Child Development: Risk Factors for Adverse Outcomes in Developing Countries

Epidemiology Research Unit, The University of the West Indies, Mona, Jamaica.
The Lancet (Impact Factor: 45.22). 02/2007; 369(9556):145-57. DOI: 10.1016/S0140-6736(07)60076-2
Source: PubMed


Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifiable biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine deficiency, and iron deficiency anaemia. The evidence is also sufficient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the effect of other potential risk factors on child development. The prevalence of the risk factors and their effect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse effects on the development of the world's poorest children.

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    • "These workers suggest that individuals can be in a psychological state termed " uncertainty to the unfamiliar " and it is this which elicits inhibited behavior. Walker et al. (2007) reported that in young children (wasting) being underweight at the time of testing, and stunting are associated with apathy and less positive affect, and in addition studies showed stunting to be associated with poorer attention and social relations. A study of undernourished children in Bangladesh showed that greater stunting and wasting was associated with less sociability, greater fearfulness , more negative emotionality and less attentiveness (Baker- Henningham, Hamadani, Huda, & Grantham-McGregor, 2009). "
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    ABSTRACT: Previous work has shown that malnutrition has deleterious effects on both IQ and aspects of temperament. It is hypothesized that while malnutrition bears a direct relation to IQ, aspects of temperament are also involved in a mediating role so that they produce indirect associations between malnutrition and IQ. The study examines the association of 3 indices of malnutrition-stunting, anemia and wasting-to Verbal IQ (VIQ) and Performance IQ (PIQ) and temperament in 1,376 3-year-old and 11-year-old children in Mauritius. Two dimensions of temperament were extracted from ratings of behavior and were labeled as Uninhibited (UI) and Task Orientation (TO). At age 3 stunting had direct relations to Verbal IQ and Performance IQ and also indirect relations via the mediating effect of temperament (UI but not TO). In the case of anemia there were no direct relations to VIQ or PIQ but both temperament meditators were involved in indirect relations. For wasting, indirect but not direct relations were observed. When age 11 cognitive performance was examined, there were direct relations to stunting and anemia and indirect relations via UI, but not TO. The relations between malnutrition and IQ were graded and linear showing that it is not only when malnutrition is defined by its severest levels that it has an effect on cognitive performance. It is suggested that malnutrition affects those brain structures and functions that are involved in both cognitive behavior and temperament. (PsycINFO Database Record
    Developmental Psychology 11/2015; DOI:10.1037/dev0000046 · 3.21 Impact Factor
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    • "In the last decade, parenting programs have been effectively implemented in low-and middle-income countries (LMIC) to improve child nutrition and stimulation, two primary contributors to poor child development (Walker et al., 2007). Given the reliable relationship identified between parenting difficulties and maternal depression (Murray et al., 2014), existing strategies promoting relevant parenting ultimately depend on the mother's psychological well-being. "
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    ABSTRACT: Rationale: A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12-36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up. Objectives: The objectives of this study were to describe and critically examine a) perceived barriers and facilitators related to implementation processes of intervention content, training and supervision and delivery from the perspectives of delivery agents and supervisors; b) perceived barriers and facilitators related to enactment of practices from the perspective of intervention mothers participating in the parenting program; and c) whether the program was implemented as intended. Methods: Semi-structured interviews were conducted at midline with peer delivery agents (n = 12) and intervention mothers (n = 31) and at endline with supervisors (n = 4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators of intervention content, training and supervision, delivery and enactment. Additionally, mothers' recall and enactment of practices were coded and analyzed statistically. Monitoring of group sessions and home visits were examined to reveal whether the program was implemented as intended. Results: Among the program's five key messages, 'love and respect' targeting maternal psychological well-being was the most practiced by mothers, easiest to implement by delivery agents, and mothers reported the most internal facilitators for this message. A detailed manual and structured monitoring forms were perceived to facilitate training, intervention delivery, and supervision. Interactive and active strategies based on social-cognitive learning theory were reported as facilitators to intervention delivery. Only program attendance, but not barriers, facilitators or message recall, was significantly positively related to message enactment. Monitoring of group sessions and home visits showed that the program was largely implemented as intended. Conclusions: This implementation assessment revealed a number of important barriers and facilitators from the perspectives of delivery agents, supervisors and program participants. The methods and results are useful to examining and informing the content, delivery, and scaling up of the current program as well as future mother-child interventions in LMIC settings.
    Social Science [?] Medicine 11/2015; 147. DOI:10.1016/j.socscimed.2015.10.069 · 2.89 Impact Factor
    • "Many factors influence infant caregiving, infant development, and caregiver–infant relationships, but few studies to date have examined variation in infant caregiving in LMIC, our third question. As it happens, most of the world's very young children live in LMIC—an estimated 560 million children under 5 years of age (Grantham-McGregor et al., 2007)—but precious little is known about the caregiving they receive or how it matters (Tomlinson, Bornstein, Marlow, & Swartz, 2014; Walker et al., 2007). The contemporary developmental literature is demonstratively skewed to populations living in technologically advanced high-income countries (HIC). "
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    ABSTRACT: Caregiving is requisite to wholesome child development from the beginning of life. A cross-sectional microgenetic analysis of six caregiving practices across the child's 1st year (0-12 months) in 42,539 families from nationally representative samples in 38 low- and middle-income countries is reported. Rates of caregiving varied tremendously within and across countries. However, caregiving practices followed one of two developmental trajectories: (a) greater proportions of caregivers read, told stories, and named, counted, and drew with each additional month of infant age, and (b) proportions of caregivers who played, sang songs, and took their infants outside increased each month from birth but reached an asymptote at 4-5 months. Rates and growth functions of caregiving have implications for infant care and development. Published 2015. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
    Child Development 08/2015; 86(5). DOI:10.1111/cdev.12402 · 4.92 Impact Factor
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