Abstract
It is well established that low resource environments early in life can predispose children to adverse health and compromised developmental outcomes. We explore possible mechanistic pathways underlying poor developmental outcomes in children growing up in a low resource setting in urban Bangladesh. We tested associations between psychosocial risks, namely maternal distress and poor caregiving experiences, and biological risks, namely poor growth (HAZ) and inflammation (C-reactive protein: CRP), and children’s developmental outcomes. Child development was measured using the Mullen Scales of Early Learning (MSEL) at 6 and 27 months in one cohort, and using the MSEL and Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 36 and 60 months respectively in another cohort. In the younger cohort, we found that more inflammation (estimated by the child’s CRP level at four months) predicted lower receptive language scores at 6 months, while more frequent caregiving interactions predicted higher receptive language scores at 6 months. In the older cohort, we found that at 27 months, a child’s growth measured by his or her current HAZ was positively associated with gross motor, visual reception, receptive language, and expressive language scores. In the oldest cohort, we found that higher HAZ and more frequent stimulating activities in the home predicted higher motor and language scores, whereas more inflammation (as estimated by CRP over the first two years of life) predicted lower motor scores at 36 months. At 60 months, we found that HAZ and caregiving experiences were positively associated with verbal IQ, whereas inflammation was negatively associated with verbal IQ. This work identifies malnutrition, inflammation, and caregiving as potential sites of intervention to improve neurodevelopment in children growing up in global poverty.
Highlights
The scope of childhood poverty is troubling with nearly 20% of children in the developing world living in extreme poverty, defined by the World Bank as living on less than $1.90 per day [1]
The level of inflammation was high as indicated by mean C-reactive protein (CRP) scores of 3.90 (SD = 6.02) at 6 months in CRYTO and 6.21 (SD = 12.74) at 24 months in PROVIDE
We suggest that the increasing divergence on the Mullen Scales of Early Learning (MSEL) with children’s age may reflect one of three scenarios: 1) an increasing ability of the MSEL to differentiate between developmental trajectories as children age due to increasing measurement accuracy, 2) a developmental effect whereby children fall behind on developmental outcome gradually over time due to the acceleration of developmental milestone achieved as children age, 3) Developmentally dependent and/or cumulative effects of risk and protective factors
Summary
The scope of childhood poverty is troubling with nearly 20% of children in the developing world living in extreme poverty, defined by the World Bank as living on less than $1.90 per day [1]. Examples of poverty-related exposure that may directly impact child development include biological risks such as inadequate nutrition and childhood infections that precipitate inflammation and impact nutrition, as well as psychosocial risks, such as family and caregiver stress and parental mental health problems, which can impact both the amount and quality of cognitive stimulation to which a child is exposed. Low HAZ tends to be the result of malnutrition and infectious disease, two common risk exposures with possible impacts on neural development [2]. With regard to psychosocial risks, previous research has highlighted the impact of stress, parental mental health illness, and the social caregiving environment as a key mechanism through which poverty impacts early child development [8, 9, 10, 11, 12]. Studies investigating maternal depression have revealed its impact on childhood development as early as three months [13] and throughout childhood [14]
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