Child Development: Risk Factors for Adverse Outcomes in Developing Countries

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


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

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    • "These include early years' experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health. Preamble to the Rio Political Declaration on Social Determinants of Health, adopted by UN Member States inOctober 2011World HealthOrganization (2011)There are extensive (and at times disparate) literatures on the nature and determinants of health inequities experienced by children globally and, more specifically, within high-income countries (Anda et al., 2006;Arseneault, Bowes, & Shakoor, 2010;Black et al., 2008;Black, Morris, & Bryce, 2003;Bolte, Tamburlini, & Kohlhuber, 2010;Braubach & Fairburn, 2010;Bzostek & Beck, 2011;Carpenter & Stacks, 2009;Conger & Donnellan, 2007;Currie et al., 2012;Department of Health, 2010, 2013Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009;Gilbert et al., 2009;Graham, 2007;Grantham-McGregor et al., 2007;Hertzman & Boyce, 2010;Irish, Kobayashi, & Delahanty, 2010;Leventhal & Newman, 2010;Marmot & on behalf of the Commission on Social Determinants ofHealth, 2007;Marmot & Wilkinson, 2006;McEwen & Gianaros, 2010;Pickett & Wilkinson, 2007;Rough, Goldblatt, Marmot, & Nathanson, 2013;Shonkoff, 2010;Shonkoff, Boyce, & McEwen, 2009;Spencer, 2012;The Marmot Review, 2010;Turner, Finkelhor, & Ormrod, 2006;Viner et al., 2012;Waldfogel, Craigie, & Brooks-Gunn, 2010;Walker et al., 2007Walker et al., , 2011Wilkinson & Pickett, 2009;World Health Organization, 2008; World Health Organization Regional Office for Europe, 2013; World Health Organization and the WorldBank, 2011). Most approaches to synthesizing this body of knowledge focus on the extent to which social stratification leads to: (1) differential rates of exposure to material and psychosocial hazards that are detrimental to well-being; and (2) differential vulnerability or resilience to the impact of such exposures on health and subsequent wellbeing (Bartley, 2004;Diderichsen, Evans, & Whitehead, 2001;Graham, 2007;Kreiger, 2011;Marmot, 2005;Spencer, 2012;Viner et al., 2012). "
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    ABSTRACT: The limited evidence that is available indicates that children with intellectual disabilities are at increased risk of exposure to all of the major categories of social determinants of poorer physical and mental health. They are more likely to live in households characterized by low socioeconomic position (SEP) and poverty, and to be exposed to recurrent poverty. Over time they are more likely to become poor and less likely to escape from poverty. They are more likely to be exposed to a wide range of material and psychosocial hazards that are detrimental to their health, including inadequate nutrition; poor housing conditions; exposure to environmental toxins; family, peer, and community violence; poor parenting; and family instability. They are also less likely to have access to the resources necessary to build resilience in the face of adversity. However, the published literature in this area is highly variable in its scope and quality. In order to better identify and understand health inequities in this particularly vulnerable group of children, we suggest the following priorities for future research: (1) longitudinal studies using the extensive network of cohort studies in high-income countries to elucidate pathways and mechanisms in the association of low family SEP with childhood intellectual disability and to strengthen the evidence base on the combined impact of SEP and intellectual disability on health and well-being across the life course; (2) cross-sectional and longitudinal studies in different country settings to strengthen the evidence base in areas where it is weak; (3) controlled interventions designed to test approaches to reducing discrimination and strengthening resilience at both an individual and societal level.
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    • "These workers suggest that individuals can be in a psychological state termed " uncertainty to the unfamiliar " and it is this which elicits inhibited behavior. Walker et al. (2007) reported that in young children (wasting) being underweight at the time of testing, and stunting are associated with apathy and less positive affect, and in addition studies showed stunting to be associated with poorer attention and social relations. A study of undernourished children in Bangladesh showed that greater stunting and wasting was associated with less sociability, greater fearfulness , more negative emotionality and less attentiveness (Baker- Henningham, Hamadani, Huda, & Grantham-McGregor, 2009). "
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    ABSTRACT: Previous work has shown that malnutrition has deleterious effects on both IQ and aspects of temperament. It is hypothesized that while malnutrition bears a direct relation to IQ, aspects of temperament are also involved in a mediating role so that they produce indirect associations between malnutrition and IQ. The study examines the association of 3 indices of malnutrition-stunting, anemia and wasting-to Verbal IQ (VIQ) and Performance IQ (PIQ) and temperament in 1,376 3-year-old and 11-year-old children in Mauritius. Two dimensions of temperament were extracted from ratings of behavior and were labeled as Uninhibited (UI) and Task Orientation (TO). At age 3 stunting had direct relations to Verbal IQ and Performance IQ and also indirect relations via the mediating effect of temperament (UI but not TO). In the case of anemia there were no direct relations to VIQ or PIQ but both temperament meditators were involved in indirect relations. For wasting, indirect but not direct relations were observed. When age 11 cognitive performance was examined, there were direct relations to stunting and anemia and indirect relations via UI, but not TO. The relations between malnutrition and IQ were graded and linear showing that it is not only when malnutrition is defined by its severest levels that it has an effect on cognitive performance. It is suggested that malnutrition affects those brain structures and functions that are involved in both cognitive behavior and temperament. (PsycINFO Database Record
    Full-text · Article · Nov 2015 · Developmental Psychology
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    • "In the last decade, parenting programs have been effectively implemented in low-and middle-income countries (LMIC) to improve child nutrition and stimulation, two primary contributors to poor child development (Walker et al., 2007). Given the reliable relationship identified between parenting difficulties and maternal depression (Murray et al., 2014), existing strategies promoting relevant parenting ultimately depend on the mother's psychological well-being. "
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    ABSTRACT: A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12–36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up.
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