Melissa Gladstone

Melissa Gladstone
University of Liverpool | UoL · Department of Women's and Children's Health

MBChB., M.D., FRCPCH, BSc Dip Neurodisability

About

202
Publications
93,496
Reads
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Introduction
My research focuses on the assessment and interventions for children with developmental and disabilities in low income settings globally. I am presently undertaking large field studies in a number of African linking child development/behaviour with environmental factors, infections and nutrition which may influence it. I aim to understand how interventions supporting children in early years can be inclusive of children with neurodevelopmental disorders and how they can be best used in the community. I created a tool, the MDAT, now used in over 12 countries for the developmental assessment (https://mdatchilddevelopmentanddisability.liv.ac.uk) and am leading a study to identify children with disabilities earlier https://www.liverpool.ac.uk/translational-medicine/research/indigo-study)
Additional affiliations
February 2004 - June 2006
University of Malawi
Position
  • Lecturer
January 2014 - present
Alder Hey Children's NHS Foundation Trust
Position
  • Senior Lecturer Neurodevelopmental Paediatrics
January 2014 - present
University of Liverpool
Position
  • Professor (Associate)
Education
September 2012 - August 2013
London School of Hygiene and Tropical Medicine
Field of study
  • Diploma in Practical Epidemiology
January 2004 - January 2008
Sheffield Hallam University
Field of study
  • Diploma in Paediatric Neurodisability
January 2004 - June 2010
University of Liverpool
Field of study
  • Medicine - Women and Children's Health MD

