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Social Ecological Factors Influencing Children's School Readiness in Low-Income South African Communities
Early Education and Development
... In South Africa (SA), a Majority World country (Alam 2019;Draper et al. 2022;Khan et al. 2022), the importance of social emotional development for school readiness has been recognised (Goldschmidt and Pedro 2020;Munnik and Smith 2019). School readiness is a highly salient issue in South Africa, and it is generally acknowledged to encompass a range of developmental skills that children need to successfully navigate the school environment, such as cognitive, social emotional, motor, early literacy and early numeracy skills (Draper et al. 2024). A national study with 4-year-old children has highlighted the positive association between social emotional development and learning outcomes (Giese et al. 2022;Tredoux et al. 2023), and social emotional functioning was positively associated with 'positive deviance' (i.e., children from low-income settings who outperform their peers) (Henry and Giese 2023). ...
... Home visitors were also trained to use the social emotional subsection of the International Development and Early Learning Assessment (IDELA, suitable for children 3-6 years old) (Pisani, Borisova, and Dowd 2018) with the child. The SDQ is used extensively across diverse global settings, and the IDELA is also optimised for use across global settings and has been used previously in this age group in SA (Draper et al. 2024). In this sample, the SDQ and the social emotional section of IDELA showed acceptable internal reliability (> 0.7). ...
To address the need for interventions targeting social emotional development and mental health of young children in South Africa, the Mazi Umntanakho (‘know your child’) digital tool was co‐designed, and piloted with caregivers and 3–5‐year‐old children involved in home visiting programmes promoting early childhood development. The aim of this study was to qualitatively evaluate the feasibility and acceptability of this tool in four urban and four rural low‐income communities, from the perspective of home visitors and caregivers. Focus groups were conducted with home visitors ( n = 117) and caregivers ( n = 72). Issues relating to the feasibility of implementing the tool included timing of using the tool, technical and social implementation challenges, WhatsApp as the preferred platform, and participants' recommendations for future implementation. Overall, the tool was acceptable for home visitors and caregivers and was perceived to have a positive impact on children's development, and the relationship between caregivers and children.
This qualitative study aimed to capture community perspectives of the risks and protective factors for social emotional development and mental health of young children in low-income South Africa settings, and was conducted as one component of a larger study with the ultimate aim of co-designing the Mazi Umntanakho (‘know your child’) digital tool. Twenty focus group discussions (n = 154, 97% female) were held with staff of community-based organisations (CBOs) and community health worker (CHW) programmes in urban and rural sites from four geographical regions. Data were analysed thematically, and grouped according to components of nurturing care (responsive caregiving, safety and security, good health, adequate nutrition, opportunities for early learning) and risk and protective factors. Risks reported by participants far outweighed protective factors, and the most dominant theme identified was risks associated with responsive caregiving from CBO and CHW perspectives. These related to participants’ perceptions of caregivers’ attitudes, knowledge, beliefs, behaviours, and challenges not conducive to the provision of responsive caregiving. The most commonly perceived risks to safety and security were substance abuse, along with economic challenges, neglect, abuse and violence. Basic needs not being met was reported as the main risk to adequate nutrition and good health, followed by insufficient services. Limited resources and caregivers’ limited education and literacy were perceived to be risks to early learning. These findings highlight the urgent need to mitigate risks and amplify protective factors for the social emotional development and mental health of young children in South Africa. It is critical that these are considered within the contextual realities of low-income communities.
Direct assessments of executive functions (EFs) are increasingly used in research and clinical settings, with a central assumption that they assess “universal” underlying skills. Their use is spreading globally, raising questions about the cultural appropriateness of assessments devised in Western industrialized countries. We selectively reviewed multidisciplinary evidence and theory to identify sets of cultural preferences that may be at odds with the implicit assumptions of EF assessments. These preferences relate to motivation and compliance; cultural expectations for interpersonal engagement; contextualized vs. academic thinking; cultural notions of speed and time; the willingness to be silly, be incorrect, or do the opposite; and subject-matter familiarity. In each case, we discuss how the cultural preference may be incompatible with the assumptions of assessments, and how future research and practice can address the issue. Many of the cultural preferences discussed differ between interdependent and independent cultures and between schooled and unschooled populations. Adapting testing protocols to these cultural preferences in different contexts will be important for expanding our scientific understanding of EF from the narrow slice of the human population that has participated in the research to date.
Background
Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes.
Methods
The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children’s mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children’s developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers’ parenting stress, child stimulation practices, and child developmental outcomes.
Results
The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers’ stimulation practices and children’s developmental outcomes were not universally supported.
Conclusion
The findings show that improved caregiver stimulation practices are likely to improve children’s developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs.
Trial registration
Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID number: PACTR20180774832663 Date: 26/July/2018.
We report on a national South African multistage cluster sampling survey of early development in 5,222 children aged 50-59 months enrolled in preschool programmes. Children were assessed on the Early Learning Outcomes Measure (ELOM 4&5), the ELOM Social-Emotional Rating Scale, and linear growth (height-for-age), in the last quarter of 2021. ELOM 4&5 is standardised for South Africa and measures development in five domains: Gross Motor, and Fine Motor Development, Numeracy and Mathematics, Cognition and Executive Functioning, and Literacy and Language skills. Cut scores are used to classify children as On Track, Falling Behind, or Falling Far Behind expected developmental standards. Post-survey weights were computed, permitting us to interpret results as representative of children attending early learning programmes. Only 45.7% of the sample were On Track overall. Apart from Literacy and Language (54.7%), no other domain exceeded 50% On Track. Children who were better off socio-economically achieved higher scores (except for Gross Motor Development). Height-for-age measurements revealed a stunting rate of 5.1%, (>8.8% in one province). A mixed linear model analysis showed that age, sex, quintile, growth status, and socio-emotional score were significant predictors of the total ELOM 4&5 score, with growth status and quintile being stronger predictors. The results indicate concerningly poor preparedness for school. Two further surveys prior to 2030 will be undertaken and used to establish the country’s progress toward meeting Sustainable Development Goal 4.2: “all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”.
Background
Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings.
Methods
We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey.
Results
Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16).
