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      Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

      research-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 9 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 2 , 42 , 43
      BMJ Open
      BMJ Publishing Group
      motor development, cognitive development, language development, early life risk factors, preterm, SGA, maternal education, paternal education, maternal short stature, maternal anaemia and anaemia in infancy, access to clean water, access to sanitation, breast feeding, diarrhoea

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          Abstract

          Objective

          To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).

          Design

          Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.

          Data sources

          We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.

          Eligibility criteria for selecting studies

          Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.

          Analyses

          Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.

          Results

          We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (–0.24 to –0.05) and 0.23 SD (–0.42 to –0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from −0.18 to −0.10 SDs.

          Conclusions

          Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

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          Most cited references53

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          Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels

          Background Stunting affects one-third of children under 5 y old in developing countries, and 14% of childhood deaths are attributable to it. A large number of risk factors for stunting have been identified in epidemiological studies. However, the relative contribution of these risk factors to stunting has not been examined across countries. We estimated the number of stunting cases among children aged 24–35 mo (i.e., at the end of the 1,000 days’ period of vulnerability) that are attributable to 18 risk factors in 137 developing countries. Methods and Findings We classified risk factors into five clusters: maternal nutrition and infection, teenage motherhood and short birth intervals, fetal growth restriction (FGR) and preterm birth, child nutrition and infection, and environmental factors. We combined published estimates and individual-level data from population-based surveys to derive risk factor prevalence in each country in 2010 and identified the most recent meta-analysis or conducted de novo reviews to derive effect sizes. We estimated the prevalence of stunting and the number of stunting cases that were attributable to each risk factor and cluster of risk factors by country and region. The leading risk worldwide was FGR, defined as being term and small for gestational age, and 10.8 million cases (95% CI 9.1 million–12.6 million) of stunting (out of 44.1 million) were attributable to it, followed by unimproved sanitation, with 7.2 million (95% CI 6.3 million–8.2 million), and diarrhea with 5.8 million (95% CI 2.4 million–9.2 million). FGR and preterm birth was the leading risk factor cluster in all regions. Environmental risks had the second largest estimated impact on stunting globally and in the South Asia, sub-Saharan Africa, and East Asia and Pacific regions, whereas child nutrition and infection was the second leading cluster of risk factors in other regions. Although extensive, our analysis is limited to risk factors for which effect sizes and country-level exposure data were available. The global nature of the study required approximations (e.g., using exposures estimated among women of reproductive age as a proxy for maternal exposures, or estimating the impact of risk factors on stunting through a mediator rather than directly on stunting). Finally, as is standard in global risk factor analyses, we used the effect size of risk factors on stunting from meta-analyses of epidemiological studies and assumed that proportional effects were fairly similar across countries. Conclusions FGR and unimproved sanitation are the leading risk factors for stunting in developing countries. Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition.
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            Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial.

            Stimulation and nutrition delivered through health programmes at a large scale could potentially benefit more than 200 million young children worldwide who are not meeting their developmental potential. We investigated the feasibility and effectiveness of the integration of interventions to enhance child development and growth outcomes in the Lady Health Worker (LHW) programme in Sindh, Pakistan.
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              • Article: not found

              Enteric infections, diarrhea, and their impact on function and development.

