Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
University of Michigan School of Dentistry, Ann Arbor, Michigan, United States of America.
PLoS Med. 2021 Apr 19;18(4):e1003578. doi: 10.1371/journal.pmed.1003578. eCollection 2021 Apr.
The influence of the safety and security of environments on early childhood development (ECD) has been under-explored. Although housing might be linked to ECD by affecting a child's health and a parent's ability to provide adequate care, only a few studies have examined this factor. We hypothesized that housing environment is associated with ECD in sub-Saharan Africa (SSA).
From 92,433 children aged 36 to 59 months who participated in Multiple Indicator Cluster Survey (MICS) in 20 SSA countries, 88,271 were tested for cognitive and social-emotional development using the Early Childhood Development Index (ECDI) questionnaire and were thus included in this cross-sectional analysis. Children's mean age was 47.2 months, and 49.8% were girls. Children were considered developmentally on track in a certain domain if they failed no more than 1 ECDI item in that domain. In each country, we used conditional logistic regression models to estimate the association between improved housing (housing with finished building materials, improved drinking water, improved sanitation facilities, and sufficient living area) and children's cognitive and social-emotional development, accounting for contextual effects and socioeconomic factors. Estimates from each country were pooled using random-effects meta-analyses. Subgroup analyses were conducted by the child's gender, maternal education, and household wealth quintiles. On-track cognitive development was associated with improved housing (odds ratio [OR] = 1.15, 95% CI 1.06 to 1.24, p < 0.001), improved drinking water (OR = 1.07, 95% CI 1.00 to 1.14, p = 0.046), improved sanitation facilities (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.014), and sufficient living area (OR = 1.06, 95% CI 1.01 to 1.10, p = 0.018). On-track social-emotional development was associated with improved housing only in girls (OR = 1.14, 95% CI 1.04 to 1.25, p = 0.006). The main limitations of this study included the cross-sectional nature of the datasets and the use of the ECDI, which lacks sensitivity to measure ECD outcomes.
In this study, we observed that improved housing was associated with on-track cognitive development and with on-track social-emotional development in girls. These findings suggest that housing improvement in SSA may be associated not only with benefits for children's physical health but also with broader aspects of healthy child development.
环境的安全保障对儿童早期发展（ECD）的影响尚未得到充分探索。尽管住房可能通过影响儿童的健康和父母提供充分照顾的能力与 ECD 相关，但仅有少数研究对此因素进行了检验。我们假设住房环境与撒哈拉以南非洲（SSA）的 ECD 有关。
在来自 SSA 20 个国家的 92433 名年龄在 36 至 59 个月的儿童中，有 88271 名儿童接受了使用早期儿童发展指数（ECDI）问卷进行的认知和社会情感发展测试，因此被纳入本次横断面分析。儿童的平均年龄为 47.2 个月，其中 49.8%为女孩。如果儿童在某个领域的 ECDI 项目中失败不超过 1 项，则认为其在该领域的发展处于正轨。在每个国家，我们使用条件逻辑回归模型来估计改善住房（使用完成建筑材料、改善饮用水、改善卫生设施和充足生活空间的住房）与儿童认知和社会情感发展之间的关联，同时考虑到背景影响和社会经济因素。利用随机效应荟萃分析汇总了来自每个国家的估计值。根据儿童的性别、母亲教育程度和家庭财富五分位数进行了亚组分析。认知发展正常与改善住房（比值比[OR] = 1.15，95%CI 1.06 至 1.24，p < 0.001）、改善饮用水（OR = 1.07，95%CI 1.00 至 1.14，p = 0.046）、改善卫生设施（OR = 1.15，95%CI 1.03 至 1.28，p = 0.014）和充足生活空间（OR = 1.06，95%CI 1.01 至 1.10，p = 0.018）有关。仅在女孩中，认知发展正常与改善住房有关（OR = 1.14，95%CI 1.04 至 1.25，p = 0.006）。本研究的主要局限性包括数据集的横断面性质和 ECDI 的使用，后者缺乏衡量 ECD 结果的敏感性。
在这项研究中，我们发现改善住房与认知发展正常以及女孩的社会情感发展正常有关。这些发现表明，在 SSA 改善住房不仅可能对儿童的身体健康有益，而且可能对儿童健康发展的更广泛方面有益。
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