Conclusion
Our study findings suggest a strong positive link between maternal stimulation activities and children’s developmental outcomes among communities in poor rural settings.
Trial registration
NA (not a clinical trial).
Background: While there is now considerable evidence in support of a relationship between executive function (EF) and academic success, these findings almost uniformly derive from Western and high-income countries. Yet, recent findings from low- to -middle-income countries have suggested that patterns of EF and academic skills differ in these contexts, but there is little clarity on the extent, direction and nature of their association.
Aim: This study aimed to investigate the contribution of EF to pre-academic skills in a sample of preschool children (N = 124; Mage = 50.91 months; 45% female).
Setting: Two preschools were recruited from an urban setting in a community with both formal and informal housing, overcrowding, high levels of crime and violence, and poor service delivery. Three preschools were recruited from rural communities with household plots, a slow rate of infrastructure development, reliance on open fires for cooking, limited access to running water and rudimentary sanitation.
Methods: Pre-academic skills were assessed using the Herbst Early Childhood Development Criteria test, and EF was assessed using the Early Years Toolbox.
Results: Although EF scores appeared high and pre-academic skills were low (in norm comparisons), EF inhibition (ß = 0.23, p = 0.001) and working memory (ß = 0.25, p 0.001) nevertheless showed strong prediction of pre-academic skills while shifting was not significant.
Conclusion: While EF is an important predictor of pre-academic skills even in this low- and middle-income country context, factors in addition to EF may be equally important targets to foster school readiness in these settings.
Contribution: The current study represents a first step towards an understanding of the current strengths that can be leveraged, and opportunities for additional development, in the service of preparing all children for the demands of school.
A child’s home environment has been shown to be related to the development of early numeracy skills in some countries. However, significant relationships between home learning environment and math achievement have not consistently been found, and likely vary across different cultural and socio-political contexts. Here we explored the home environment and early numeracy skills of 243 children (3-5 years), who were not attending preschool programmes in very low-income settings in Cape Town, South Africa. Caregivers completed a questionnaire including information regarding experiences of children in the home; children completed a number identification task, a counting task and the Give-N task. The amount of resources in the home learning environment (e.g. the number of books and toys), frequency of home learning activities caregivers did with their children, and caregiver levels of education and income were not associated with number knowledge. While the home learning environment has been shown to be important for developing early numeracy skills in previous research, this study suggests that factors other than the home learning environment may also be important targets to foster numeracy skills and school readiness in low-income settings in South Africa.
This paper used longitudinal data from five studies conducted in Bangladesh, Bhutan, Cambodia, Ethiopia, and Rwanda to examine the links between family stimulation and early childhood development outcomes ( N = 4904; M age = 51.5; 49% girls). Results from random‐effects and more conservative child‐fixed effects models indicate that across these studies, family stimulation, measured by caregivers’ engagement in nine activities (e.g., reading, playing, singing), predicted increments in children's early numeracy, literacy, social‐emotional, motor, and executive function skills (standardized associations ranged from 0.05 to 0.11 SD ). Study‐specific models showed variability in the estimates, with null associations in two out of the five studies. These findings indicate the need for additional research on culturally specific ways in which caregivers may support early development and highlight the importance of promoting family stimulation to catalyze positive developmental trajectories in global contexts.
Research Highlights
Research on the links between family stimulation and early childhood development in low‐and‐middle‐income countries (LMICs) is limited.
We used longitudinal data from studies conducted in five LMICs to examine the links between family stimulation and early childhood development outcomes.
Results suggest that family stimulation predicted increments in children's numeracy, literacy, social‐emotional, motor, and executive function skills.
We found variability in the observed estimates, with null associations in two out of the five studies, suggesting the need for additional research in LMICs.
A child must be exposed to early learning situations and assisted in developing the skills and ways of functioning to develop, thrive, and be ready for school. It is established that poor school readiness preparation (SRP) negatively impacts subsequent learning outcomes. A qualitative study was conducted in Gugulethu, a poor community in the Western Cape province in South Africa, to determine how Early Childhood Development centres in a poor community prepare children for schooling. The study involved a sample of 12 community-based ECD centres. Interviews and focus group discussions were conducted with direct role-players, including principals, practitioners, and ECD industry key informants. Data was enriched through direct observation of operations at each facility. The study found that all the community-based ECD centres struggle to provide quality SRP. Contributing factors include limited ECD practitioner training, education resources, infrastructure, and facility management. Because these conditions relate to poverty, they affect the SRP of most children in poorer communities, such as Gugulethu, who tend to only have access to under-resourced ECD centres. The study concludes that, given the appalling performance of South Africa’s basic education system, the government has to accept that improving its learning outcomes begins with vastly improving the SRP of children from birth.
It has become increasingly apparent that publishing research on child development from certain countries is especially challenging. These countries have been referred to collectively as the Majority World, the Global South, non-WEIRD (Western, Educated, Industrial, Rich, and Democratic), or low-and middle-income countries. The aim of this paper is to draw attention to these persistent challenges , and provide constructive recommendations to contribute to better representation of children from these countries in child development research. In this paper, we outline the history of publication bias in developmental science , and issues of generalization of research from these countries and hence where it 'fits' in terms of publishing. The importance of explaining context is highlighted, including for research on measurement child development outcomes , and attention is drawn to the vicious publication
South Africa’s basic education system is dysfunctional. It scores last or close to last in a myriad of metrics and delivers learners with some of the worst literacy and numeracy competencies worldwide. A bimodal distribution in the results exists when learners from the richest socioeconomic quintile are performing adequately well, while learners from the poorest quintiles are failing. This paper presents a system dynamics simulation model to describe the causal linkages between improved early childhood and pre-school learning practices on the education system as a whole. The paper investigates the difference in performance between rich and poor communities. Three interventions explore the research question of whether it is the number of enrolments into early childhood development programs that increases a cohort’s school readiness, or rather the quality of the early childhood development programs into which they were enrolled. The results answer the research question for the Western Cape province by showing that increasing the quality of the formal ECD programs leads to a greater percentage of school-ready five year olds than increasing the percentage of enrolled children, but that decreasing community poverty leads to better results than either intervention. The results show the simulation model to be a powerful tool to assist with policy setting and intervention testing for any other province or country by simply changing the input data and calibration.
