvement (actor effect). Furthermore, mediation tests indicated that paternal justification of violence was negatively and indirectly associated with early childhood development through paternal involvement. Moreover, maternal justification of violence was negatively and indirectly associated with early childhood development through both maternal and paternal involvement. Conclusion: Mothers' and fathers' justifying attitudes toward domestic violence emerge as a possible risk factor for child development that can be addressed by preventive interventions.
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Affiliation(s)
- Gamze Turunç
- Department of Psychology, 52979Koç University, Istanbul, Turkey
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15
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Brittain K, Zerbe A, Phillips TK, Gomba Y, Mellins CA, Myer L, Abrams EJ. Impact of adverse childhood experiences on women's psychosocial and HIV-related outcomes and early child development in their offspring. Glob Public Health 2022; 17:2779-2791. [PMID: 34613893 PMCID: PMC8983791 DOI: 10.1080/17441692.2021.1986735] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
Adverse childhood experiences (ACEs) may have a critical influence on adult outcomes and subsequent offspring development, but few data have explored the effects of ACEs in low-resource settings where the burdens of childhood adversity and HIV are high. Among mothers living with HIV in Cape Town, we examined the effects of ACEs on maternal psychosocial and HIV-related outcomes, as well as early child development in their offspring aged 36-60 months. The World Health Organization's Adverse Childhood Experiences International Questionnaire was used to measure maternal reports of ACEs, and the Ages & Stages Questionnaire to screen for developmental delays in their offspring. Among 353 women (median age: 32 years), 84% reported ≥1 ACEs. Increased report of ACEs was strongly associated with depressive symptoms, hazardous alcohol use, intimate partner violence and self-reported suboptimal adherence to antiretroviral therapy. These associations were driven by more severe childhood experiences, including abuse, neglect and exposure to collective violence. Among 255 women who reported on their child's development, maternal ACEs were associated with poorer socioemotional development. These data suggest that childhood adversity has long-term effects on maternal outcomes as well as their children's socioemotional development and point to ACEs that might be targeted for screening and intervention.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Tamsin K. Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Yolanda Gomba
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
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16
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Kasambala M, Mduluza T, Vengesai A, Mduluza-Jokonya T, Jokonya L, Midzi H, Makota RB, Mutemeri A, Maziti E, Dube-Marimbe B, Chibanda D, Mutapi F, Mukaratirwa S. Effect of Schistosoma haematobium infection on the cognitive functions of preschool age children and benefits of treatment from an endemic area in Zimbabwe. BMC Infect Dis 2022; 22:809. [PMID: 36316647 PMCID: PMC9620666 DOI: 10.1186/s12879-022-07784-7] [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: 06/01/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Schistosomiasis is known to affect the cognitive functions of children, however, but there is paucity of information on its impact on early childhood development in developing countries where the disease is endemic. This study aimed at determining the effects of schistosomiasis due to Schistosoma haematobium on early childhood development in children below 5 years old from Murewa District, Zimbabwe, including the benefits of treatment. Methods Preschool age children (PSAC) under the age of 5 years were screened at baseline and at 6 months post-treatment for S. haematobium infections diagnosed using the urine filtration method. Cognitive domains were assessed using the Griffith Mental Developmental Scales III on 136 PSAC. Multivariate logistic regression was used to determine the level of association between S. haematobium infection and performance in the cognitive domains adjusting for confounding factors (i.e. nutrition, hemoglobin levels, gender and age). Median Development Quotient scores of each cognitive domain at baseline and at 6 months post-treatment were compared and quantified. Results After adjusting for confounding factors, PSAC infected with S. haematobium had greater odds of having lower scores in the Foundation of Learning Domain (OR = 3.9, p = 0.008), Language and Communication Domain (OR = 3.2, p = 0.017), Eye-Hand Coordination Domains (OR = 10.7, p = 0.001), Personal-Social-Emotional Domain (19.3, p = 0.001) and in the Overall General Development Domain (7.2, p = 0.011). Improvement of cognitive performance was observed at 6 months post treatment in the following Domains; Language and Communication Domain (p = 0.003), Eye-Hand Coordination Domain (p = 0.02) and General Development Domain (p = 0.006). Conclusion The study showed that S. haematobium infection in PSAC is associated with lower cognitive scores in the Foundation of Learning, Language and Communication, Eye-Hand Coordination, Personal-Social-Emotional and in the Overall General Development domains. Our results strengthen the call for inclusion of PSAC in routine deworming programs for the control of urinary schistosomiasis and the need to develop locally validated tools to monitor early child development in endemic areas where resources are limited.
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Affiliation(s)
- Maritha Kasambala
- grid.16463.360000 0001 0723 4123School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa ,grid.13001.330000 0004 0572 0760Department of Biological Sciences and Ecology, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Takafira Mduluza
- grid.13001.330000 0004 0572 0760Department of Biotechnology and Biochemistry, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe ,grid.16463.360000 0001 0723 4123School of Medicine and Medical Sciences, University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa
| | - Arthur Vengesai
- grid.13001.330000 0004 0572 0760Department of Biotechnology and Biochemistry, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe ,grid.442709.c0000 0000 9894 9740Department of Biochemistry, Faculty of Medicine, Midlands State University, Senga Road, Gweru, Zimbabwe
| | - Tariro Mduluza-Jokonya
- grid.13001.330000 0004 0572 0760Department of Biotechnology and Biochemistry, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Luxwell Jokonya
- grid.13001.330000 0004 0572 0760Department of Surgery, College of Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Herald Midzi
- grid.13001.330000 0004 0572 0760Department of Biotechnology and Biochemistry, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Rutendo Birri Makota
- grid.13001.330000 0004 0572 0760Department of Biological Sciences and Ecology, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Arnold Mutemeri
- grid.13001.330000 0004 0572 0760Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Emmanuel Maziti
- grid.13001.330000 0004 0572 0760Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Bazondlile Dube-Marimbe
- grid.13001.330000 0004 0572 0760Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Dixon Chibanda
- grid.13001.330000 0004 0572 0760Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Mt Pleasant, P.O. Box MP 167, Harare, Zimbabwe
| | - Francisca Mutapi
- grid.4305.20000 0004 1936 7988Institute for Immunology and Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Charlotte Auerbach Rd, EH9 3JT Edinburgh, UK
| | - Samson Mukaratirwa
- grid.16463.360000 0001 0723 4123School of Life Sciences, University of KwaZulu-Natal, KwaZulu-Natal, Durban, South Africa ,grid.412247.60000 0004 1776 0209One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, West Indies Saint Kitts And Nevis
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McIsaac JD, Lamptey D, Harley J, MacQuarrie M, Cummings R, Rossiter MD, Janus M, Turner J. Early pandemic impacts on family environments that shape childhood development and health: A Canadian study. Child Care Health Dev 2022; 48:1122-1133. [PMID: 35997511 PMCID: PMC9539253 DOI: 10.1111/cch.13046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/06/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Changes to income and employment are key social determinants of health that have impacted many families during the COVID-19 pandemic. This research aimed to understand how changes to employment and income influenced family environments that contribute to early childhood development and health. METHODS A concurrent triangulation mixed method design was used through a cross-sectional survey on early impacts of the COVID-19 pandemic involving families with young children in the Canadian Maritime provinces (n = 2158). Analyses included multivariate regression models to examine whether changes to employment and income predicted changes to Family access to resources and social support, parenting Abilities and self-care at home, and home Routines and Environments (FARE Change Scale). Content analysis was used to identify themes from the open-ended questions. RESULTS Changes to employment and income early in the pandemic like no longer working but continued to receive salary, working fewer hours for the same salary earned before the pandemic, no longer working nor receiving salary, working fewer hours resulting in salary reduction, essential worker status and household income were significant predictors of FARE Change Scale when ethnicity/cultural background and province of residence are controlled (P < .05). Themes provided a description of family impacts, including shifting employment and income, finding time and capacity, feelings of guilt and the creation of new routines. CONCLUSION Our study provides insight on the implications of public health restrictions, such as the importance of increased time for parents (through reduced work hours) and access to resources and social support to support child development and health.
