Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

Ayesha Sania, ICAP and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York city, New York, USA
Christopher R. Sudfeld, Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Goodarz Danaei, Deaprtment of Global Health and Population, and Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Günther Fink, Household Economics and Health System Research Unit, Schweizerisches Tropen- und Public Health-Institut, Basel, Switzerland
Dana C. McCoy, Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA
Zhaozhong Zhu, Departments of Epidemiology and Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Mary C. Smith Fawzi, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
Mehmet Akman, Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
Shams E. Arifeen, Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
Aluisio J D Barros, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
David Bellinger, Department of Neurology, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts, USA
Maureen M. Black, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
Alemtsehay Bogale, Nutrition and Scientific Affairs, The Nature’s Bounty Co, Ronkonkoma, New York, USA
Joseph M. Braun, Brown University School of Public Health, Providence, Rhode Island, USA
Nynke van den Broek, Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
Verena Carrara, Department of Maternal and Child Health, Shoklo Malaria Research Unit, Mae Sot, Thailand
Paulita Duazo, Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
Christopher Duggan, Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
Lia C H Fernald, Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
Melissa Gladstone, Women and Children's Health, University of Liverpool, Institute of Translational Medicine, Liverpool, UK
Jena Hamadani, Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
Alexis J. Handal, College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
Siobán Harlow, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
Melissa Hidrobo, Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
Chris Kuzawa, Department of Anthropology, Northwestern University, Evanston, Illinois, USA
Ingrid Kvestad, Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway
Lindsey Locks, Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Karmin Manji, Department of Pediatrics and Child Health, Muhibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Honorati Masanja, Ifakara Health Institute, Dar es Salam, Tanzania
Alicia Matijasevich, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brasil
Christine McDonald, Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital, Oakland, California, USA
Rose McGready, Faculty of Tropical Medicine, Mahidol University, Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
Arjumand Rizvi, Pediatrics and Child Health, Aga Khan Medical University, Karachi, Pakistan
Darci Santos, Department of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
Leticia Santos, Department of Collective Health, Universidade Federal da Bahia, Salvador, Brazil
Dilsad Save, Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
Roger Shapiro, Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Barbara Stoecker, Department of Nutritional Sciences, Oklahoma State University College of Human Environmental Sciences, Stillwater, Oklahoma, USA
Tor A. Strand, Department of Laboratory Medicine, Sykehuset Innlandet Helseforetaket, Brumunddal, Norway
Sunita Taneja, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
Martha-Maria Tellez-Rojo, Division of Research on Public Health, National Institute of Perinatology, Mexico City, Mexico
Fahmida Tofail, Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
Aisha K. Yousafzai, Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Majid Ezzati, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
Wafaie Fawzi, Deaprtment of Global Health and Population, Epidemiology, and Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA

Document Type

Article

Publication Date

8-16-2019

Abstract

Objective To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).

Design Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.

Data sources We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.

Eligibility criteria for selecting studies Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.

Analyses Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.

Results We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (–0.24 to –0.05) and 0.23 SD (–0.42 to –0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from −0.18 to −0.10 SDs.

Conclusions Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Comments

This study was supported by Grand Challenges Canada under the Saving Brains program (grant # 0073-03) to Harvard T H Chan School of Public Health. AS was supported by National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number T32AI114398.

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