Abstract Background Many children in low- and middle-income countries fail to reach their cognitive potential, with experiences before age 3 critical in shaping long-term development. Zanzibar’s Jamii ni Afya program is the first national, digitally enabled community health volunteer (CHV) program promoting early childhood development (ECD) following the Nurturing Care Framework within an integrated maternal and child healthcare package. Using program baseline data, we explored home environment, caregivers’ parenting, health and nutrition knowledge and practices, and ECD outcomes in Zanzibar. Methods We conducted a national household survey among 499 children aged 18-29 months using two-stage cluster sampling in February 2019. The primary outcome was child development score measured using the Caregiver Reported Early Developmental Index (CREDI), with higher scores representing higher levels of child development. We analyzed CREDI scores, along with MICS questions on parenting knowledge, practices, and characteristics of the home environment. We developed multivariate regression models to assess associations between caregiver-child interactions, knowledge of dietary diversity, and ECD. Results Ten percent of children had overall CREDI z-scores 2 standard deviations [SD] or more below the global reference population mean, with 28% of children at risk of developmental delay with z-scores 1 SD or more below the mean. Cognitive and language domains were of highest concern (10.2 and 12.7% with z-score
Early childhood care and education (ECCE) programs are an important mechanism for supporting foundational skill development and successful progression through later schooling. School readiness assessments that serve as reliable indicators of children’s later educational outcomes are most useful for education systems, but little is known about how well-existing assessments predict primary school performance in low- and middle-income countries. This study uses longitudinal data from Ghana to investigate how the International Development and Early Learning Assessment (IDELA) predicts future reading and math skills as measured by the Early Grade Reading Assessment (EGRA) and Early Grade Mathematics Assessment (EGMA). Results demonstrate significant and meaningful associations between IDELA scores in ECCE and early primary school academic skills. We find that all domains of development measured by IDELA (i.e., Emergent Literacy, Emergent Numeracy, Motor Development, and Social-emotional Development) are predictive of later academic performance, and that the domains of Emergent Literacy and Emergent Numeracy are the strongest predictors of EGRA and EGMA. Our findings indicate that it is feasible to monitor children’s school readiness with strong predictive validity across several years of schooling, and points to several promising avenues for future research for education monitoring systems across the region.
This study aims to evaluate the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old by using meta-analysis. A systematic search of the Chinese and English databases including Pubmed, Embase, the Cochrane Library, CNKI, Weipu, Wanfang, and CBMdisc databases from January 1, 1990, to July 31, 2021, was performed. Articles concerning the relationship between home parenting environment and the cognitive and psychomotor development in children under 5 years old were included. Review Manager 5.4 was used for meta-analysis. Subgroup analysis in terms of age and region were performed. A total of 12 articles were included, including 11 in English and 1 in Chinese. Meta-analysis showed that there was significant relationship between home parenting environment and the cognitive and psychomotor development of children (r = 0.31; r = 0.21). Subgroup analysis showed that correlation between home parenting environment and the cognitive and psychomotor development of children was stronger in children over 18 months compared to those under 17 months [(r = 0.33, r = 0.21) vs. (r = 0.28, r = 0.17)]. The converted summary r value between home parenting environment and cognitive development in developing and developed countries was both 0.32. Conclusively, there is a positive correlation between the home parenting environment and the cognitive and psychomotor development of children under 5 years old. Improving the home parenting environment of children is beneficial to promote their early development.
Parental beliefs and parenting practices in early childhood are fundamental for the development of preschoolers’ school readiness and executive functions. This study examined the role of socioeconomic status (SES), ethnicity, maternal self-competence, parental cognitive stimulation, and maternal supportive discipline as predictors of five-year-old preschoolers’ school readiness and executive function abilities in 70 families of low-SES homes with a Chilean majority or indigenous Mapuche minority background in Chile. Additionally, the mediating role of parental beliefs and parenting practices between SES and school readiness or executive functioning respectively was investigated as suggested by the Family Stress Model. Results show that maternal supportive discipline predicted school readiness above and beyond SES and ethnicity. Furthermore, maternal supportive discipline mediated the relation between SES and school readiness, whereby higher SES positively affected maternal supportive discipline, which in turn had a favorable effect on school readiness. All other associations were non-significant. The outcomes highlight that parental involvement of culturally diverse families from low-SES backgrounds is important for children's cognitive development. School readiness of Chilean preschoolers from low-SES homes might possibly be improved by enhancing maternal sensitivity and positive behavioral control strategies. These parenting skills have the potential to mitigate the adverse effects of low-SES environments to some extent. The findings of this study inform interventions integrated into early childhood education programs.
The need for contextually appropriate and accessible school readiness assessment instruments in South Africa is well documented. The Emotional Social Screening tool for School Readiness (E3SR) screens for emotional and social competencies as a component of school readiness. This competency-based screening instrument was developed as a nine-factor model consisting of 54 items. This research study reports on the psychometric properties and factor structure of the E3SR by exploratory factor analysis. Ten preschool centres registered under the Social Welfare Act in the Cape Town Metropolitan region situated in the high-, middle- and low-socio-economic status (SES) areas constituted the research setting. A pilot study using a survey design was conducted. The E3SR protocols were completed by teachers on Grade R children during the fourth term of the academic year. The data set of 330 protocols satisfied the assumptions for inferential statistics, except for normal distribution. Normality was violated statistically; however, given the time frame, learners were expected to have mastered the competencies measured. Therefore, the violation of normal distribution was supported theoretically. Exploratory factor analysis yielded a six-factor structure, including Emotional maturity, Emotional management, Sense of self, Social skills, Readiness to learn and Communication. All the extracted factors displayed an adequate internal consistency, with a good reliability (α = 0.97). The E3SR can be shortened from 56 to 36 items without losing any important content. The E3SR can supplement formative assessments and enhance communication between role players to build children’s emotional and social competencies.