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Affiliation(s)
- Jessie‐Lee D. McIsaac
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada,Faculty of EducationMount Saint Vincent UniversityHalifaxCanada,Department of Child and Youth StudyMount Saint Vincent UniversityHalifaxCanada
| | - De‐Lawrence Lamptey
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada,School of Health and Policy ManagementYork UniversityTorontoCanada
| | - Jane Harley
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada
| | - Madison MacQuarrie
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada
| | - Randi Cummings
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada
| | | | - Magdalena Janus
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
| | - Joan Turner
- Early Childhood Collaborative Research CentreMount Saint Vincent UniversityHalifaxCanada,Department of Child and Youth StudyMount Saint Vincent UniversityHalifaxCanada
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Godoy PBG, Shephard E, Argeu A, Silveira LR, Salomone E, Aldred C, Green J, Polanczyk GV, Matijasevich A. Social communication therapy for children at risk for neurodevelopmental difficulties: Protocol for a clinical trial. Ann N Y Acad Sci 2022; 1514:104-115. [PMID: 35506888 DOI: 10.1111/nyas.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Exposure to adverse environments are risk factors for neurodevelopmental problems in childhood. Children exposed to such environments may benefit from interventions that target social communication abilities, since these are protective factors for healthy neurodevelopment. This randomized controlled trial will test the efficacy of Paediatric Autism Communication Therapy (PACT) in improving social communication development in young children at risk for neurodevelopmental difficulties living in poverty in Brazil. Participants will be 160 children aged 2-4 years with lower-than-average social communication abilities and their primary caregivers. Child-caregiver dyads will be recruited from public childhood education centers in impoverished urban regions of the city of São Paulo, Brazil. Lower-than-average social communication abilities will be defined by standard scores (≤84) on the socialization and/or communication domains of the Vineland Adaptive Behavior Scales. Child-caregiver dyads will be randomized to receive 12 sessions of the PACT intervention (n = 80) or 5 months of community support as usual plus psychoeducation (n = 80). The primary outcome (parent-child interaction) and secondary outcomes (parent-reported social communication abilities and neurophysiological activity during a live social interaction) will be measured pre- and postintervention. This study may lead to new interventions for vulnerable young children in Brazil and better understanding of the neural mechanisms of PACT.
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Affiliation(s)
- Priscilla B G Godoy
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Shephard
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Adriana Argeu
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Leticia R Silveira
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Erica Salomone
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Catherine Aldred
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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19
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Bowe AK, Hourihane J, Staines A, Murray DM. The predictive value of the ages and stages questionnaire in late infancy for low average cognitive ability at age 5. Acta Paediatr 2022; 111:1194-1200. [PMID: 35202483 PMCID: PMC9314849 DOI: 10.1111/apa.16309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
Aim This retrospective, longitudinal study examined the predictive value of the ages and stages questionnaire (ASQ) in late infancy for identifying children who progressed to have low cognitive ability at 5 years of age. Methods The ASQ was performed on 755 participants from the Irish BASELINE birth cohort at 24 or 27 months of age. Intelligence quotient was measured at age 5 with the Kaufmann Brief Intelligence Test, Second Edition, and low cognitive ability was defined as a score more than 1 standard deviation below the mean. The ASQ’s predictive value was examined, together with other factors associated with low cognitive ability at 5 years. Results When the ASQ was performed at 24 or 27 months, the overall sensitivity for identifying low cognitive ability at 5 years was 20.8% and the specificity was 91.1%. Using a total score cut‐off point increased the sensitivity to 46.6% and 71.4% at 24 and 27 months, but specificity fell to 74.1% and 67.2%, respectively. After adjusting for ASQ performance, maternal education and family income were strongly associated with cognitive outcomes at 5 years. Conclusion The ASQ did not detect the majority of children with low cognitive ability at age 5. Alternative methods need investigation.
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Affiliation(s)
- Andrea K. Bowe
- INFANT Research Centre, Paediatric Academic Unit Cork University Hospital Cork Ireland
- Department of Paediatrics, School of Medicine University College Cork Cork Ireland
| | - Jonathan Hourihane
- INFANT Research Centre, Paediatric Academic Unit Cork University Hospital Cork Ireland
- Paediatrics Royal College of Surgeons in Ireland Dublin Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy and Community Health Dublin City University Dublin Ireland
| | - Deirdre M. Murray
- INFANT Research Centre, Paediatric Academic Unit Cork University Hospital Cork Ireland
- Department of Paediatrics, School of Medicine University College Cork Cork Ireland
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20
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Abstract
Research on paternal investment and child growth and development is limited outside of high-income countries. Using nationally representative data from low-resource Serbian Roma communities, this study examined father investment (direct care), its predictors and the associations between paternal investment, stepfather presence and child physical growth and early development. The sample included 1222 children aged 35-59 months, out of which 235 were living with biological fathers. Child outcomes included height-for-age Z-scores, stunting and early child developmental score. Roma paternal investment was relatively low. There was a positive association of father investment and children's height, and no association with developmental score. The presence of father vs. stepfather did not exert any influence on children. Instead, maternal and child characteristics explained both the overall development and height for Roma children. Thus, older children, born to literate, lower parity mothers of higher status and greater investment had better developmental and growth outcomes; girls were the preferred sex, owing to expected fitness benefits. Reverse causality emerged as the most likely pathway through which the cross-sectional association of father direct care with child growth may manifest, such that Roma fathers tend to bias their investment towards taller, more endowed children, because of greater fitness pay-off.
