Venancio Sonia Isoyama, Teixeira Juliana Araujo, de Bortoli Maritsa Carla, Bernal Regina Tomie Ivata
Health Institute, Secretariat of Health of São Paulo, São Paulo, SP, Brazil.
Centro Brasileiro de Pesquisa Aplicada à Primeira Infância, Insper, São Paulo, SP, Brazil.
Lancet Reg Health Am. 2021 Dec 23;5:100139. doi: 10.1016/j.lana.2021.100139. eCollection 2022 Jan.
This study aims to identify the contexts, environments, and nurturing care predictors that determine whether a child is developmentally on track in Ceará, Brazil.
We analysed data from a cross-sectional study conducted with caregivers of 6,447 children aged 0-59 months during a vaccination campaign in Ceará in October 2019. The validated Child Development Assessment Questionnaire was used to assess early childhood development (ECD) and children with a z-score ≥ -1 SD were considered developmentally on track. We conducted logistic regression models to understand the effects of contexts, environments, and nurturing care domains on ECD.
Children in the early years (< 36 months) were more likely to meet the ECD milestones if they were not born with low birth weight (AOR: 0·64; 95% CI: 0·42-0·97), were exposed to manufactured toys in their house (2·68; 1·97-3·66), their heads of household were employed (1·61; 1·16-2·23), and their caregivers had read the Child Health Handbook (1·42; 1·13-1·77) and engaged them in stimulating activities (1·71; 1·26-2·32). Children aged 36-59 months were more likely to meet the ECD milestones if they were breastfed (never: ref. / < 3 months: 3·72; 1·91-7·26 / 3-5 months: 3·21; 1·74-5·93 / 6-11 months: 3·73; 1·95-7·16 / ≥ 12 months: 3·89; 2·25-6·72), had books at home (0: ref / 1-3: 1·71; 1·22-2·40 / 4-6: 2·24; 1·27-3·94 / 7+: 2·71; 1·05-7·00), and their caregivers received information about ECD (1·49; 1·11-2·01) and engaged them in stimulating activities (1·80; 1·27-2·56). Children aged 36-59 months were less likely to meet developmental milestones if they watched TV or used tablets/smartphones for more than two hours per day (0·61; 0·44-0·84), played with household objects (0·62; 0·41-0·92), participated in governmental early childhood programmes aimed at vulnerable families (0·62; 0·45-0·86), had families that participated in income transfer programmes (0·68; 0·47-0·99) (families living in poverty or extreme poverty), and their caregivers considered slapping (0·67; 0·48-0·94) a necessary disciplinary method.
Having favourable socioeconomic conditions, breastfeeding, the absence of harsh discipline, caregivers who provide responsive care, and the provision of opportunities for early learning are the key factors that increase the likelihood of a child achieving their full developmental potential in Ceará, Brazil.
This study was supported by the Maria Cecília Souto Vidigal Foundation (F0245), Brazil. The funder had no role in the design, analysis, or writing of this article.
本研究旨在确定在巴西塞阿拉州决定儿童发育是否正常的背景、环境和养育照护预测因素。
我们分析了2019年10月在塞阿拉州一次疫苗接种活动期间对6447名0 - 59个月儿童的照料者进行的横断面研究数据。使用经过验证的儿童发育评估问卷来评估幼儿发育（ECD），z分数≥ -1标准差的儿童被视为发育正常。我们进行了逻辑回归模型分析，以了解背景、环境和养育照护领域对幼儿发育的影响。
如果幼儿（＜36个月）出生时不是低体重儿（比值比：0·64；95%置信区间：0·42 - 0·97）、家中有成品玩具（2·68；1·97 - 3·66）、户主有工作（1·61；1·16 - 2·23）、其照料者读过《儿童健康手册》（1·42；1·13 - 1·77）并让他们参与刺激性活动（1·71；1·26 - 2·32），那么他们更有可能达到幼儿发育里程碑。36 - 59个月的儿童如果进行母乳喂养（从未：参照组/＜3个月：3·72；1·91 - 7·26 / 3 - 5个月：3·21；1·74 - 5·93 / 6 - 11个月：3·73；1·95 - 7·16 /≥12个月：3·89；2·25 - 6·72）、家中有书籍（0本：参照组/1 - 3本：1·71；1·22 - 2·40 / 4 - 6本：2·24；1·27 - 3·94 / 7本及以上：2·71；1·05 - 7·00）、其照料者获得了有关幼儿发育的信息（1·49；1·11 - 2·01）并让他们参与刺激性活动（1·80；1·27 - 2·56），那么他们更有可能达到幼儿发育里程碑。36 - 59个月的儿童如果每天看电视或使用平板电脑/智能手机超过两小时（0·61；0·44 - 0·84）、玩家用物品（0·62；0·41 - 0·92）、参加针对弱势家庭的政府幼儿项目（0·62；0·45 - 0·86）、家庭参与了收入转移项目（0·68；0·47 - 0·99）（生活在贫困或极端贫困中的家庭）以及其照料者认为扇耳光（0·67；0·48 - 0·94）是一种必要的管教方法，那么他们达到发育里程碑的可能性较小。
拥有良好的社会经济条件、母乳喂养、没有严厉的管教、提供响应式照护的照料者以及提供早期学习机会是增加巴西塞阿拉州儿童充分发挥其发育潜力可能性的关键因素。
本研究由巴西玛丽亚·塞西莉亚·索托·维迪加尔基金会（F0245）资助。资助者在本文的设计、分析或撰写过程中没有参与。
