Lobo Eunice, R Deepa, Mandal Siddhartha, Menon Jyothi S, Roy Aditi, Dixit Shweta, Gupta Ruby, Swaminathan Sumathi, Thankachan Prashanth, Bhavnani Supriya, Divan Gauri, Prabhakaran Poornima, van Schayck Onno Cp, Babu Giridhara Rathnaiah, Srinivas Prashanth Nuggehalli, Mukherjee Debarati
Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bangalore, India.
Institute of Public Health Bengaluru, Bengaluru, Karnataka, India.
Wellcome Open Res. 2024 Nov 22;9:486. doi: 10.12688/wellcomeopenres.22817.2. eCollection 2024.
Over 250 million children are developing sub-optimally due to their exposure to early life adversities. While previous studies have examined the effects of nutritional status, psychosocial adversities, and environmental pollutants on children's outcomes, little is known about their interaction and cumulative effects.
This study aims to investigate the independent, interaction, and cumulative effects of nutritional, psychosocial, and environmental factors on children's cognitive development and mental health in urban and rural India. It also seeks to explain pathways leading to inequities in child outcomes at the individual, household, and neighbourhood levels.
A mixed-methods prospective cohort study will be conducted on 1600 caregiver-child dyads (child age 3-10 years) in urban and rural India. Nutritional status, psychosocial adversities, environmental pollutants, and child mental health outcomes will be assessed using parent-report questionnaires. Performance-based measures will be used to assess cognitive outcomes. Venous blood and urine samples will be used to measure nutritional and pesticide biomarkers in 500 children. Indoor air pollution will be monitored in 200 households twice, during two seasons. Multilevel regression, weighted quantile sum regression, and Bayesian kernel machine regression will assess the individual and combined effects of exposures on child outcomes. Thematic analysis of in-depth interviews and focus group discussions will explore pathways to middle-and late childhood development inequities.
The data will be used to formulate a Theory of Change (ToC) to explain the biological, psychosocial, and environmental origins of children's cognitive and mental health outcomes across the first decade of life in diverse Indian settings, which can inform interventions targets for promoting children's outcomes beyond the first 1000 days, potentially generalizable to similar under-resourced global settings. The COINCIDE research infrastructure will comprise a valuable global health resource, including prospective cohort data, validated study tools, and stored biological and environmental samples for future studies.
超过2.5亿儿童由于早年经历逆境而发育欠佳。虽然此前的研究考察了营养状况、心理社会逆境和环境污染物对儿童发育结果的影响，但对于它们之间的相互作用和累积效应却知之甚少。
本研究旨在调查营养、心理社会和环境因素对印度城乡儿童认知发展和心理健康的独立、相互作用及累积效应。研究还试图解释在个体、家庭和社区层面导致儿童发育结果不平等的途径。
将对印度城乡1600对照顾者-儿童二元组（儿童年龄3至10岁）开展一项混合方法的前瞻性队列研究。营养状况、心理社会逆境、环境污染物和儿童心理健康结果将通过家长报告问卷进行评估。基于表现的测量方法将用于评估认知结果。将采集500名儿童的静脉血和尿液样本，以测量营养和农药生物标志物。将在两个季节对200户家庭的室内空气污染进行两次监测。多水平回归、加权分位数和回归以及贝叶斯核机器回归将评估暴露因素对儿童发育结果的个体和综合效应。对深入访谈和焦点小组讨论进行主题分析，将探索儿童中期和晚期发育不平等的途径。
这些数据将用于制定一个变革理论（ToC），以解释在印度不同环境下儿童生命最初十年认知和心理健康结果的生物学、心理社会和环境根源，这可为促进儿童1000天之后发育结果的干预目标提供信息，有可能推广到资源匮乏情况类似的全球环境。COINCIDE研究基础设施将成为一项宝贵的全球卫生资源，包括前瞻性队列数据、经过验证的研究工具以及为未来研究储存的生物和环境样本。