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Affiliation(s)
- Jelena Čvorović
- Institute of Ethnography, Serbian Academy of Sciences and Arts, Kneza Mihaila 36, Belgrade, Serbia
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21
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Arshanapally S, Green K, Slaughter K, Muller R, Wheaton D. Use of a Paid Digital Marketing Campaign to Promote a Mobile Health App to Encourage Parent-Engaged Developmental Monitoring: Implementation Study. JMIR Pediatr Parent 2022; 5:e34425. [PMID: 35380545 PMCID: PMC9019642 DOI: 10.2196/34425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The internet has become an increasingly popular medium for parents to obtain health information. More studies investigating the impact of paid digital marketing campaigns for parents on promoting children's healthy development are needed. OBJECTIVE This study aims to explore the outcomes of a paid digital marketing campaign, which occurred from 2018 to 2020, to promote messages about parent-engaged developmental monitoring and ultimately direct parents to the Centers for Disease Control and Prevention's (CDC's) Milestone Tracker app, a mobile health (mHealth) app developed by the CDC. METHODS The paid digital marketing campaign occurred in 3 phases from 2018 to 2020. In each phase, 24 to 36 marketing messages, in English and Spanish, were created and disseminated using Google's Universal App Campaigns and Facebook Ads Manager. Outcomes were measured using impressions, clicks, and install data. Return on investment was measured using click-through rate (CTR), cost per click, and cost per install metrics. RESULTS The Google-driven marketing messages garnered a total of 4,879,722 impressions (n=1,991,250, 40.81% for English and n=2,888,472, 59.19% for Spanish). The messages resulted in a total of 73,956 clicks (n=44,328, 59.94% for English and n=29,628, 40.06% for Spanish), with a total average CTR of 1.52% (2.22% for English and 1.03% for Spanish). From these clicks, there were 13,707 installs (n=9765, 71.24% for English and n=3942, 28.76% for Spanish) of the CDC's Milestone Tracker app on Google Play Store. The total average cost per install was US $0.93 across all phases. The phase 3 headline "Track your child's development" generated the highest CTR of 3.23% for both English and Spanish audiences. The Facebook-driven marketing messages garnered 2,434,320 impressions (n=1,612,934, 66.26% for English and n=821,386, 33.74% for Spanish). The messages resulted in 44,698 clicks (n=33,353, 74.62% for English and n=11,345, 25.38% for Spanish), with an average CTR of 1.84% (2.07% for English and 1.38% for Spanish). In all 3 phases, animated graphics generated the greatest number of clicks among both English and Spanish audiences on Facebook when compared with other types of images. CONCLUSIONS These paid digital marketing campaigns can increase targeted message exposure about parent-engaged developmental monitoring and direct a parent audience to an mHealth app. Digital marketing platforms provide helpful metrics that can be used to assess the reach, engagement, and cost-effectiveness of this effort. The results from this study suggest that paid digital marketing can be an effective strategy and can inform future digital marketing activities to promote mHealth apps targeting parents of young children.
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Affiliation(s)
- Suraj Arshanapally
- Oak Ridge Institute of Science and Education, Atlanta, GA, United States.,National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Katie Green
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Karnesha Slaughter
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
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22
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Čvorović J. Maternal age at marriage and child nutritional status and development: evidence from Serbian Roma communities. Public Health Nutr 2022; 25:1-34. [PMID: 35260202 PMCID: PMC9991790 DOI: 10.1017/s1368980022000544] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/12/2021] [Accepted: 03/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children. DESIGN Roma nationally representative population-based study. Proxies for child nutritional outcomes included children's individual-level height-for-age z (HAZ) and weight-for-age z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO's reference population (children aged 0-59 months), and Early Child Development (children aged 36-59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes, and other sociodemographic determinants as possible confounders. SETTING Aggregated data from UNICEF's fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements. SUBJECTS Children (n= 2652) aged 0-59 months born to ever-married women aged 15-48. RESULTS 64% of women married before age 18, 19% of children were stunted, 9% wasted, and Early Child Development score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0-24) emerged as the main predictor of children's nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child's age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes. CONCLUSIONS Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children's wellbeing include improved sanitation, child characteristics, maternal literacy and reproductive behavior, and parental investment.
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Affiliation(s)
- Jelena Čvorović
- Institute of Ethnography, Serbian Academy of Sciences and Arts, Belgrade,
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23
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Jeong J, Bliznashka L, Ahun MN, Karuskina-Drivdale S, Picolo M, Lalwani T, Pinto J, Frey M, Velthauz D, Donco R, Yousafzai AK. A pilot to promote early child development within health systems in Mozambique: a qualitative evaluation. Ann N Y Acad Sci 2022; 1509:161-183. [PMID: 34859451 PMCID: PMC8978755 DOI: 10.1111/nyas.14718] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Health systems offer unique opportunities for integrating services to promote early child development (ECD). However, there is limited knowledge about the implementation experiences of using health services to target nurturing care and ECD, especially in sub-Saharan Africa. We conducted a qualitative implementation evaluation to assess the delivery, acceptability, perceived changes, and barriers and facilitators associated with a pilot strategy that integrated developmental monitoring, nutritional screening, and early learning and nutrition counseling into the existing health facility, and community-based services for young children in rural Mozambique. We completed individual interviews with caregivers (N = 36), providers (N = 27), and district stakeholders (N = 10), and nine facility observational visits at three primary health facilities in October-November 2020. We analyzed data using thematic content analysis. Results supported fidelity to the intended pilot model and acceptability of nurturing care services. Respondents expressed various program benefits, including strengthened health system capacity and improved knowledge, attitudes, and practices regarding nurturing care and ECD. Government leadership and supportive supervision were key facilitators, whereas health system resource constraints were key barriers. We conclude that health systems are promising platforms for supporting ECD and discuss several programmatic recommendations for enhancing service delivery and maximizing potential impacts on nurturing care and ECD outcomes.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marilyn N. Ahun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | | | | | | | | | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
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24
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Hammond B, Pressman AW, Quinn C, Benjamin M, Luesse HB, Mogilner L. Evaluating the Keystones of Development - An Online Curriculum for Residents to Promote Positive Parenting in Primary Care. Acad Pediatr 2022; 22:151-159. [PMID: 34129925 DOI: 10.1016/j.acap.2021.06.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents' knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. METHODS We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. RESULTS The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. CONCLUSIONS In this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.