Publications

Publications (202)
Article
Full-text available
Background Although 80% of children with disabilities live in developing countries, there are few culturally appropriate developmental assessment tools available for these settings. Often tools from the West provide misleading findings in different cultural settings, where some items are unfamiliar and reference values are different from those of W...
Article
Full-text available
Background Premature birth is the leading cause of neonatal death and second leading in children under 5. Information on outcomes of preterm babies surviving the early neonatal period is sparse although it is considered a major determinant of immediate and long-term morbidity. Methods Systematic review of studies reporting outcomes for preterm bab...
Article
Full-text available
Background Annually 125 million pregnancies are at risk of malaria infection. However, the impact of exposure to malaria in pregnancy on neurodevelopment in children is not well understood. We hypothesized that malaria in pregnancy and associated maternal immune activation result in neurodevelopmental delay in exposed offspring. Methods and findin...
Article
Full-text available
Background: The early childhood years provide an important window of opportunity to build strong foundations for future development. One impediment to global progress is a lack of population-based measurement tools to provide reliable estimates of developmental status. We aimed to field test and validate a newly created tool for this purpose. Met...
Article
Full-text available
Background Globally, nearly 250 million children (43% of all children under 5 years of age) are at risk of compromised neurodevelopment due to poverty, stunting, and lack of stimulation. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved infant and young child feeding (IYCF) on early child...
Preprint
Full-text available
Objectives: The scarcity of epidemiological data on anaemia in low- and middle-income countries, coupled with poor characterisation of overlapping risk factors in high-risk settings and contrasting approaches to the assessment of iron status with inflammation, represent critical gaps to address. This study aimed to characterise the prevalence and p...
Preprint
Full-text available
Maternal depression affects one in five women in Malawi. Integrated interventions simultaneously addressing multiple risks are a promising strategy to improve mental health. This study evaluated the impact of a nutrition-sensitive social behaviour change (SBC) interventions (agriculture and livelihoods, male engagement, and Caring for the Caregiver...
Article
The lack of a valid and interpretable score to track early child development over time is a primary reason for neglecting child development in policymaking. Many instruments exist, but there is no accepted method for comparing their scores across different ages, samples, and instruments. This paper aims (1) to enhance the Development Score (D-score...
Article
Background Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well...
Article
Full-text available
This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster‐randomized controlled trial implemented in rural Malawi (2022–2025). We fit an evidence‐based theoretical model using structural equation modelling examining fo...
Article
Full-text available
Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Althou...
Article
Full-text available
Introduction Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings wher...
Article
Full-text available
Importance The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way. Objective To develop a core...
Article
Background Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods We piloted and adapted two subtests within the planning domain of the Kaufman Assessment Battery for Children-2nd edition (KABC-II) for use in...
Article
Full-text available
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of...
Preprint
Full-text available
Introduction: Early childhood development forms the foundations for functioning later in life. Thus, the ability to accurately monitor developmental trajectories is critical. However, such monitoring is complicated by reliance on time-intensive assessments which often necessitate administration by skilled professionals. This difficulty is exacerbat...
Preprint
Full-text available
This cohort profile paper describes a large longitudinal prenatal birth cohort study with Rohingya refugee and host communities in Cox’s Bazar, Bangladesh. Over the course of 12 months, this study recruited 2889 pregnant women, a subsample of husbands (N=853), and, where present, an existing child aged 36 to 60 months (Early Years cohort / EY; n=52...
Article
Full-text available
Background PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods The PREC...
Article
The term ‘executive functions’ (EFs) refers to a set of skills that support flexible control over thought and action. Classic EFs (working memory, inhibitory control, and cognitive flexibility) do not show measurable stable function until after the third year of life and continue to develop into early adulthood. However, even at the earliest ages,...
Article
Full-text available
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with...
Article
Full-text available
Aim To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21‐year period. Method The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021. Results A total of 1811 articles underwent review agai...
Preprint
Full-text available
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFA) and lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modif...
Preprint
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation (PS) has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the developme...
Article
Full-text available
Background Standards of early childhood development (ECD) are needed to determine whether children living in different contexts are developmentally on track. The Early Childhood Development Index 2030 (ECDI2030) is a population-level measure intended to be used in household surveys to collect globally comparable data on one of the indicators chosen...
Preprint
Full-text available
Background To assess the neurodevelopment of children under three years, a multinational team of subject matter experts (SMEs) led by the World Health Organization (WHO) developed the Global Scales for Early Development (GSED). The measures include 1) a caregiver-reported short form (SF), 2) a directly administered long form (LF), and 3) a caregive...
Article
Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors then influenced by postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of placental complications as well as e...
Article
Background Early diagnosis of cerebral palsy is possible by 5 months corrected age for ‘at‐risk’ infants, using diagnostic tools such as the Hammersmith Infant Neurological Examination (HINE), Prechtl's General Movements Assessment (GMA) and magnetic resonance imaging (MRI). This is an uncertain and stressful time for parents where provision of app...
Article
Background : There is a need for follow-up of early-life stunting intervention trials into childhood to determine their long-term impact. A holistic school-age assessment of health, growth, physical and cognitive function will help to comprehensively characterise the sustained effects of early-life interventions. Methods: The Sanitation Hygiene Inf...
Conference Paper
Objectives This study reports on the creation and validation of the Global Scales for Early Development (GSED), an ambitious measure of child development that can be used across countries for 0–3-year-olds. The GSED measure is designed to: i) contribute to the assessment of UN Sustainable Development Goal (SDG) 4.2.1, the ‘proportion of children de...
Article
Full-text available
Introduction We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to address the shortage of school-age assessment tools that combine growth, physical and cognitive function. Here we present i) development, acceptability and feasibility of the SAHARAN toolbox; ii) characteristics of a pilot co...
Preprint
Full-text available
Background: More than 250 million children below 5 years, many of them in sub-Saharan Africa, do not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation (PS) alongside nutritional supplementation has shown promising effects on improving development in children exposed to severe acute malnutrition (SAM) but p...
Article
Full-text available
Cerebral malaria (CM) remains a significant global health challenge with high morbidity and mortality. Malarial retinopathy has been shown to be diagnostically and prognostically significant in the assessment of CM. The major mechanism of death in paediatric CM is brain swelling. Long term morbidity is typically characterised by neurological and ne...
Article
Full-text available