The present study investigated the cross-cultural variations in parents' views on the role of play in child development and the primary purpose of preschool education from Ethiopia and Hungary. It also examined the cross-cultural variations in preschoolers' executive functions (EF), the frequency of their engagement in home activities, and the role of these activities in the development of EF skills. Participants included 266 preschoolers (Ethiopia: 139 of which 44.6% boys; Mage = 63.83 months; SD = 7.68 months; Hungary: 127 of which 48% boys; Mage = 62.06 months; SD = 9.37 months) with their parents (Ethiopia: 45.32% male; Mage = 36.66 years; SD = 7.14 years; Hungary: 13.18% male; Mage = 37.71 years; SD = 5.97 years). The independent samples t-test showed that Ethiopian parents view fostering academic skills for preschooler significantly more important than their Hungarian counterparts do. We also found that while Ethiopian parents hold the belief that academic and cognitive development is the major purpose of preschool education, Hungarian prioritize social-emotional development and entertainment. Additionally, preschoolers in Ethiopia were reported to engage in academic and arts and crafts activities after preschool significantly more frequently than their Hungarian counterparts. On the contrary, preschoolers in Hungary were found to engage in fine-motor activities, solitary play, sports and other physical activities significantly more frequently than their Ethiopian counterparts. No significant differences were found in EF skills between preschoolers from Ethiopia and Hungary. Results from hierarchical regression analyses showed that, after accounting for age and SES, preschoolers' frequency of pretend play and their parents' play support beliefs were found to be small to medium-sized predictors of inhibitory control skills in both samples. However, children's frequency of having breakfast at home was another significant predictor in the Ethiopian sample only. The frequency of participation in arts and crafts and other fine-motor activities were found to be important predictors of preschoolers' visual-spatial working memory skills in the Ethiopian and the Hungarian samples, respectively. We also found that, after controlling for SES, parental play support was an important factor associated with preschoolers' shifting skills only in the Hungarian sample. Based on the findings, we made important conclusions.
Spanking remains common around the world, despite evidence linking corporal punishment to detrimental child outcomes. This study tested whether children (Mage = 11.60) who were spanked (N = 40) exhibited altered neural function in response to stimuli that suggest the presence of an environmental threat compared to children who were not spanked (N = 107). Children who were spanked exhibited greater activation in multiple regions of the medial and lateral prefrontal cortex (PFC), including dorsal anterior cingulate cortex, dorsomedial PFC, bilateral frontal pole, and left middle frontal gyrus in response to fearful relative to neutral faces compared to children who were not spanked. These findings suggest that spanking may alter neural responses to environmental threats in a manner similar to more severe forms of maltreatment.
Fully realising the potential of children and adolescents will require an ecological life course approach, together with multisectoral, coordinated, integrated action for the provision of care and services for children and adolescents, argue Mark Tomlinson and colleagues
Background:
The International Study of Movement Behaviours in the Early Years, SUNRISE, was initiated to assess the extent to which young children meet movement behaviour guidelines (physical activity, sedentary behaviour, screen time, sleep).
Objective:
The South African SUNRISE pilot study assessed movement behaviours in preschool children from two low-income settings, and associations between these movement behaviours, adiposity, motor skills and executive function (EF).
Methods:
Preschool child/parent pairs (n = 89) were recruited from preschools in urban Soweto and rural Sweetwaters. Height and weight were measured to assess adiposity. Physical activity was assessed using accelerometers while sedentary behaviour, screen time and sleep were assessed via parent report. Fine and gross motor development were measured using the Ages and Stages Questionnaire-3, and EF was assessed using the Early Years Toolbox.
Results:
The proportion of children meeting the physical activity guideline was 84%, 66% met the sleep guideline, 48% met the screen time guideline, and 26% met all three guidelines. Rural children were more active, but spent more time on screens compared to urban children. Most children were on track for gross (96%) and fine motor (73%) development, and mean EF scores were in the expected range for all EF measures. EF was negatively associated with screen time, and gross motor skills were positively associated with physical activity.
Conclusion:
The South African SUNRISE study contributes to the growing literature on 24-hour movement behaviours in SA preschool children, and highlights that these behaviours require attention in this age group.
Age-appropriate early childhood development is greatly influenced by exposure to various mediating and moderating factors. Developmental outcomes cannot be viewed in isolation, but by considering the interaction of the various risks and protective factors that influence early child development. A non-experimental, cross-sectional research design was employed. Data was collected in a low-income community in Gauteng, South Africa. Caregivers with children (n = 276) between the ages of 3 years and 6 years 11 months (mean 51.57 months; SD ± 12.4) whose children were in a preschool were invited to participate in the research study. Participants were divided into two groups, children with developmental delays and children without a developmental delay. The study sample included high risk, vulnerable preschool children, with a developmental delay prevalence of 80.1% (221/276). Families included were exposed to an average of five (SD ± 1.86) environmental and/or biological risks. According to a logistic regression model, three factors were significantly associated with increasing resilience amongst children with no developmental delay: living with both parents (p < 0.031, OR 4.5, 95% CI 1.2–17.2), caregivers having at least completed Grade 8 to 12 (p < 0.027, OR 11.9, 95% CI 1.4–10.5) and parents being married (p < 0.023, OR 5.1, 95% CI 1.3–20.9). Important protective factors in low-income communities like caregiver education, living with both parents and parental marriage can inform public health messaging and other population-based interventions to support early childhood development.
Background and objectives:
Previous research has demonstrated associations between maternal experience of intimate partner violence (IPV) and a range of adverse outcomes among women and their young children. However, few studies have examined the associations between maternal experience of IPV and early child development (ECD) outcomes in low- and middle-income countries (LMIC). Our objectives in this study were to examine the association between IPV victimization and ECD and assess whether the association was mediated by maternal and paternal stimulation.
Methods:
We combined cross-sectional data from the Demographic and Health Surveys for 15 202 households representing mothers and fathers of children aged 36 to 59 months in 11 LMIC. We used multivariable linear regression models to estimate the association between IPV victimization in the year preceding the survey and ECD, which we measured using the Early Child Development Index. We used path analysis to determine if the association between IPV victimization and ECD was mediated through maternal and paternal stimulation.
Results:
After adjusting for sociodemographic variables, IPV victimization was negatively associated with ECD (β = -.11; 95% confidence interval = -.15 to -.07). Path analysis indicated that the direct association between IPV victimization and ECD was partially and independently mediated through maternal and paternal stimulation.