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Affiliation(s)
- Blair Hammond
- Mount Sinai Parenting Center (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY.
| | - Aliza W Pressman
- Mount Sinai Parenting Center (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY
| | - Carrie Quinn
- Mount Sinai Parenting Center (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY
| | - Mariel Benjamin
- Mount Sinai Parenting Center (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY
| | | | - Leora Mogilner
- Mount Sinai Parenting Center (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai (B Hammond, AW Pressman, C Quinn, M Benjamin, L Mogilner), New York, NY
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25
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Zhang Y, Kang L, Zhao J, Song PY, Jiang PF, Lu C. Assessing the Inequality of Early Child Development in China - A Population-Based Study. Lancet Reg Health West Pac 2021; 14:100221. [PMID: 34671753 PMCID: PMC8484893 DOI: 10.1016/j.lanwpc.2021.100221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
Background As a country with the second largest child population in the world, China has little population-level evidence on who has been left behind in early childhood development (ECD). Knowledge of inequalities in ECD will inform the Chinese government in policies on promoting ECD and guide global-level monitoring on ECD progress. Methods Using data from the first wave of ECD surveys conducted in China at the least-developed region, most-developed region, and a megacity (Shanghai) in 2017 and 2018, we measured population-level ECD with early Human Capability Index for a total of 63,559 children aged 36-59 months old. A child was classified as developmentally on track if his/her overall development score was above the 20th percentile of the pooled populations. We measured inequalities in ECD with the absolute inequality in five domains: gender/sex, family income, maternal schooling, residential Hukou, and migrant- or left-behind status. Besides observed inequalities, we used a multilevel logistic regression model to generate adjusted inequalities. Findings Children developmentally on track ranges from 71% (95% CI 70 to 72%) in the least-developed region, 82% (95% CI 81 to 83%) in the most-developed region, and 86% (95% CI 85 to 87%) in Shanghai. Significant unadjusted inequalities in ECD were observed in all five dimensions. After controlling for other socioeconomic factors, significant differences remained in three dimensions: those living in the poorest families, or with lower maternal schooling, or boys were less likely to be developmentally on track than their counterparts (lower by 10[95% CI 8 to 11]-15[95% CI 13 to 17], 7[95% CI 5 to 10]-10[95% CI 7 to 12], and 5[95% CI 4 to 6]-6[95% CI 5 to 8] percentage points respectively). Interpretation Efforts of reducing ECD inequalities in China shall focus primarily on reducing poverty and improving maternal education. Funding National Natural Science Foundation of China (81773443), Shanghai Committee of Science and Technology (2018SHZDZX05), Shanghai Municipal Health Commission (GWV-10.1-XK07; GDEK201708), Shanghai Education Committee, Chinese Social Science Foundation (BFA140046), Macao Tong Chai Charity Association, Beijing Sany Charitable Foundation, China Medical Board (#20-388), UNICEF, Faculty Grant of Brigham & Women's Hospital, Economic and Social Research Council [grant reference number ES/T003936/1’] as a UKRI Collective Fund Award “UKRI GCRF Harnessing the Power of Global Data to Support Young Children's Learning and Development Collaborative."
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Affiliation(s)
- Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, affiliated to School of Medicine Shanghai Jiao Tong University.,School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Le Kang
- China Institute for Educational Finance Research, Peking University
| | - Jin Zhao
- Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, affiliated to School of Medicine Shanghai Jiao Tong University
| | | | - Prof Fan Jiang
- Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, affiliated to School of Medicine Shanghai Jiao Tong University.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, affiliated to School of Medicine Shanghai Jiao Tong University
| | - Chunling Lu
- Division of Global Health Equity, Brigham & Women's Hospital and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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26
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Sullivan JA, Zvara BJ, Keim SA, Andridge R, Anderson SE. Knowledge of Infant Development and Parent Well-Being: Cross-Sectional Analysis of Toddlers. J Dev Behav Pediatr 2021; 42:442-449. [PMID: 34397572 PMCID: PMC8371675 DOI: 10.1097/dbp.0000000000000918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/01/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge about child development is associated with parenting and children's outcomes. Parents with less accurate knowledge about developmental milestones may have unrealistic expectations for their child's behavior, which may affect parent well-being. Limited research has examined this topic relative to depression, but other aspects of parent well-being (e.g., parenting stress) are unexplored. METHODS Cross-sectional analysis of an ongoing prospective cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation.) Primary caregivers (93% mothers) completed the 20-item Knowledge of Infant Development Index (KIDI) and questionnaires for child temperament and 3 aspects of parent well-being (depressive and anxious symptoms, parenting stress, and general health). Covariate-adjusted regression models assessed relationships between the KIDI score and each well-being outcome. We hypothesized that parents with less knowledge would have more symptoms of depression and anxiety, greater parenting stress, and poorer health. Whether associations were stronger for parents of children born preterm or who had high negative affect was explored. RESULTS Knowledge of Infant Development Index scores were associated with sociodemographic characteristics, child temperament, and gestational age (more knowledge: higher socioeconomic position, less child negative affect, and full-term birth). KIDI scores did not predict any aspect of parent well-being, and there was no evidence that child temperament or preterm birth altered these findings. CONCLUSION In this sample of parents of toddlers assessed in 2018/19, greater knowledge of infant development was not associated with parent well-being.
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Affiliation(s)
- Jacqueline A. Sullivan
- The Research Institute, Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Bharathi J. Zvara
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A. Keim
- The Research Institute, Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Sarah E. Anderson
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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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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Kuhn L, Liu C, Wang T, Luo R. Home Environment and Early Development of Rural Children: Evidence from Guizhou Province in China. Int J Environ Res Public Health 2021; 18:6121. [PMID: 34204071 DOI: 10.3390/ijerph18116121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/11/2023]
Abstract
Delays in early child development are among the aspects underlying the persistent developmental gaps between regions and social strata. This study seeks to examine the relationship between the home environment and early child development in less-developed rural areas by drawing on data from 445 children from villages in Guizhou province in southwest China. A demographic questionnaire, the Home Observation Measurement of the Environment (HOME), and the Bayley Scales of Infant Development, version III (BSID-III), were used to measure the child’s demographic characteristics, home environment, and early development outcomes, respectively. Our data show that the sample children suffer a delay in various dimensions of child development and a deficit in the HOME scale. The results from a hierarchical regression model suggest that the availability of learning material at home, caregivers’ responsiveness and organization sub-scales are significantly positively correlated with the early development of sample children, after controlling for general socioeconomic status, health, and nutrition, and this correlation differs by gender. These results imply that the provision of learning material to households, promoting caregivers’ responsiveness and organization in less-developed rural areas could improve early child development among deprived children.
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Pedroso J, Herkrath FJ, Buccini G, Venancio SI, Pérez-Escamilla R, Gubert MB. Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil. Food Nutr Bull 2021; 42:77-90. [PMID: 33878902 DOI: 10.1177/0379572120987815] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal early child development (ECD) is fundamental for every child to achieve their developmental potential and thrive. Household food insecurity (HFI) is a risk factor for suboptimal development, but there is still a need to better understand the pathways that explain this relationship. OBJECTIVE To evaluate whether maternal mental health and infant's diet mediate the association between HFI and ECD using structural equation modeling. METHODS Cross-sectional study with 474 mother-infant dyads. Mothers answered a questionnaire that evaluated variables through validated instruments. Structural equation modeling analyses were conducted to obtain standardized effects (β) and bias-corrected 95% CI, enabling comparisons between the magnitude of the effects. The following observed variables were included: HFI, ECD, consumption of a healthy and diverse diet, the presence of a partner in the household, wanted pregnancy, and current breastfeeding. Latent variables were included to evaluate mental health, poverty, and neonatal health. RESULTS Poor maternal mental health mediated the relationship between HFI and ECD (β = -.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower development scores directly (β = .21) and indirectly (β = .02). Not having a partner (β = .05) and having an unwanted pregnancy (β = .02) predicted indirectly lower development scores. CONCLUSIONS Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood, and unwanted pregnancy through different pathways. Therefore, public policies and interventions that aim to promote an optimal ECD should also approach these aspects.