Interest in measuring cognition in children in low-resourced settings has increased in recent years, but options for cognitive assessments are limited. Researchers are faced with challenges when using existing assessments in these settings, such as trained workforce shortages, less relevant testing stimuli, limitations of proprietary assessments, a...
Article
Full-text available
Although access to effective medical care for acutely sick children has improved globally, the number of children surviving but who may not be thriving due to disability, is increasing. This study aimed to understand the views of health professionals, educators and caregivers of pre-school children with disabilities in Malawi, Pakistan and Uganda r...
Article
Full-text available
Introduction Children’s early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children’s early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Ear...
Article
Full-text available
Introduction With the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early Development (GSED) project aims to provide population and programmatic level measures of ECD for 0–3 years that are valid, reliable and have psychometrically...
Article
Full-text available
Background Complications of prematurity are the leading cause of neonatal mortality, and the majority of these deaths occur in low and middle-income countries. Research in these settings has focused on improved outcomes for preterm infants in hospital settings, however, research into the continuation of preterm care in the home after discharge from...
Article
Full-text available
Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods: The PRE...
Article
Background: Neurodevelopment assessment tools for low-resource settings are urgently needed. However, most available tools were developed in high-income settings and may lack cross-cultural validity. Methods: We piloted and adapted two subtests (pattern reasoning and story completion) within the Kaufman Assessment Battery for Children-2 nd edition...
Article
Full-text available
Background Children born small for gestational age (SGA) may experience more long-term neurodevelopmental issues than those born appropriate for gestational age (AGA). This study aimed to assess differences in the neurodevelopment of children born SGA or AGA within a periurban community in Pakistan. Methods This was a prospective cohort study in w...
Article
Malaria in pregnancy (MIP) causes poor birth outcomes, but its impact on neurocognitive development has not been well characterized. Between 2012 and 2014, we enrolled 307 mother-infant pairs and monitored 286 infants for neurocognitive development using the Malawi Developmental Assessment Tool at 6, 12, and 24 months of age. MIP was diagnosed from...
Article
Full-text available
BACKGROUND AND OBJECTIVES Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness. METHODS Children aged 2...
Article
Full-text available
Introduction Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. Methods A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a clus...
Article
Full-text available
Objective Children with developmental disabilities are associated with a high risk of poor school enrollment and educational attainment without timely and appropriate support. Epidemiological data on cerebral palsy and associated comorbidities required for policy intervention in global health are lacking. This paper set out to report the best avail...
Preprint
Full-text available
Background: There is a need for follow-up of early-life stunting intervention trials into childhood to determine their long-term impact. A holistic school-age assessment of health, growth, physical and cognitive function will help to comprehensively characterise the sustained effects of early-life interventions. Methods The Sanitation Hygiene Infan...
Conference Paper
Aims Maternal responsiveness, defined as the mother’s ability to perceive their infant’s behaviour and respond appropriately, may impact early child development (ECD). The quality of maternal responsiveness may be reduced by maternal depression. This sub-study of the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe aims...
Conference Paper
Aims Cerebral palsy (CP) is a disorder of movement and posture¹ due to a defect or lesion of the immature brain it requires treatments and therapies from a young age which would need to be carried out throughout their lives. Around 2 per 1000 live births are diagnosed in the UK.² Goal setting is a recommended part of therapy and is being used more...
Conference Paper
Full-text available
Aims School-age health, growth and development are poorly characterised in low- and middle-income countries. School-age is both highly predictive of adult function as well as an important age for protective interventions. We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to measure growth,...
Article
Full-text available
Background Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. Methods We systematically searched MEDLINE, EMBASE, Global Hea...
Article
Full-text available
Background: Invasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants aged <90 days in Blantyre, Malawi over a 14-year period and evaluated the indirect impact of...
Article
Full-text available
Background We are now moving beyond the focus of ‘child survival’ to an era which promotes children thriving and developing rather than simply ‘surviving’. In doing so, we are becoming more aware of the large variation of child development screening tools available globally, but in particular, those in low/middle-income countries (LMICs). Methods...
Preprint
Full-text available
Background Rates of disability are high in resource-poor settings with eighty-five percent of disabled children living in these settings. Long-term caregiving for disabled children is associated with fatigue, financial difficulties, parenting distress, and other psychological issues. Studies have shown a link between parenting children with intelle...
Preprint
Full-text available
Background Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. Methods We systematically searched MEDLINE, EMBASE, Global Hea...
Article
Full-text available
Background Despite recent advances in treatment and prevention, the prevalence of cerebral malaria (CM) remains high globally, especially in children under 5 years old. As treatment improves, more children will survive episodes of CM with lasting neurodisabilities, such as social and behavioural issues. Behaviour problems in children who survive CM...
Article
Full-text available
The likelihood of a newborn child dying before their fifth birthday (under-5 mortality rate) is universally acknowledged as a reflection of the social, economic, health, and environmental conditions in which children (and the rest of society) live, but little is known about the likelihood of a newborn child having a lifelong disability before their...
Article
Full-text available
The composition of the maternal vaginal microbiome influences the duration of pregnancy, onset of labor, and even neonatal outcomes. Maternal microbiome research in sub-Saharan Africa has focused on non-pregnant and postpartum composition of the vaginal microbiome. Here we aimed to illustrate the relationship between the vaginal microbiome of 99 la...
Article
Introduction Congenital and infantile hydrocephalus are assumed to be major contributors to pediatric morbidity, mortality and functional disability in low-income countries. Despite this, epidemiologic data and the overview of neurodevelopmental outcomes in these regions is very limited. We aimed to pilot the use of a wide range of more locally sui...
Article
Full-text available
Children with severe acute malnutrition (SAM) remain vulnerable after treatment at nutritional rehabilitation units (NRUs). The objective was to assess the concurrent pathways in a hypothesized model between caregiver body mass index (BMI), the home environment, and child nutritional status, and development (gross motor, fine motor, language, and s...
Preprint
Full-text available
Background: Invasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants aged <90 days in Blantyre, Malawi over a 14 year period and evaluated the impact of the 12 No...
Article
Full-text available
Background: Children with severe acute malnutrition (SAM) who require nutritional rehabilitation unit (NRU) treatment often have poor developmental and nutritional outcomes following discharge. The Kusamala Program is a 4-d hospital-based counseling program for caregivers of children with SAM that integrates nutrition, water, sanitation, and hygie...
Article
Malaria is a substantial febrile illness threat for children living in or travelling from endemic countries. It is a medical emergency but outcomes are better when there is prompt assessment, treatment and appropriate specialist input. It is one of the most common imported infections in the United Kingdom, and children are particularly vulnerable t...