School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
BMC Pediatr. 2019 Aug 8;19(1):276. doi: 10.1186/s12887-019-1654-9.
Growth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5 years in low- and middle-income countries.
A secondary analysis of nationally representative data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5 years from the randomly selected households was ascertained using a 10-item scale which assessed four developmental domains: language-cognitive, physical, socio-emotional, and approaches to learning with a total development score ranging from 0 (the least optimal) to 10 (the most optimal). Children's growth, the height-for-age Z score (HAZ), was calculated using the WHO Child Growth Standards. Unadjusted (Pearson's correlation coefficient, r) and adjusted estimations (standardised mean difference (SMD) adjusted for child sex, child age, and household wealth index) of the magnitude of the association between HAZ and ECD scores were calculated for each country.
Data contributed by 178,393 children aged 36 to 59 months from 55 countries were included in the analyses. The pooled r between HAZ and standardised ECD scores was 0.12 and the pooled adjusted SMD was 0.06. The r ranged from ~ 0 in Barbados, Lebanon, and Moldova to 0.32 in Pakistan and 0.36 in Nigeria. Overall, 47/55 countries had correlation coefficients less than the cut-off for a small association. The adjusted SMDs were ~ 0 in 20 countries. All SMDs were lower than the cut-off for a small effect size. The magnitudes of the association were highest in South Asia and lowest in Middle East and North Africa, and lowest in the highest HDI group.
The association between growth and development in early childhood appears to be primarily a co-occurrence because the magnitude of the association varies among settings from no association in higher-income countries to a moderate level in low-income countries. In low-income countries, interventions targeting child growth and ECD should be integrated given their common risks frequency in these settings. Overall, growth is not a sensitive and therefore suitable indicator of child development.
儿童的生长和早期发育（ECD）是至关重要的结果。本研究旨在探讨儿童生长与低中等收入国家 3 至 5 岁儿童全面发展之间的关系。
这是对联合国儿童基金会多指标类集调查（MICS）和国家人口与健康调查（DHS）中收集的具有代表性的数据进行的二次分析。通过一个评估四个发展领域的 10 项量表来确定 3 至 5 岁儿童的早期发展：语言认知、身体、社会情感和学习方法，总发展得分范围为 0（最不理想）至 10（最理想）。使用世卫组织儿童生长标准计算儿童的生长情况，即身高年龄 Z 分数（HAZ）。为每个国家计算 HAZ 与 ECD 得分之间关联程度的未经调整（Pearson 相关系数，r）和调整估计值（根据儿童性别、年龄和家庭财富指数调整的标准化均数差（SMD））。
纳入分析的来自 55 个国家的 36 至 59 个月龄的 178393 名儿童的数据。HAZ 与标准化 ECD 得分之间的总体 r 为 0.12，总体调整 SMD 为 0.06。r 值范围从巴贝多、黎巴嫩和摩尔多瓦的~0 到巴基斯坦的 0.32 和尼日利亚的 0.36。总体而言，55 个国家中有 47 个国家的相关系数小于小关联的临界值。20 个国家的调整 SMD 接近 0。所有 SMD 均低于小效应量的临界值。关联的程度在南亚最高，在中东和北非最低，在最高人类发展指数组中最低。
儿童早期生长和发育之间的关联似乎主要是一种同时发生的现象，因为关联的程度在不同的环境中有所不同，从高收入国家的无关联到低收入国家的中等水平。在低收入国家，鉴于这些环境中共同存在的风险频率，应将针对儿童生长和 ECD 的干预措施结合起来。总体而言，生长不是儿童发展的敏感指标，因此不太适合作为指标。