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Affiliation(s)
- Jéssica Pedroso
- 28127University of Brasilia, Brasilia, Distrito Federal, Brazil
| | | | - Gabriela Buccini
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, USA
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Buccini G, Venancio SI, Pérez-Escamilla R. Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis. Ann N Y Acad Sci 2021; 1497:57-73. [PMID: 33738809 DOI: 10.1111/nyas.14589] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/31/2020] [Revised: 12/31/2020] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
To address inequities that prevent socioeconomically vulnerable young children from reaching their full developmental potential, Brazil implemented Programa Criança Feliz (PCF) ("Happy Child" early childhood development program) in 2934 of its 5570 municipalities. A qualitative case study was carried out on the basis of in-depth interviews with 22 key informants, employing purposive sampling, from past or current national and state coordination teams. Thematic analysis followed the RE-AIM framework, and complex adaptive system constructs mapped how barriers and enablers influenced scale-up. One overarching theme related to PCF emergence, and 18 subthemes were identified within the RE-AIM. An enabling national political environment favored PCF emergence through a top-down approach that led to governance challenges. Changes in the enrollment criteria for families facilitated reach, and evidence-based methodology favored the designing of the home visits. However, operationalizing the intersectoral actions remains a barrier for effectiveness, while intrasectoral resistance across levels delayed adoption. WhatsApp facilitated networking, capacity building, and adoption. Rushed scale-up generated barriers for quality delivery and led to different implementation pathways across municipalities. Legal institutionalization is critical to assure permanent funding and maintenance. PCF has enhanced early childhood services in Brazil, but strong negative feedback loops need to be addressed for effective sustainability.
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Affiliation(s)
- Gabriela Buccini
- Department of Environmental and Occupational Health, University of Nevada Las Vegas School of Public Health, Las Vegas, Nevada
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Schiariti V, Simeonsson RJ, Hall K. Promoting Developmental Potential in Early Childhood: A Global Framework for Health and Education. Int J Environ Res Public Health 2021; 18:ijerph18042007. [PMID: 33669588 PMCID: PMC7923196 DOI: 10.3390/ijerph18042007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023]
Abstract
In the early years of life, children’s interactions with the physical and social environment- including families, schools and communities—play a defining role in developmental trajectories with long-term implications for their health, well-being and earning potential as they become adults. Importantly, failing to reach their developmental potential contributes to global cycles of poverty, inequality, and social exclusion. Guided by a rights-based approach, this narrative review synthesizes selected studies and global initiatives promoting early child development and proposes a universal intervention framework of child-environment interactions to optimize children’s developmental functioning and trajectories.
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Affiliation(s)
- Verónica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Rune J Simeonsson
- School Psychology Program, School of Education, University of North Carolina, Chapel Hill, NC 27599, USA
- School of Education and Communication, Jönköping University, SE-551 11 Jönköping, Sweden
| | - Karen Hall
- School Psychology Program, School of Education, University of North Carolina, Chapel Hill, NC 27599, USA
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Alderman H, Friedman J, Ganga P, Kak M, Rubio-Codina M. Assessing the performance of the Caregiver Reported Early Development Instruments (CREDI) in rural India. Ann N Y Acad Sci 2020; 1492:58-72. [PMID: 33378099 PMCID: PMC8246540 DOI: 10.1111/nyas.14543] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022]
Abstract
Although many education and health programs aim to improve early childhood development, it is challenging to assess developmental levels of infants and small children through large household surveys. The Caregiver Reported Early Development Instruments (CREDI) has been proposed as an adaptable, practical, and low‐cost instrument for measuring the developmental status of children under 3 years of age at scale, as it is relatively short and collected by caregiver report. This study employed the CREDI to measure the development of a sample of 994 children ages 22–35 months in rural India and compared the results to those obtained using the Bayley Scales of Infant and Toddler Development (Bayley‐III), a reliable and widely used instrument, albeit one not always suited to large‐scale data collection efforts given its length, cost, and complexity of administration. The CREDI validation exercise showed that caregivers can provide assessments in keeping with the more interactive (hence more time‐consuming and training‐intensive) Bayley‐III instrument. Noteworthy, there was no indication that concordance of the instruments differed by education of the caregiver. This is important as it points to alternate feasible tools to measure child development outcomes through large‐scale surveys.
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Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC
| | | | - Paula Ganga
- Department of Political Science, Columbia University, New York, New York
| | - Mohini Kak
- World Bank, South Asia Health, Washington, DC
| | - Marta Rubio-Codina
- Inter-American Development Bank, Social Protection and Health, Washington, DC
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Römer P, Mathes B, Reinelt T, Stoyanova P, Petermann F, Zierul C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr 2020; 109:2491-2501. [PMID: 32603488 DOI: 10.1111/apa.15453] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
AIM We systematically reviewed the literature on the influence of low and moderate amounts of prenatal alcohol and nicotine exposure on early child development. This paper also suggests possible directions for future research in order to tackle the controversial findings identified. METHODS The PubMed and Web of Science electronic databases were searched together with the reference lists of the selected papers. Empirical studies were included if they focused on the effects of low or moderate exposure, reported outcomes on child development within the first 2 years of life and were published in English between January 2009 and December 2019. The eligibility of the included studies was based on three authors reading the full text. RESULTS The final sample comprised 17 papers. Of these, 13 focused on the effects of prenatal alcohol exposure and they reported decreased sensory sensibility, smaller body sizes and increased cognitive capacities. The other four looked at prenatal nicotine exposure, and they primarily found impairments in children's orienting, communication and motor skills. CONCLUSION Any amount of prenatal alcohol and nicotine exposure appeared to risk healthy child development. There were many reasons for consumption and numerous effects on the child, but representative data from interdisciplinary research were missing.
