Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Maternal and Child Health, Federal University of Ceará, Fortaleza, Brazil.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Am J Prev Med. 2021 Apr;60(4):579-586. doi: 10.1016/j.amepre.2020.08.012. Epub 2020 Nov 5.
More than 200 million children fail to reach their full developmental potential in low- and middle-income countries. Adverse childhood experiences, maternal mental health, and intimate partner violence are negatively associated with child development outcomes. The relationship of these risk factors with child communication, gross motor, fine motor, problem-solving, and personal-social development scores in Brazil are assessed.
A population-based, cross-sectional study of preschool children living in the state of Ceará, Brazil, in 2017 was conducted. Child development was assessed with the Ages and Stages Questionnaire. Adverse childhood experiences for children were self-reported by the participants' mothers using the Centers for Disease Control and Prevention Adverse Childhood Experiences Study‒adapted metric. Maternal mental health and intimate partner violence were evaluated using validated questionnaires. Sample-adjusted multivariable generalized linear models with interaction terms were used to determine the association of intimate partner violence, maternal mental health, and adverse childhood experiences with developmental outcomes and identify possible moderators. Data were analyzed between 2019 and 2020.
Children exposed to ≥3 adverse childhood experiences had -0.12 (95% CI= -0.24, 0) lower communication, -0.25 (95% CI= -0.46, -0.03) lower gross motor, -0.27 (95% CI= -0.47, -0.07) lower fine motor, and -0.17 (95% CI= -0.3, -0.03) lower personal-social domain scores than children with no adverse childhood experiences. Furthermore, the greater number of adverse childhood experiences was linearly associated with lower developmental scores. Maternal mental health and intimate partner violence were also associated with lower development scores.
Adverse childhood experiences were independently associated with developmental outcomes in Brazilian children. Community-based interventions to reduce the impact of adverse childhood experiences, intimate partner violence, and maternal mental health may benefits child development outcomes.
在中低收入国家，超过 2 亿儿童未能充分发挥其发展潜力。不良的童年经历、产妇心理健康和亲密伴侣暴力与儿童发展结果呈负相关。本研究评估了这些风险因素与巴西儿童沟通、粗大运动、精细运动、解决问题和个人-社会发展评分的关系。
本研究是一项 2017 年在巴西塞阿拉州进行的基于人群的学龄前儿童横断面研究。采用年龄与阶段问卷评估儿童发育情况。儿童的不良童年经历由参与者的母亲使用疾病控制与预防中心的不良童年经历研究改编指标进行自我报告。产妇心理健康和亲密伴侣暴力使用经过验证的问卷进行评估。采用带有交互项的样本调整多元广义线性模型来确定亲密伴侣暴力、产妇心理健康和不良童年经历与发育结果的关联，并确定可能的调节因素。数据分析于 2019 年至 2020 年进行。
经历≥3 次不良童年经历的儿童在沟通方面的评分低 0.12（95%CI=-0.24，0），粗大运动评分低 0.25（95%CI=-0.46，-0.03），精细运动评分低 0.27（95%CI=-0.47，-0.07），个人-社会领域评分低 0.17（95%CI=-0.3，-0.03），而无不良童年经历的儿童的评分更高。此外，不良童年经历的数量与发育评分呈线性相关。产妇心理健康和亲密伴侣暴力也与较低的发育评分相关。
不良的童年经历与巴西儿童的发育结果独立相关。以社区为基础的干预措施减少不良童年经历、亲密伴侣暴力和产妇心理健康的影响，可能有利于儿童的发育结果。