Conclusions:
Interventions that include components to prevent IPV may be effective for improving ECD in LMIC.
Spatial injustice and urban residential segregation represent significant dimensions in the historical development of the settlement patterns of South Africa's urban poor, which have strong links to colonialism and apartheid. A myriad of political, economic, legal and social factors contributed to the legacy of spatial injustice and socioeconomic exclusion that characterises contemporary towns and cities. This contribution provides a historical exposition of the leading causes of spatial injustice and segregated urban settlement in South Africa during colonialism and apartheid, and adopts a spatial perspective in its analysis of relevant legislation, case law and academic literature. Advancing this critical spatial awareness is essential, as it remains elusive in current approaches to the interpretation and implementation of the housing rights of South Africa's urban poor.
Background
Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.
Methods
Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36–59 months; 65 and 17 countries), home stimulation (36–59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36–59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains—child gender, household wealth and residential area—and compared across regions and country income groups.
Results
63% of children were not exposed to stunting or extreme poverty; 39% of 3–4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.
Conclusions
Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.
Community violence is a prevalent form of interpersonal violence in South Africa for children living in low-income areas. Trauma arising from violence exposure is of concern in contexts where access to treatment is often unattainable. As simultaneous multisectoral strategies show higher potential to counter interpersonal violence than single interventions, the World Health Organization with partners created INSPIRE. INSPIRE takes an integrated approach coordinated across formal and informal settings of civil and private society. Responding to research paucity on methods that counter community violence in LMIC settings, this study employed a cross-sectional correlational design consisting of a sample of 2,477 children aged 10 to 17 years from the Young Carers 2009–2010 study conducted in a low-income, HIV-endemic province of South Africa highly affected by community violence. Multiple logistic regressions assessed individual and dose associations between four INSPIRE-based violence prevention strategies—positive parenting, basic necessities, formal social support, and school structural support—and direct and indirect community violence outcomes. Three strategies had significant associations with community violence outcomes: necessities (direct p < .001; adjusted odds ratio [AOR] = .57; indirect p < .01; AOR = .62), formal support (direct p < .05; AOR = .83; indirect p < .05; AOR = .73), and school support (direct p < .001; AOR = .53; indirect p < .001; AOR = .49). Combined interventions in direct and indirect community violence analyses demonstrated that children reporting a higher number of strategies were less likely to have experienced community violence. This outcome extends the results of longitudinal studies in South Africa highlighting social protection with care as a means to overcome structural deprivation strains, thereby reducing the likelihood of children’s exposure to community violence. Moreover, these findings uphold the INSPIRE model as an effective cross-sectoral approach to prevent and reduce the community violence that children experience.
This study examined variation in the timing of 5,447 infants’ and toddlers’ reported acquisition of 12 basic social-emotional skills across and within 11 developing and developed country sites. Although children differed significantly across sites in when they attained social-emotional skills on average (e.g., M age Brazil = 20.50 months vs. M age India = 26.92 months), there was also substantial heterogeneity across skills. For example, children in Pakistan were reported to demonstrate sympathy on average seven months earlier than their peers in Ghana, whereas the opposite was true for sharing. Overall, country-level health and education were strongly associated (r > .60) with earlier site-level skill attainment. In addition to heterogeneity across sites, we also observed notable within-site variability in skill development (ICCs = .03 to .38). Future research is needed to identify sources of variability and how to promote skills that matter within a given context.
Background: Preparing children for mainstream school occurs in systems that act as an
overarching context. The perspectives of stakeholders influence how they prepare children for mainstream education.
Aim: The aim of this study was to develop an understanding of the contextual factors that
affect school readiness as identified by stakeholders. School readiness was conceptualised as a function of contextual influences and connections between individual and systemic factors enabling the child to benefit from the curriculum.
Setting: This exploratory study was conducted in the Metro North Education District in
Cape Town.
Methods: Five focus group interviews were conducted with a snowball sample of
35 stakeholders including parents (n = 9) and professionals from education (n = 17) and health (n = 9) systems. Transcriptions were thematically analysed. Resultant themes were summarised to reflect stakeholders’ perceptions.
Results: The results showed four major groups of factors that affect school readiness:
community, adverse experiences, educational and familial factors. Firstly, community factors thematically identified were unemployment, socio-economic status (SES) and culture as impacting school readiness. Secondly, adverse experiences included violence, trauma and substance abuse that affect school readiness. Thirdly, educational factors identified are lack of stimulation, barriers to learning, teacher support and cooperation between stakeholders that influence readiness. Fourthly, familial factors such as parental support, variation in child-rearing practices and caregiver literacy exert influence on school readiness.
Conclusion: Acknowledgement of and engagement with the above-mentioned four factors
could result in a nuanced and contextual understanding of school readiness and might foster cooperation between stakeholders.
Background:
Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables.
Methods:
BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal-Wallis test.
Results:
Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found.
Conclusion:
Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.
Background:
Advocates for children's rights have recommended the elimination of all forms of violent discipline given its detrimental effects on children's development. Yet, little is known about the global prevalence of various forms of discipline, including physical and psychological aggression, as well as alternative forms of non-violent discipline, especially in low- and middle-income countries (LMICs).
Objective:
This study aims to obtain national, regional, and global prevalence estimates of the percentage and number of 2- to- 4-y-olds in LMICs exposed to these disciplinary practices by their caregivers.
Participants and setting:
We use data collected between 2010 and 2016 from 107,063 2- to- 4-y-old children living in 49 LMICs as part of the Multiple Indicator Cluster Survey (MICS).
Methods:
Using the best-fitting model based on cross-validation techniques, we performed predictive modeling to generate country-level prevalence estimates for 131 LMICs in 2013, as well as 95% confidence intervals around these estimates.
Results:
We estimate that 296.2 million 2- to- 4-y-olds (95% CI 256.9, 300.9) were exposed to non-violent discipline in 2013, which corresponds to 83.9% of the population. Furthermore, 220.4 million (95% CI 138.1, 283.7) and 230.7 million (95% CI 128.4, 300.6) children were exposed to aggressive physical and psychological discipline, respectively, which corresponds to prevalence of 62.5% and 65.4%. We also identify a high heterogeneity in the estimates across and within regions, finding a higher prevalence of both violent disciplinary methods in South Asia and Sub-Saharan Africa.