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Affiliation(s)
- Pia Römer
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Birgit Mathes
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Tilman Reinelt
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Polina Stoyanova
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Franz Petermann
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
| | - Claudia Zierul
- Centre for Clinical Psychology and Rehabilitation University of Bremen Bremen Germany
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Roseboom TJ, Ozanne SE, Godfrey KM, Isasi CR, Itoh H, Simmons R, Bansal A, Barker M, Plosch T, Sloboda DM, Matthews SG, Fall CHD, Poston L, Hanson MA. Unheard, unseen and unprotected: DOHaD council's call for action to protect the younger generation from the long-term effects of COVID-19. J Dev Orig Health Dis 2021; 12:3-5. [PMID: 32962780 DOI: 10.1017/S2040174420000847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Building on the successes of child survival, we review the evidence needed to ensure both that children who survive also thrive and that recommendations promote equity, with no child left behind. To illustrate the critical roles played by nutrition and child development, we revise the Conceptual Framework for the Causes of Malnutrition and Death and the Nurturing Care Framework to create the Conceptual Framework of All Children Surviving and Thriving. The revised framework highlights the goals of child growth and development, supported by health, nutrition, learning, responsive caregiving, and security and safety. We review the challenges posed by undernutrition, stunting, micronutrient deficiencies, overweight, and children not reaching their developmental potential. Although integrated nutrition-childhood development interventions have shown promising effects, most have not been implemented at scale. Implementation science that investigates how and why integrated interventions work in real life, along with the acceptability, feasibility, cost, coverage, and sustainability of the interventions, is needed to ensure equity for all children thriving.
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Affiliation(s)
- Maureen M Black
- RTI International, Research Triangle Park, North Carolina 27709, USA.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA;
| | - Angela C B Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA;
| | - Chessa K Lutter
- RTI International, Research Triangle Park, North Carolina 27709, USA.,Department of Family Science, University of Maryland School of Public Health, College Park, Maryland 20742, USA
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French B, Outhwaite LA, Langley-Evans SC, Pitchford NJ. Nutrition, growth, and other factors associated with early cognitive and motor development in Sub-Saharan Africa: a scoping review. J Hum Nutr Diet 2020; 33:644-669. [PMID: 32734599 DOI: 10.1111/jhn.12795] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Food insecurity, poverty and exposure to infectious disease are well-established drivers of malnutrition in children in Sub-Saharan Africa. Early development of cognitive and motor skills - the foundations for learning - may also be compromised by the same or additional factors that restrict physical growth. However, little is known about factors associated with early child development in this region, which limits the scope to intervene effectively. To address this knowledge gap, we compared studies that have examined factors associated with early cognitive and/or motor development within this population. METHODS Predetermined criteria were used to examine four publication databases (PsycInfo, Embase, Web of Science and Medline) and identify studies considering the determinants of cognitive and motor development in children aged 0-8 years in Sub-Saharan Africa. RESULTS In total, 51 quantitative studies met the inclusion criteria, reporting on 30% of countries across the region. Within these papers, factors associated with early child development were grouped into five themes: Nutrition, Growth and Anthropometry, Maternal Health, Malaria and HIV, and Household. Food security and dietary diversity were associated with positive developmental outcomes, whereas exposure to HIV, malaria, poor maternal mental health, poor sanitation, maternal alcohol abuse and stunting were indicators of poor cognitive and motor development. DISCUSSION In this synthesis of research findings obtained across Sub-Saharan Africa, factors that restrict physical growth are also shown to hinder the development of early cognitive and motor skills, although additional factors also influence early developmental outcomes. The study also reviews the methodological limitations of conducting research using Western methods in sub-Saharan Africa.
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Affiliation(s)
- B French
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - L A Outhwaite
- Centre for Education Policy & Equalising Opportunities, Institute of Education, University College London, London, UK.,School of Psychology, University of Nottingham, Nottingham, UK
| | | | - N J Pitchford
- School of Psychology, University of Nottingham, Nottingham, UK
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Zhong J, Kuhn L, Wang T, Liu C, Luo R. The Interrelationships between Parental Migration, Home Environment, and Early Child Development in Rural China: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:ijerph17113862. [PMID: 32485934 PMCID: PMC7312289 DOI: 10.3390/ijerph17113862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/15/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/19/2023]
Abstract
A growing body of literature is providing evidence of a negative association between parental migration and child development. Meanwhile, the chain of relationships between parental migration, home environment, and early child development has not yet been well documented in China. This paper investigates the interrelationships between parental migration, home environment, and early child development in an undeveloped area of western rural China. In total, 444 households were included in the study. Bayley Scales of Infant Development version III (BSID-III), Home Observation Measurement of the Environment (HOME), and a socioeconomic questionnaire, were used to measure children’s development outcomes, home environment, and socioeconomic characteristics in sample households. A mediation effect model was used to estimate the interrelationships between parental migration, home environment, and child development. The results demonstrate that home environment works as a significant mediator, through which parental migration is associated with a 0.07 standard deviation (SD), 0.13 SD, 0.12 SD, and 0.10 SD decline in the child’s cognitive, language, motor, and social-emotional scores, respectively. For future studies, the key findings suggest that interventions aimed at improving the home environments of left-behind children might be necessary in rural China.
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Affiliation(s)
- Jingdong Zhong
- School of Economics, Peking University, Beijing 100871, China;
| | - Lena Kuhn
- Leibniz Institute of Agricultural Development in Transition Economics, 06120 Halle, Germany;
| | - Tianyi Wang
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing 100871, China; (T.W.); (C.L.)
| | - Chengfang Liu
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing 100871, China; (T.W.); (C.L.)
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing 100871, China; (T.W.); (C.L.)
- Correspondence: ; Tel.: +86-010-6276-0156
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Zhang D, Jin L, Liang D, Geng R, Liu Y, Ling Y, Jiang F, Zhang Y. Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study. JMIR Form Res 2020; 4:e17179. [PMID: 32463374 PMCID: PMC7290447 DOI: 10.2196/17179] [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: 11/24/2019] [Revised: 02/10/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development. Objective This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States
| | - Lan Jin
- Center for Intercultural Learning, Mentorship, Assessment and Research, Purdue University, West Lafayette, IN, United States
| | - Di Liang
- School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Ruijin Geng
- Clinical Research Center, Morehouse School of Medicine, Atlanta, GA, United States
| | - Yun Liu
- Kunming Children's Hospital, Kunming, China
| | - Yu Ling
- Kunming Children's Hospital, Kunming, China
| | - Fan Jiang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai, China
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Milbrath G, Constance C, Ogendi A, Plews-Ogan J. Comparing Two Early Child Development Assessment Tools in Rural Limpopo, South Africa. BMC Pediatr 2020; 20:197. [PMID: 32380968 PMCID: PMC7204218 DOI: 10.1186/s12887-020-02101-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Providing increased cognitive stimulation or learning opportunities to young children significantly increases cognitive and social-emotional competence later in life. This study aims to determine the acceptability of a pediatric assessment tool to track early child development (ECD) in a rural health district in Limpopo, South Africa. Methods A total of 11 primary health nurses from the region in two focus groups were selected to learn and compare two ECD assessment tools: the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and Ages and Stages Questionnaire (ASQ). Data were analyzed using versus coding to compare between the two focus groups and between ASQ and CAT/CLAMS. Results The major categories that emerged from the discussion were current practice, usability, resource management, cultural adaptation, patient and parent factors, and new knowledge. Conclusions This study illustrates the challenges related to adapting and implementing ECD assessment in an environment where ECD is largely unknown by local residents, and differs from the environment in which the tool was initially developed. Further work is needed to develop new tools or alter existing tools that can be adapted to diverse settings and cultures.
