Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development.

Francisca Mutapi,Simbarashe Rusakaniko,Rivka Lim,Lorraine Pfavayi,Dixon Chibanda,Takafira Mduluza,Maritha Kasambala,Arnold Mutemeri,Derick Osakunor,Xiao-Nong Zhou

doi:10.1371/journal.pntd.0009660

Abstract

There is a paucity of reference early childhood development (ECD) data at community level in rural Africa. Our objective was to conduct a comprehensive assessment of ECD in rural Zimbabwe and determine the impact of stunting and schistosome infections on ECD. Using the Griffiths Scales of Child Development, we conducted a cross sectional assessment of Eye and Hand Coordination (EHC), Personal-Social-Emotional (PSE), Language and Communication (LC), Foundations of Learning (FL) and Gross Motor (GM) domains and the summary General Development (GD) in 166 children aged 6–72 months. The effects of stunting, malnutrition and Schistosoma haematobium infection on ECD was determined. The impact of praziquantel curative treatment of schistosome infection on the developmental scores was determined through a longitudinal follow up at 6 and 12 months. From an initial 166 children, 11 were found to have developmental deficits warranting further investigation. Of the remaining 155, 58.7% recorded a good (≥ average) score for the overall General Development (GD). Proportions of children scoring above the cut-off (≥ average) for each domain were GM (84.5%), PSE (80.6%), EHC (61.9%), FL (43.9%) and LC (44.5%). The prevalence of stunting was 26.8% (95% CI = 20.1%–34.8%) Scores for stunted children were significantly lower for EHC (p = 0.0042), GM (p = 0.0099), and GD (p = 0.0014) with the fraction of lower scores attributable to stunting being GM = 63.4%, GD = 46.6%, EHC = 45%, and LC = 21%. S. haematobium infection prevalence was 39.7% and mean infection intensity was 5.4 eggs/10 ml urine. Infected children had poorer cognitive performance scores for the FL (p = 0.0005) with 30.8% of poor FL attributable to the infection. Performance in all domains improved to the expected normal or above reference levels at 6 and 12 months post curative treatment of schistosome infections. Our study documented reference values for ECD in rural Zimbabwean children. The study detected deficiencies in the FL domain, which were more pronounced in children, infected with schistosomes, highlighting the need for provision of cognitive stimulation tools and access to early childhood foundation education. There is also need for improved child nutrition and treatment of schistosome infections to improve child development outcomes.

Highlights

The early childhood period is considered the most important developmental phase throughout the lifespan of a child with events occurring in these first few years being critical for the child’s developmental trajectory and life course. https://www.who.int/social_determinants/themes/ earlychilddevelopment/en/)
There is a paucity of comprehensive early childhood development data at community level in rural Africa
We assessed the development of rural Zimbabwean children aged 6–72 months and determined the impact of stunting and schistosome infections on their 5 developmental domains; Eye and Hand Coordination, Personal-Social-Emotional, Language and Communication, Foundations of Learning and Gross Motor domains and the summary General Development

Summary

Introduction

The early childhood period is considered the most important developmental phase throughout the lifespan of a child with events occurring in these first few years being critical for the child’s developmental trajectory and life course. https://www.who.int/social_determinants/themes/ earlychilddevelopment/en/). These events influence the child’s mental and physical health, education and future economic participation. In most African countries, child development in rural areas is monitored as part of the monthly growth monitoring in child health programs These programs mostly consist of weighing, height measuring, and nutrition advice to caregivers. In Zimbabwe, the growth-monitoring program is part of the child health surveillance system, which uses basic measures such as weight-for-age, height-for-age and mid-upper arm circumference (MUAC) to chart child development. This is conducted at primary health centres with input from village health workers who monitor the number of eligible children in their communities. A study in Mutasa District in Zimbabwe in 2015 indicated that 70% of children below 5 years of age missed their monthly weighing, meaning that for most children, subtle changes and malnutrition went undetected [1]

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