              Enteric infections, with or without overt diarrhea, have profound effects on intestinal absorption, nutrition, and childhood development as well as on global mortality. Oral rehydration therapy has reduced the number of deaths from dehydration caused by infection with an enteric pathogen, but it has not changed the morbidity caused by such infections. This Review focuses on the interactions between enteric pathogens and human genetic determinants that alter intestinal function and inflammation and profoundly impair human health and development. We also discuss specific implications for novel approaches to interventions that are now opened by our rapidly growing molecular understanding.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                3 October 2019
                : 9
                : 10
                : e026449
                Affiliations
                [1 ] departmentICAP and Department of Epidemiology, Mailman School of Public Health , Columbia University , New York city, New York, USA
                [2 ] departmentDepartment of Global Health and Population , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                [3 ] departmentDeaprtment of Global Health and Population, and Epidemiology , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                [4 ] departmentHousehold Economics and Health System Research Unit , Schweizerisches Tropen- und Public Health-Institut , Basel, Switzerland
                [5 ] departmentHarvard Graduate School of Education , Harvard University , Cambridge, Massachusetts, USA
                [6 ] departmentDepartments of Epidemiology and Environmental Health , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                [7 ] departmentDepartment of Global Health and Social Medicine , Harvard Medical School , Boston, Massachusetts, USA
                [8 ] departmentDepartment of Family Medicine , Marmara University School of Medicine , Istanbul, Turkey
                [9 ] departmentMaternal and Child Health Division , ICDDR,B , Dhaka, Bangladesh
                [10 ] departmentPostgraduate Program in Epidemiology , Federal University of Pelotas , Pelotas, Brazil
                [11 ] departmentDepartment of Neurology , Harvard Medical School and Boston Children’s Hospital , Boston, Massachusetts, USA
                [12 ] departmentDepartment of Pediatrics , University of Maryland School of Medicine , Baltimore, Maryland, USA
                [13 ] departmentNutrition and Scientific Affairs , The Nature’s Bounty Co , Ronkonkoma, New York, USA
                [14 ] Brown University School of Public Health , Providence, Rhode Island, USA
                [15 ] departmentMaternal and Newborn Health , Liverpool School of Tropical Medicine , Liverpool, UK
                [16 ] departmentDepartment of Maternal and Child Health , Shoklo Malaria Research Unit , Mae Sot, Thailand
                [17 ] departmentOffice of Population Studies Foundation, Inc , University of San Carlos , Cebu City, Philippines
                [18 ] departmentCenter for Nutrition , Boston Children's Hospital , Boston, Massachusetts, USA
                [19 ] departmentCommunity Health Sciences , School of Public Health, University of California , Berkeley, California, USA
                [20 ] departmentWomen and Children's Health , University of Liverpool, Institute of Translational Medicine , Liverpool, UK
                [21 ] departmentCollege of Population Health , University of New Mexico , Albuquerque, New Mexico, USA
                [22 ] departmentDepartment of Epidemiology , University of Michigan School of Public Health , Ann Arbor, Michigan, USA
                [23 ] departmentPoverty Health and Nutrition Division , International Food Policy Research Institute , Washington, DC, USA
                [24 ] departmentDepartment of Anthropology , Northwestern University , Evanston, Illinois, USA
                [25 ] departmentRegional Centre for Child and Youth Mental Health and Child Welfare , NORCE Norwegian Research Center , Bergen, Norway
                [26 ] departmentDepartment of Nutrition , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                [27 ] departmentDepartment of Pediatrics and Child Health , Muhibili University of Health and Allied Sciences , Dar es Salaam, Tanzania
                [28 ] Ifakara Health Institute , Dar es Salam, Tanzania
                [29 ] departmentDepartamento de Medicina Preventiva, Faculdade de Medicina FMUSP , Universidade de São Paulo , Sao Paulo, Brasil
                [30 ] departmentChildren's Hospital Oakland Research Institute , UCSF Benioff Children's Hospital , Oakland, California, USA
                [31 ] departmentFaculty of Tropical Medicine, Mahidol University , Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mae Sot, Thailand
                [32 ] departmentCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford, UK
                [33 ] departmentPediatrics and Child Health , Aga Khan Medical University , Karachi, Pakistan
                [34 ] departmentDepartment of Collective Health , Universidade Federal da Bahia , Salvador, Brazil
                [35 ] departmentDepartment of Public Health , Marmara University School of Medicine , Istanbul, Turkey
                [36 ] departmentDepartment of Immunology and Infectious Disease , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                [37 ] departmentDepartment of Nutritional Sciences , Oklahoma State University College of Human Environmental Sciences , Stillwater, Oklahoma, USA
                [38 ] departmentDepartment of Laboratory Medicine , Sykehuset Innlandet Helseforetaket , Brumunddal, Norway
                [39 ] departmentCentre for Health Research and Development , Society for Applied Studies , New Delhi, India
                [40 ] departmentDivision of Research on Public Health , National Institute of Perinatology , Mexico City, Mexico
                [41 ] departmentNutrition and Clinical Services Division , ICDDR,B , Dhaka, Bangladesh
                [42 ] departmentMRC Centre for Environment and Health , School of Public Health, Imperial College London , London, UK
                [43 ] departmentDeaprtment of Global Health and Population, Epidemiology, and Nutrition , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr Ayesha Sania; ays328@ 123456mail.harvard.edu
                Author information
                http://orcid.org/0000-0002-4038-151X
                Article
                bmjopen-2018-026449
                10.1136/bmjopen-2018-026449
                6797384
                31585969
                6355e1be-9a5f-4be2-8342-d80333b1a527
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 02 September 2018
                : 15 August 2019
                : 16 August 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000060, National Institute of Allergy and Infectious Diseases;
                Award ID: T32AI114398
                Funded by: FundRef http://dx.doi.org/10.13039/501100004828, Grand Challenges Canada;
                Award ID: 0073-03
                Categories
                Global Health
                Original Research
                1506
                1699
                Custom metadata
                unlocked

                Medicine
                motor development,cognitive development,language development,early life risk factors,preterm,sga,maternal education,paternal education,maternal short stature,maternal anaemia and anaemia in infancy,access to clean water,access to sanitation,breast feeding,diarrhoea

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