Conclusions:
These results suggest the need for new policies and programs to minimize violent discipline around the world.
Most of what is known about the association between children's executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle‐income country context. Participants were 1,480 children, aged 4 to 7 years old, who participated in an endline assessment of the Tayari program, an early childhood education model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large‐scale direct assessments of EF with young children. Assessor ratings of children's attention‐related behaviors during testing were positively associated with their performance on EF tasks (rs = .12 – .27). An executive function composite score was not related to demographic factors or to children's exposure to the Tayari program. However, the executive function composite score was uniquely associated with performance‐based measures of early literacy (β = .18, 95% confidence interval [CI] = .05, .31), early numeracy (β = .16, 95% CI = .07, 26), and social‐emotional competencies (β = .12, 95% CI = .03, .20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which executive function skills inform ongoing efforts to invest in early childhood education in low and middle‐income countries.
The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children’s externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of our new composites. Girls and children with more siblings had fewer externalizing behavior problems and more prosocial behaviors at four years. Further, maternal depressive symptoms and food insecurity were uniquely linked to more externalizing behavior problems at four years. In contrast, maternal education, home environment quality, and social-emotional skills at two years were associated with more prosocial behaviors at four years.
Relatively little research has addressed whether conceptual frameworks of early learning generalize across different national contexts. This article reports on a cross-country measurement invariance analysis of the International Development and Early Learning Assessment (IDELA). The IDELA is a direct assessment tool for 3- to 6-year-old children, intended to measure Early Literacy, Early Numeracy, Motor, and Social-Emotional development. Its generalizability is evaluated using samples from 5 countries: Afghanistan (N = 2,629); Bolivia (N = 480); Ethiopia (N = 682); Uganda (N = 504); and Vietnam (N = 675). The 4-domain model of the IDELA was supported in each country, although the domains were highly correlated. Measurement invariance analysis revealed that most IDELA items do not provide a basis for comparing children’s development over the 5 countries. This research supports the use of the IDELA for program evaluation and within-country monitoring purposes, but cautions against its use for international comparisons.
Executive-function (EF) skills are a set of attention-regulation skills that provide a neurocognitive foundation for adapting to changing circumstances across the life span; EF skills measured in childhood are associated with important real-world outcomes (e.g., school and job success). Although training can improve EF skills, the benefits of training frequently fail to transfer to these outcomes. We argue that EF skills are associated with outcomes such as school success only to the extent that they first contribute to intermediate-level EF-based life skills that are more directly instrumental in achieving key outcomes. These intentional intermediate-level skills are configurations of specific EF skills and non-EF skills that are used when reasoning and solving problems in a variety of domains. We further argue that an effective way to bridge the gap between specific EF skills and real-world outcomes is by training these EF-based life skills that people need to function effectively in society. We propose that this can best be achieved using a civic-scientific approach, engaging citizens (e.g., children, youth, parents, teachers) in the design process from the beginning so that interventions are responsive to perceived needs and address perceived obstacles to success and sustainability.
This qualitative study explored caregivers' perceptions of factors influencing early childhood development in low‐income, urban South African settings, from a social ecological perspective. Individual interviews were conducted with 15 caregivers of 3–5‐year‐old children; a reflexive thematic analysis approach was adopted. In the family and home context, caregivers spoke about their role in developing, nurturing, providing, protecting and disciplining their children. Risks included low socioeconomic status, dysfunctional relationships and caregiver mental health; resources related to early learning and social support. In the preschool/school context, caregivers discussed the value of early learning, and priorities for selecting early childhood care and education settings. Community risks included violence and crime; resources mentioned were social support, community programmes and infrastructure. The social ecological model provides a holistic and contextually relevant perspective for understanding multiple factors (risks and protective factors) influencing early childhood development in low‐income South African settings.
Biological and psychosocial stressors that have been associated with income include family dynamics such as household chaos, family conflict, maternal depression, harsh parenting, lower parental responsiveness, and exposure to violence. Research from high income countries has shown that exposure to violence may have detrimental effects on children's self-regulation, with possible flow-on implications for broad later-life outcomes, but less is known about such links in low- and- middle income countries, where many children live in violent communities and households and where physical punishment remains the norm. This study aimed to investigate exposure to violence, in addition to coercive parenting, and its associations with self-regulation among 243 3- to 5-year-olds (M = 4.7 ± 0.6; 51.9 % female) from low-income settings in Cape Town and who were not attending Early Childhood Care and Education (ECCE). Results showed that self-regulation was not associated with child exposure to community violence, but it was positively associated with coercive parenting (β = 0.17; p = 0.03). The null concurrent associations between exposure to violence and self-regulation suggest the need for additional research aimed at understanding later potential developmental sequelae. It is important that findings regarding coercive parenting are contextualised within local social norms around parenting styles, as well as the influence of living in dangerous communities on parenting practices.
Parenting plays a determining role in the development of school readiness. Socio-economic adversity often has a detrimental effect on the quality of parenting, which in turn has a negative impact on the school readiness of children. Intervention research was done to develop and implement a parenting skills programme for parents of Grade R learners in two resource-poor communities in South Africa. The findings indicate that parents can improve in the important areas of parenting, namely, the quality of the parent–child relationship, parent–child interaction, and creating a home-learning environment that could enhance the school readiness of their Grade R children. Social workers are in the ideal position to implement such a parenting skills programme. It will be part of their preventive work to limit later psychosocial problems in clients linked to lack of schooling, behavioural problems and unemployment.
Missing data are a pervasive problem in data analysis. Three common methods for addressing the problem are (a) complete-case analysis, where only units that are complete on the variables in an analysis are included; (b) weighting, where the complete cases are weighted by the inverse of an estimate of the probability of being complete; and (c) multiple imputation (MI), where missing values of the variables in the analysis are imputed as draws from their predictive distribution under an implicit or explicit statistical model, the imputation process is repeated to create multiple filled-in data sets, and analysis is carried out using simple MI combining rules. This article provides a non-technical discussion of the strengths and weakness of these approaches, and when each of the methods might be adopted over the others. The methods are illustrated on data from the Youth Cohort (Time) Series (YCS) for England, Wales and Scotland, 1984–2002.
