South African Medical Research Council, Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Lancet. 2024 Nov 23;404(10467):2094-2116. doi: 10.1016/S0140-6736(24)01389-8. Epub 2024 Nov 18.
Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2-5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs. Paper 2 focuses on the cost of inaction and the implications of not investing in the next 1000 days. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. Intervention research in LMICs in the next 1000 days is scarce. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals.
在生命的前 1000 天，即从受孕到两岁，接下来的 1000 天，即儿童从 2 岁到 5 岁，是促进培育和关爱的环境、建立健康行为以及巩固早期成果、维持或改善健康发展轨迹的机会窗口。本系列论文中的第一篇，即关于儿童早期发展和下一个 1000 天的两部分系列论文的第一部分，重点关注生命历程向接下来的 1000 天的过渡，描述了为什么这个发展时期很重要，确定了塑造儿童发展的关爱环境、风险和保护因素，估计了接受充分培育关爱的儿童人数，并探讨了当前的干预措施是否满足儿童的需求。第二篇论文重点关注不作为的代价以及不投资于接下来的 1000 天的影响。在低收入和中等收入国家（LMICs），只有 6200 万 3 岁和 4 岁的儿童（25.4%）在接下来的 1000 天中接受了充分的培育关爱，使 1.819 亿儿童面临危及健康发展的风险。在培育关爱健康、营养、保护、响应式关爱和学习等各个维度的投入在各国之间存在很大差异。在 LMICs，尽管在此期间 86.2%的儿童体重健康，但不到三分之一的儿童接受发展刺激或免受身体惩罚，只有 38.8%的儿童接受幼儿保育和教育服务。在 LMICs，下一个 1000 天的干预研究很少。在这个时期，发展适宜的培育关爱连续性、卫生、教育和保护部门之间的协调以及支持照顾者和提高教育和保健质量的干预措施的实施仍然是重中之重。这些部门在为这一年龄组提供优质早期保育和教育方面发挥着关键作用，这将有助于最大限度地发挥全球儿童的发展潜力和机会，并有助于实现可持续发展目标的进展。
