Goto Ryunosuke, Frodl Thomas, Skokauskas Norbert
Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan.
Department of Psychiatry and Psychotherapy, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany.
Pediatrics. 2021 Sep;148(3). doi: 10.1542/peds.2021-050332. Epub 2021 Aug 17.
Despite 1 in 10 children being affected by armed conflicts, there is limited evidence on the effects of conflicts on early childhood development (ECD), an important Sustainable Development Goals indicator. We aimed to elucidate the relationship between exposure to conflicts and ECD.
We conducted a multinational observational study using population-based data on 27 538 children 36 to 59 months old from Demographic and Health Surveys from 12 low- and middle-income countries merged with prospective data on conflicts from Uppsala Conflict Data Program. We estimated the association between 1 to 5 consecutive years of exposure to conflicts within 50 km and ECD after inverse probability of treatment weighting. Mediators of the relationship between conflicts and ECD were identified. We also estimated the association between conflicts and individual domains of ECD.
Exposure to conflicts was associated with a 5.9% decrease (95% confidence interval -7.5% to -4.3%) in the probability of a child being developmentally on track from the first year of exposure. This was compounded after the second year, with 5 consecutive years of exposure associated with a 10.4% decrease in the probability of a child being developmentally on track (95% confidence interval -13.7% to -7.2%). A lack of access to early childhood education was a significant mediator into the fifth year of exposure. Among individual ECD domains, socioemotional development was disproportionately impaired.
Exposure to nearby conflicts is associated with an increased probability of delayed ECD, especially with chronic exposure. Children in affected areas should be provided psychosocial support and early childhood education from an early stage.
尽管每10名儿童中就有1名受到武装冲突的影响，但关于冲突对幼儿发展（这是一项重要的可持续发展目标指标）影响的证据有限。我们旨在阐明接触冲突与幼儿发展之间的关系。
我们开展了一项跨国观察性研究，使用了来自12个低收入和中等收入国家人口与健康调查的27538名36至59个月大儿童的基于人群的数据，并与乌普萨拉冲突数据计划的冲突前瞻性数据相结合。在进行治疗权重逆概率分析后，我们估计了50公里范围内连续1至5年接触冲突与幼儿发展之间的关联。确定了冲突与幼儿发展之间关系的中介因素。我们还估计了冲突与幼儿发展各个领域之间的关联。
从接触冲突的第一年起，接触冲突与儿童发育正常的概率降低5.9%（95%置信区间为-7.5%至-4.3%）相关。第二年之后这种情况更加严重，连续5年接触冲突与儿童发育正常的概率降低10.4%相关（95%置信区间为-13.7%至-7.2%）。无法获得幼儿教育是接触冲突到第五年时的一个重要中介因素。在幼儿发展的各个领域中，社会情感发展受到的损害尤为严重。
接触附近的冲突与幼儿发展延迟的可能性增加相关，尤其是长期接触。应从早期就为受影响地区的儿童提供心理社会支持和幼儿教育。
