Department of Nutrition, University of California Davis, Davis, CA, USA.
Department of Nutrition and Food Science, University of Ghana, Legon Accra, Ghana.
J Child Psychol Psychiatry. 2017 Nov;58(11):1264-1275. doi: 10.1111/jcpp.12751. Epub 2017 May 23.
Previous reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.
We conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.
Out of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.
Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.
先前的综述确定了 44 个中低收入国家儿童早期发育不良（ECD）的风险因素。为了为ECD 干预措施的设计提供信息，需要进一步了解它们的相对影响和途径。
我们对四项前瞻性队列研究中的 18 个月语言和运动发育相关因素进行了路径分析，这些队列研究参与了加纳（n=1023）、马拉维（n=675 和 1385）和布基纳法索（n=1122）进行的国际基于脂质的营养补充剂（iLiNS）项目的试验。在两个队列中，孕妇在怀孕期间入组。在两个队列中，婴儿在 6 或 9 个月时入组。在多元线性回归和结构方程模型（SEM）中，我们检查了之前综述中确定的 44 个因素中的 22 个，以及另外 12 个预期与 ECD 相关的因素。
在检查的 34 个因素中的 42 个指标中，有 6 个在 3 或 4 个队列中与 18 个月的语言和/或运动发育相关：儿童线性和体质量增长、游戏材料的多样性、与照料者的活动、饮食多样性以及儿童血红蛋白/铁状况。与儿童发育无关的因素是产妇 Hb/铁状况、妊娠期间产妇患病和炎症、产妇感知压力和抑郁、产后 6 个月内纯母乳喂养以及儿童腹泻、发热、疟疾和急性呼吸道感染的指标。社会经济地位与语言发展之间的关联主要通过照顾者与儿童的互动实践来介导，而这种模式在运动发育方面在不同队列中并不一致。
确保高质量 ECD 的干预措施的关键要素可能是促进照顾者与儿童的互动活动、多种游戏材料和多样化的饮食，以及预防线性和体质量增长不良以及改善儿童血红蛋白/铁状况。
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