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Affiliation(s)
- Gwyneth Milbrath
- University of Illinois Chicago College of Nursing, 845 S Damen Ave MC802, Chicago, IL, 60612, USA.
| | | | | | - James Plews-Ogan
- University of Virginia Children's Hospital, Charlottesville, USA
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Kohli-Lynch M, Ponce Hardy V, Bernal Salazar R, Bhopal SS, Brentani A, Cavallera V, Goh E, Hamadani JD, Hughes R, Manji K, Milner KM, Radner J, Sharma S, Silver KL, Lawn JE, Tann CJ. Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation. BMJ Open 2020; 10:e032134. [PMID: 32341042 PMCID: PMC7204990 DOI: 10.1136/bmjopen-2019-032134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Received: 06/04/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. SETTING We evaluated 32 RCEL projects across 17 LMICs on four continents. PARTICIPANTS Overall, 2165 workers delivered ECD interventions to 25 909 families. INTERVENTION Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. PRIMARY AND SECONDARY OUTCOMES We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. RESULTS Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. CONCLUSIONS This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.
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Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Raquel Bernal Salazar
- Economics Department, Universidad de Los Andes, Bogota, Colombia
- Centro de Estudios de Desarrollo Economico (CEDE), Universidad de Los Andes, Bogota, Colombia
| | - Sunil S Bhopal
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle upon Tyne, UK
| | - Alexandra Brentani
- Departamento do Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard Van Leer Foundation, The Hague, Netherlands
| | - Jena D Hamadani
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Rob Hughes
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, United Kingdom
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Social Aspects of Health across the Life Course, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Abstract
In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.
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Affiliation(s)
- Sophie Budge
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
| | - Alison H Parker
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
| | - Paul T Hutchings
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
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Chandna J, Ntozini R, Evans C, Kandawasvika G, Chasekwa B, Majo F, Mutasa K, Tavengwa N, Mutasa B, Mbuya M, Moulton LH, Humphrey JH, Prendergast A, Gladstone M. Effects of improved complementary feeding and improved water, sanitation and hygiene on early child development among HIV-exposed children: substudy of a cluster randomised trial in rural Zimbabwe. BMJ Glob Health 2020; 5:e001718. [PMID: 32133164 PMCID: PMC7042608 DOI: 10.1136/bmjgh-2019-001718] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/16/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 11/03/2022] Open
Abstract
Introduction HIV-exposed uninfected children may be at risk of poor neurodevelopment. We aimed to test the impact of improved infant and young child feeding (IYCF) and improved water, sanitation and hygiene (WASH) on early child development (ECD) outcomes. Methods Sanitation Hygiene Infant Nutrition Efficacy was a cluster randomised 2×2 factorial trial in rural Zimbabwe ClinicalTrials.gov NCT01824940). Pregnant women were eligible if they lived in study clusters allocated to standard-of-care (SOC; 52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement/day from 6 to 18 months, complementary feeding counselling; 53 clusters); WASH (pit latrine, 2 hand-washing stations, liquid soap, chlorine, play space, hygiene counselling; 53 clusters) or IYCF +WASH (53 clusters). Participants and fieldworkers were not blinded. ECD was assessed at 24 months using the Malawi Developmental Assessment Tool (MDAT; assessing motor, cognitive, language and social skills); MacArthur Bates Communication Development Inventory (assessing vocabulary and grammar); A-not-B test (assessing object permanence) and a self-control task. Intention-to-treat analyses were stratified by maternal HIV status. Results Compared with SOC, children randomised to combined IYCF +WASH had higher total MDAT scores (mean difference +4.6; 95% CI 1.9 to 7.2) and MacArthur Bates vocabulary scores (+8.5 words; 95% CI 3.7 to 13.3), but there was no evidence of effects from IYCF or WASH alone. There was no evidence that that any intervention impacted object permanence or self-control. Conclusions Combining IYCF and WASH interventions significantly improved motor, language and cognitive development in HIV-exposed children. Trial registration number NCT01824940.
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Affiliation(s)
- Jaya Chandna
- Department of Women and Child Health, University of Liverpool, Liverpool, UK
| | - Robert Ntozini
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Ceri Evans
- Centre for Genomics and Child Health, Blizard Institute of Cell and Molecular Science, London, U
| | | | - Bernard Chasekwa
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Naume Tavengwa
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute of Maternal and Child Health, Harare, Zimbabwe
| | - Mdhu Mbuya
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | | | - Jean H Humphrey
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Prendergast
- Centre for Genomics and Child Health, Blizard Institute of Cell and Molecular Science, London, U
| | - Melissa Gladstone
- Department of Women and Child Health, University of Liverpool, Liverpool, UK
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43
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Laurenzi CA, Skeen S, Sundin P, Hunt X, Weiss RE, Rotheram-Borus MJ, Tomlinson M. Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample. Glob Public Health 2019; 15:173-184. [PMID: 31426702 DOI: 10.1080/17441692.2019.1656274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.
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Affiliation(s)
- Christina A Laurenzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Sarah Skeen
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Phillip Sundin
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Xanthe Hunt
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Robert E Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mary Jane Rotheram-Borus
- Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Mark Tomlinson
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
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44
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Stansbery P. Translation of evidence to practice to promote early childhood development programs. Ann N Y Acad Sci 2019; 1419:23-25. [PMID: 29791731 DOI: 10.1111/nyas.13721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
The 2018 special issue of Annals of the New York Academy of Sciences on implementation research and practice for early childhood development brings together emerging evidence on implementing effective nurturing care programs, addressing issues of quality and scale. Translating evidence to practice requires addressing the barriers perceived by policy makers, which have been highlighted in the published literature. Here, I describe how UNICEF and other global partners are addressing these barriers.
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Affiliation(s)
- Pablo Stansbery
- Early Childhood Development (ECD), UNICEF East Asia and Pacific Regional Office (EAPRO), Bangkok, Thailand
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45
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Gladstone M, Phuka J, Thindwa R, Chitimbe F, Chidzalo K, Chandna J, Gleadow Ware S, Maleta K. Care for Child Development in rural Malawi: a model feasibility and pilot study. Ann N Y Acad Sci 2019; 1419:102-119. [PMID: 29791732 DOI: 10.1111/nyas.13725] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/31/2017] [Revised: 03/10/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
Abstract
Evidence demonstrates that encouraging stimulation, early communication, and nutrition improves child development. Detailed feasibility studies in real-world situations in Africa are limited. We piloted Care for Child Development through six health surveillance assistants (HSAs) in group and individual sessions with 60 caregivers and children <2 years and assessed recruitment, frequency, timings, and quality of intervention. We collected baseline/endline anthropometric, child development (MDAT), maternal stress (SRQ), and family care indicators (FCIs) data and determined acceptability through 20 interviews with caregivers and HSAs. HSAs could only provide coverage on 14.2% of eligible children in their areas; 86% of group sessions and a mean of 3.6/12 individual sessions offered to mothers were completed. Pre- and post-assessment of children demonstrated significant changes in MDAT language and social Z-scores and FCIs. Caregivers perceived sessions as beneficial and HSAs good leaders but that they could be provided through other mechanisms. Integrated Care for Child Development programs for 0-2 years old are readily accepted in Malawi, but they are not feasible to conduct universally through HSAs due to limited coverage; other models need to be considered.
