Ayesha Sania, Christopher R. Sudfeld, Goodarz Danaei, Günther Fink, Dana C. McCoy, Zhaozhong Zhu, Mary C. Smith Fawzi, Mehmet Akman, Shams E. Arifeen, Aluisio J.D. Barros, David Bellinger, Maureen M. Black, Alemtsehay Bogale, Joseph M. Braun, Nynke Van Den Broek, Verena Carrara, Paulita Duazo, Christopher Duggan, Lia C.H. Fernald, Melissa Gladstone, Jena Hamadani, Alexis J. Handal, Siobán Harlow, Melissa Hidrobo, Chris Kuzawa, Ingrid Kvestad, Lindsey Locks, Karim Manji, Honorati Masanja, Alicia Matijasevich, Christine McDonald, Rose McGready, Arjumand Rizvi, Darci Santos, Leticia Santos, Dilsad Save, Roger Shapiro, Barbara Stoecker, Tor A. Strand, Sunita Taneja, Martha-Maria Tellez-Rojo, Fahmida Tofail, Aisha K. Yousafzai, Majid Ezzati, Wafaie Fawzi
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 Design Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.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 We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.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. © 2019 Author(s).
ICAP and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, United States; Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, MA, United States; Deaprtment of Global Health and Population and Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, United States; Household Economics and Health System Research Unit, Schweizerisches Tropen-und Public Health-Institut, Basel, Switzerland; Harvard Graduate School of Education, Harvard University, Cambridge, MA, United States; Departments of Epidemiology and Environmental Health, Harvard University T H Chan School of Public Health, Boston, MA, United States; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States; Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey; Maternal and Child Health Division, ICDDR, B, Dhaka, Bangladesh; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States; Department of Pediatrics, University of Maryland, School of Medicine, Baltimore, MD, United States; Nutrition and Scientific Affairs, Nature's Bounty Co, Ronkonkoma, NY, United States; Brown University School of Public Health, Providence, RI, United States; Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Department of Maternal and Child Health, Shoklo Malaria Research Unit, Mae Sot, Thailand; Office of Population Studies Foundation Inc, University of San Carlos, Cebu City, Philippines; Center for Nutrition, Boston Children's Hospital, Boston, MA, United States; Community Health Sciences, School of Public Health, University of California, Berkeley, CA, United States; Women and Children's Health, University of Liverpool, Institute of Translational Medicine, Liverpool, United Kingdom; College of Population Health, University of New Mexico, Albuquerque, NM, United States; Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI, United States; Poverty Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States; Department of Anthropology, Northwestern University, Evanston, IL, United States; Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway; Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, MA, United States; Department of Pediatrics and Child Health, Muhibili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Ifakara Health Institute, Dar es Salam, Tanzania; Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital, Oakland, CA, United States; 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, United Kingdom; Pediatrics and Child Health, Aga Khan Medical University, Karachi, Pakistan; Department of Collective Health, Universidade Federal da Bahia, Salvador, Brazil; Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey; Department of Immunology and Infectious Disease, Harvard University T H Chan School of Public Health, Boston, MA, United States; Department of Nutritional Sciences, Oklahoma State University, College of Human Environmental Sciences, Stillwater, OK, United States; Department of Laboratory Medicine, Sykehuset Innlandet Helseforetaket, Brumunddal, Norway; Centre for Health Research and Development, Society for Applied Studies, New Delhi, India; Division of Research on Public Health, National Institute of Perinatology, Mexico City, Mexico; Nutrition and Clinical Services Division, ICDDR, B, Dhaka, Bangladesh; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Deaprtment of Global Health and Population Epidemiology, and Nutrition, Harvard University T H Chan School of Public Health, Boston, MA, United States
