乌干达农村地区一项孕产妇教育试验的分析：儿童社会人口学暴露、婴儿期生长发育与8岁时发育之间的关联

Associations between sociodemographic exposures, growth and development during infancy with development at the age of eight years among children: Analysis of a maternal education trial in rural Uganda.

作者信息

Kakwangire Paul, Ngari Moses, Muhoozi Grace, Westerberg Ane Cecilie, Atukunda Prudence, Iversen Per Ole

机构信息

Department of Nutrition, IMB, University of Oslo, Oslo, Norway.

Department of Family Life and Consumer Studies (Home Economics), Kyambogo University, Kampala, Uganda.

出版信息

J Glob Health. 2024 Dec 6;14:04228. doi: 10.7189/jogh.14.04228.

DOI:10.7189/jogh.14.04228

PMID:39641314

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11622353/

Abstract

BACKGROUND

Links between early life exposures and child development later in life are not sufficiently explored in low- and middle-income countries. We studied associations between sociodemographic variables, growth and development at six to eight months with developmental outcomes at eight years.

METHODS

We used data from a maternal education trial which included 511 mother-infant pairs at children's age of six to eight months (baseline). In this follow-up study, data from 361 mother-child pairs were available. Questionnaires were used to collect sociodemographic variables. Growth (anthropometry) was measured by study personnel and converted to z-scores according to the World Health Organization (WHO) growth reference. Child development (cognitive, motor and language) at baseline was assessed using Bayley Scales of Infant and Todler Development, third edition (BSID-III). Development at eight years was measured using two neuropsychological tools: Kaufman Assessment Battery for Children Second Edition (KABC-II) and Test of Variables of Attention (TOVA).

RESULTS

Higher weight-for-age z-scores (adjusted odds ratio (aOR) = 0.74; 95% confidence interval (CI) = 0.53, 0.98; P = 0.04), better maternal education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03). and better household head education (aOR = 0.86; 95% CI = 0.78, 0.96; P = 0.03) at six to eight months of age were associated with lower odds of scoring below average on KABC-II categorical scores at eight years of age. Motor composite scores and maternal parity at six to eight months of age were positively associated with auditory and visual TOVA scores (all P-values <0.05) at eight years. Cognitive composite scores at six to eight months of age were positively associated with visual TOVA scores (P < 0.05). In contrast, weight-for-length z-scores and household head age were negatively associated with both auditory and visual TOVA scores (P < 0.05). Being a female child was associated with lower auditory and visual TOVA scores (P < 0.05).

CONCLUSIONS

At six to eight months of age, growth and development, gender, maternal education and parity, and household head age and education were associated with child development at eight years. Interventions emphasising improved growth and development in infancy, as well as parental educational attainment, may improve long-term developmental outcomes.

摘要

背景

在低收入和中等收入国家，早期生活暴露与儿童后期发育之间的联系尚未得到充分研究。我们研究了社会人口统计学变量、6至8个月时的生长发育与8岁时发育结果之间的关联。

方法

我们使用了一项孕产妇教育试验的数据，该试验包括511对母婴，孩子年龄在6至8个月（基线）。在这项随访研究中，有361对母婴的数据可用。通过问卷收集社会人口统计学变量。生长情况（人体测量学）由研究人员测量，并根据世界卫生组织（WHO）生长标准转换为z分数。基线时儿童发育（认知、运动和语言）使用贝利婴幼儿发展量表第三版（BSID-III）进行评估。8岁时的发育使用两种神经心理学工具进行测量：考夫曼儿童评估量表第二版（KABC-II）和注意力变量测试（TOVA）。

结果

6至8个月时较高的年龄别体重z分数（调整优势比（aOR）=0.74；95%置信区间（CI）=0.53，0.98；P= 0.04）、更好的母亲教育程度（aOR=0.86；95%CI=0.78，0.96；P=0.03）和更好的户主教育程度（aOR=0.86；95%CI=0.78，0.96；P=0.03）与8岁时KABC-II分类得分低于平均水平的较低几率相关。6至8个月时的运动综合得分和母亲生育次数与8岁时的听觉和视觉TOVA得分呈正相关（所有P值<0.05）。6至8个月时的认知综合得分与视觉TOVA得分呈正相关（P<0.05）。相比之下，身长别体重z分数和户主年龄与听觉和视觉TOVA得分均呈负相关（P<0.05）。女童与较低的听觉和视觉TOVA得分相关（P<0.05）。