Background
Nurturing care is crucial for children's ongoing development during the pre-primary education period, or the next 1000 days of life. We generated nationally representative prevalence estimates of access to ten basic indicators of nurturing care among children aged 3–4 years in low-income and middle-income countries (LMICs).
Methods
We applied multiple imputation and predictive modelling to data on children living in LMICs. Individual-level data on ten indicators were from UNICEF's Multiple Indicator Cluster Surveys and the Demographic Health Surveys Program, and we included data on all children aged 36 to 59 months for whom the surveys asked relevant questions on parenting and child development. We defined minimally adequate care as receiving at least one of two indicators in each of five dimensions of nurturing care: responsive caregiving, early learning, safety and security, nutrition, and health. We used a two-step multi-level multiple imputation procedure to address missing data across individuals, indicators, and countries. Using imputed datasets, we generated a set of expected-a-posteriori estimates of the percentage and overall number of children receiving each indicator of nurturing care, as well as overall minimally adequate care, for each country, country income grouping, and region, and across all LMICs. For the 54 countries with individual-level data on all indicators, we also produced subgroup estimates of nurturing care on the basis of household wealth, child sex, and urbanicity.
Findings
We included individual-level data collected between 2005 and 2019 on 426 349 children aged 3–4 years in 104 LMICs. Across the 137 LMICs considered in our modelling, we estimated that 62·0 million (90% credible interval [CrI] 51·6–71·7) children aged 3–4 years, equivalent to 25·4% (90% CrI 21·2–29·4) of that age group in LMICs, were receiving minimally adequate nurturing care at the time of assessment, leaving 181·9 million (172·2–192·3) without adequate care. Access to care was highest for nutrition (86·2% [84·2–88·2], or 210·3 million [205·4–215·1], with healthy weight), and lowest for early learning (29·3% [21·5–39·6], or 71·5 million [52·5–96·6], in early childhood care and education), responsive caregiving (29·7% [25·6–34·9], or 72·4 million [62·4–85·0], experiencing adequate stimulation from non-maternal caregivers), and safety and security (32·3% [28·3–36·7], or 78·7 million [68·9–89·5], living without physical punishment). Gaps were evident in the estimates, with 50·8% (38·3–60·7) of children from upper middle-income countries receiving minimally adequate care compared with 5·6% (4·8–6·4) in low-income countries. Within 54 countries with complete child-level data, 10·7% (10·4–10·9) of children from households in the lowest wealth quintile had access to minimally adequate care compared with 41·2% (40·7–41·7) in the highest quintile. Inequalities were also large by urbanicity (17·7% [17·5–18.0] rural vs 32·2% [31·8–32.6] urban) but smaller by child sex (23·9% [23·6–24·2] girls vs 22·1% [21·9–22·4] boys).
Interpretation
Most children in LMICs are not receiving minimally adequate nurturing care during the next 1000-day period. Further investments in indicator measurement and resources for preschool-age children are needed, particularly for low-income populations and in the domains of responsive caregiving, early learning, and safety and security.
Funding
None.
The Give-a-Number task has become a gold standard of children's number word comprehension in developmental psychology. Recently, researchers have begun to use the task as a predictor of other developmental milestones. This raises the question of how reliable the task is, since test-retest reliability of any measure places an upper bound on the size of reliable correlations that can be found between it and other measures. In Experiment 1, we presented 81 2- to 5-year-old children with Wynn (1992) titrated version of the Give-a-Number task twice within a single session. We found that the reliability of this version of the task was high overall, but varied importantly across different assigned knower levels, and was very low for some knower levels. In Experiment 2, we assessed the test-retest reliability of the non-titrated version of the Give-a-Number task with another group of 81 children and found a similar pattern of results. Finally, in Experiment 3, we asked whether the two versions of Give-a-Number generated different knower levels within-subjects, by testing 75 children with both tasks. Also, we asked how both tasks relate to another commonly used test of number knowledge, the “What's-On-This-Card” task. We found that overall, the titrated and non-titrated versions of Give-a-Number yielded similar knower levels, though the non-titrated version was slightly more conservative than the titrated version, which produced modestly higher knower levels. Neither was more closely related to “What's-On-This-Card” than the other. We discuss the theoretical and practical implications of these results.
Objective
To systematically assess the association between corporal punishment and young children's development in low- and middle-income countries (LMICs).
Method
Data for 69 population-based surveys from the Multiple Indicators Cluster Survey (MICS) were combined. The sample included 131,164 children aged 36–59 months living in 49 LMICs. The surveys included information about children's developmental status and exposure to corporal punishment in the prior month. Logistic models, random-effects meta-analysis, and moderation analysis were used to obtain pooled estimates and assess the extent to which the association between corporal punishment and child developmental outcomes varied across countries.
Results
On average, children exposed to corporal punishment were about 24% (β = 0.76, 95% CI 0.72–0.80) less likely to be developmentally on track than children who were not exposed to corporal punishment. Challenges in social-emotional development may drive the association between child development and corporal punishment. Corporal punishment was not associated with any positive developmental outcome in any country. There was minor heterogeneity in the estimated associations, which was not explained by the extent to which corporal punishment was normative within countries.
Conclusions
All forms of corporal punishment – including spanking – are likely to be harmful to young children's development and wellbeing. Public education, legal prohibition of corporal punishment, and other efforts are needed to protect children from corporal punishment and promote their wellbeing, health, and development.
We aimed to explore pre-school teachers’ understanding of socio-emotional development in early childhood and the role it plays in school readiness. Informants were 12 pre-school teachers from Cape Town, South Africa (coloured/mixed race = 12). The teachers completed semi-structured interviews on their understanding of socio-emotional development, the role that they think socio-emotional development plays in preparing the child for school, and what social and emotional skills are essential for school readiness. A thematic analysis of the data suggested that the teachers’ perceive socio-emotional development among pre-school children to be characterised by the children’s inter- and intrapersonal skills such as the expression of emotion, communication skills, problem solving, and sharing. The teachers also perceived the children’s learning, social experiences, and learning environment adaptation competencies as important indicators of their socio-emotional development.
Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.
The widely and internationally replicated socioeconomic status (SES) gradient of executive function (EF) implies that intervention approaches may do well to extrapolate conditions and practices from contexts that generate better child outcomes (in this case, higher SES circumstances) and translate these to contexts with comparatively poorer outcomes (often low‐SES populations). Yet can the reverse also be true? Using data from equivalent assessments of 1,092 pre‐schoolers’ EFs in South Africa and Australia, we evaluated: the SES gradient of EF within each sample; and whether this SES gradient extended cross‐culturally. The oft‐found EF‐SES gradients were replicated in both samples. However, contrary to the inferences of EF‐SES associations found nationally, the most highly disadvantaged South African subsample outperformed middle‐ and high‐SES Australian pre‐schoolers on two of three EFs. This suggests the possibility of EF‐protective and ‐promotive practices within low‐ and middle‐income countries that may aid understandings of the nature and promotion of EFs.
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Executive function is foundational for cognitive development. Previous research has shown both gross motor skills and physical activity to be related to executive function. However, evidence for these relationships in the preschool years, as well as in low‐ and middle‐income countries is lacking. Therefore, this study aimed to investigate the relationships between components of executive function (inhibition, shifting and working memory) and gross motor skills (locomotor skills and object control skills) in a sample of preschool children from urban and rural low‐income settings in South Africa. Results revealed that inhibition and working memory, but not shifting, were associated with gross motor skills. More specifically: inhibition was associated with both locomotor [ß = 0.20, p = 0.047] and object control skills [ß = 0.24, p = 0.024], whereas working memory was only associated with locomotor skills [ß = 0.21, p = 0.039]. Physical activity was not associated with inhibition and shifting but was negatively associated with working memory. These results elaborate a growing evidence base linking executive function and gross motor skills in the early years, and it is the first to look at specific associations of locomotor and object control skills with executive function in the South African context (a low‐ and middle‐income country).
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Objectives:
No studies have investigated gross motor skill (GMS) proficiency of preschool-aged children across different income settings in South Africa. Research from high-income countries suggests that children from low-income settings display poorer GMS proficiency compared to higher-income peers. This study aimed to (1) describe GMS proficiency of preschool-aged children in urban high-income (UH), urban low-income (UL) and rural low-income (RL) settings; and (2) explore differences in proficiency between income settings and sex.
Design:
Descriptive cross-sectional study.
Methods:
The Test of Gross Motor Development-Edition 2 (TGMD-2) was used to assess GMS. The TGMD-2 gross motor quotient, standardised scores and raw scores were used to describe proficiency.
Results:
GMS proficiency was assessed in n=259 3-6-year-old children (n=46 UH, n=91 UL, n=122 RL). Overall, 93% of the children were classified as having 'average' or better GMS. According to TGMD-2 standardised scores, the RL children performed significantly better than UH and UL children (p=0.028 and p=0.009, respectively). RL children were significantly more proficient than UH and UL children in the strike and horizontal jump when comparing raw scores. Overall, boys performed significantly better than girls in the strike, stationary dribble, kick and leap when comparing raw scores (all p<0.001).
Conclusions:
This study reports high GMS proficiency in preschool-aged children across income settings in South Africa. The factors associated with higher GMS in low-income settings are not immediately obvious. Thus, future research should explore potential factors and identify opportunities to ensure that GMS proficiency is capitalised on as preschool-aged children enter formal schooling.
Background:
The Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.
Methods:
We estimated prevalence and YLDs for epilepsy, intellectual disability, hearing loss, vision loss, autism spectrum disorder, and attention deficit hyperactivity disorder. YLDs were estimated as the product of the prevalence estimate and the disability weight for each mutually exclusive disorder, corrected for comorbidity. We used DisMod-MR 2.1, a Bayesian meta-regression tool, on a pool of primary data derived from systematic reviews of the literature, health surveys, hospital and claims databases, cohort studies, and disease-specific registries.
Findings:
Globally, 52·9 million (95% uncertainty interval [UI] 48·7-57·3; or 8·4% [7·7-9·1]) children younger than 5 years (54% males) had developmental disabilities in 2016 compared with 53·0 million (49·0-57·1; or 8·9% [8·2-9·5]) in 1990. About 95% of these children lived in low-income and middle-income countries. YLDs among these children increased from 3·8 million (95% UI 2·8-4·9) in 1990 to 3·9 million (2·9-5·2) in 2016. These disabilities accounted for 13·3% of the 29·3 million YLDs for all health conditions among children younger than 5 years in 2016. Vision loss was the most prevalent disability, followed by hearing loss, intellectual disability, and autism spectrum disorder. However, intellectual disability was the largest contributor to YLDs in both 1990 and 2016. Although the prevalence of developmental disabilities among children younger than 5 years decreased in all countries (except for North America) between 1990 and 2016, the number of children with developmental disabilities increased significantly in sub-Saharan Africa (71·3%) and in North Africa and the Middle East (7·6%). South Asia had the highest prevalence of children with developmental disabilities in 2016 and North America had the lowest.
Interpretation:
The global burden of developmental disabilities has not significantly improved since 1990, suggesting inadequate global attention on the developmental potential of children who survived childhood as a result of child survival programmes, particularly in sub-Saharan Africa and south Asia. The SDGs provide a framework for policy and action to address the needs of children with or at risk of developmental disabilities, particularly in resource-poor countries.
Funding:
The Bill & Melinda Gates Foundation.
Evidence about the importance of stimulation and learning in childhood has been mounting in recent years, culminating with the inclusion of early childhood development in the 2015 Sustainable Development Goals. In following, there is a need for reliable measurement of early learning and development at local, national, and global levels. None of the existing tools designed to measure learning and development at the pre-primary level have been proven to be appropriate and feasible in diverse national contexts, as well as psychometrically rigorous. Therefore, Save the Children developed the International Development and Early Learning Assessment (IDELA) from 2011–2015. This paper presents evidence from the IDELA validation process including internal consistency, inter-rater reliability, test-retest reliability and concurrent validity.