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Affiliation(s)
- Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
| | - Richard Thindwa
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
| | - Fatima Chitimbe
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
| | - Kate Chidzalo
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
| | - Jaya Chandna
- Department of Women and Children's Health, Institute of Translational Medicine, Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Selena Gleadow Ware
- Department of Mental Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
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46
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Yousafzai AK, Rasheed MA, Siyal S. Integration of parenting and nutrition interventions in a community health program in Pakistan: an implementation evaluation. Ann N Y Acad Sci 2019; 1419:160-178. [PMID: 29791730 DOI: 10.1111/nyas.13649] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 11/04/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 12/27/2022]
Abstract
Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up.
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Affiliation(s)
- Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Muneera A Rasheed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Siyal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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47
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Nores M, Fernandez C. Building capacity in health and education systems to deliver interventions that strengthen early child development. Ann N Y Acad Sci 2019; 1419:57-73. [PMID: 29791726 DOI: 10.1111/nyas.13682] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022]
Abstract
Building capacity within health and education systems of low- and middle-income countries in order to deliver high-quality early childhood services requires coordinated efforts across sectors, effective governance, sufficient funding, an adequate workforce, reliable data systems, and continuous monitoring, evaluation, and improvement cycles; it also requires partnerships with the private sector, communities, and parents. In addition, building capacity requires leadership, innovation of strategies to fit into existing structures, evidence-based intervention models, and effective partnerships that help make interventions more culturally relevant, help finance them, and help create institutional long-term support and sustainability for them. In this article, we focus on identifying eight critical aspects of enabling systemic support for early childhood services. Every action that strengthens these critical aspects should be seen as necessary, but insufficient, steps toward a national strong governance structure for delivering a locally relevant and comprehensive early child development program that promotes children's developmental potentials.
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Affiliation(s)
- Milagros Nores
- National Institute for Early Education Research, New Brunswick, New Jersey
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48
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Banerjee A, Britto PR, Daelmans B, Goh E, Peterson S. Reaching the dream of optimal development for every child, everywhere: what do we know about 'how to'? Arch Dis Child 2019; 104:S1-S2. [PMID: 30885960 PMCID: PMC6557222 DOI: 10.1136/archdischild-2019-317087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Anshu Banerjee
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard van Leer Foundation, The Hague, The Netherlands
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49
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Arregoces L, Hughes R, Milner KM, Ponce Hardy V, Tann C, Upadhyay A, Lawn JE. Accountability for funds for Nurturing Care: what can we measure? Arch Dis Child 2019; 104:S34-S42. [PMID: 30885964 PMCID: PMC6557225 DOI: 10.1136/archdischild-2018-315429] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Understanding donor, government and out-of-pocket funding for early child development (ECD) is important for tracking progress. We aimed to estimate a baseline for the WHO, UNICEF and World Bank Nurturing Care Framework (NCF) with a special focus on childhood disability. METHODS To estimate development assistance spending, the Organisation for Economic Cooperation and Development's Creditor Reporting System (OECD-CRS) database was searched for 2007-2016, using key words derived from domains of the NCF (good health, nutrition and growth, responsive caregiving, security and safety, and early learning), plus disability. Associated funds were analysed by domain, donor, recipient and region. Trends of ECD/NCF were compared with reproductive, maternal, newborn and child health (RMNCH) disbursements. To assess domestic or out-of-pocket expenditure for ECD, we searched electronic databases of indexed and grey literature. RESULTS US$79.1 billion of development assistance were disbursed, mostly for health and nutrition (US$61.9 billion, 78% of total) and least for disability (US$0.7 billion, 2% of total). US$2.3 per child per year were disbursed for non-health ECD activities. Total development assistance for ECD increased by 121% between 2007 and 2016, an average increase of 8.3% annually. Per child disbursements increased more in Africa and Asia, while minimally in Latin America and the Caribbean and Oceania. We could not find comparable sources for domestic funding and out-of-pocket expenditure. CONCLUSIONS Estimated international donor disbursements for ECD remain small compared with RMNCH. Limitations include inconsistent donor terminology in OECD data. Increased investment will be required in the poorest countries and for childhood disability to ensure that progress is equitable.
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Affiliation(s)
- Leonardo Arregoces
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Rob Hughes
- Children’s Investment Fund Foundation, London, UK,Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK,Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - 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
| | - Arjun Upadhyay
- Results for Development Institute, Washington, District of Columbia, USA
| | - 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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Cavallera V, Tomlinson M, Radner J, Coetzee B, Daelmans B, Hughes R, Pérez-Escamilla R, Silver KL, Dua T. Scaling early child development: what are the barriers and enablers? Arch Dis Child 2019; 104:S43-S50. [PMID: 30885965 PMCID: PMC6557300 DOI: 10.1136/archdischild-2018-315425] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/23/2022]
Abstract
The Sustainable Development Goals, Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) and Nurturing Care Framework all include targets to ensure children thrive However, many projects to support early childhood development (ECD) do not 'scale well' and leave large numbers of children unreached. This paper is the fifth in a series examining effective scaling of ECD programmes. This qualitative study explored experiences of scaling-up among purposively recruited implementers of ECD projects in low- and middle-income countries. Participants were sampled, by means of snowball sampling, from existing networks notably through Saving Brains®, Grand Challenges Canada®. Findings of a recent literature review on scaling-up frameworks, by the WHO, informed the development of a semistructured interview schedule. All interviews were conducted in English, via Skype, audio recorded and transcribed verbatim. Interviews were analysed using framework analysis. Framework analysis identified six major themes based on a standard programme cycle: planning and strategic choices, project design, human resources, financing and resource mobilisation, monitoring and evaluation, and leadership and partnerships. Key informants also identified an overarching theme regarding what scaling-up means. Stakeholders have not found existing literature and available frameworks helpful in guiding them to successful scale-up. Our research suggests that rather than proposing yet more theoretical guidelines or frameworks, it would be better to support stakeholders in developing organisational leadership capacity and partnership strategies to enable them to effectively apply a practical programme cycle or systematic process in their own contexts.
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Affiliation(s)
- Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark Tomlinson
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada,Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | - Bronwynè Coetzee
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Rob Hughes
- Children’s Investment Fund Foundation, London, UK,Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rafael Pérez-Escamilla
- Office of Public Health Practice, Yale School of Public Health, New Haven, Connecticut, USA,Global Health Concentration, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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