Abstract
BackgroundChildren in low and middle income countries may have many risk factors for poor cognitive development, and are accordingly at a high risk of not reaching their developmental potential. Determinants for cognitive development in early life can be found among biological and socioeconomic factors, as well as in stimulation and learning opportunities.ObjectiveThe present study aimed to identify determinants of cognitive, language and motor development in 6–11 months old Nepalese infants.MethodsSix hundred infants with a length-for-age z-score <-1 were assessed with the Bayley Scales of Infant and Toddler development, 3rd edition (Bayley-III). Information on socioeconomic factors, child and maternal demographics, clinical and biological factors, and the home environment were collected. In a manual stepwise variable selection procedure, we examined the association between selected biological, socioeconomic and stimulation and learning opportunity variables and the Bayley-III cognitive, language and motor development subscale scores in multiple linear regression models.ResultsThe length-for-age z-scores was positively associated with the cognitive composite score [standardized beta (ß): 0.22, p < 0.001] and the motor composite score [(ß): 0.14, p = 0.001]. Children born with low birth weight (<2500 g) scored significantly lower on all subscale scores. Diarrheal history was associated with poor language composite scores, and females had higher language composite scores than boys [(ß): 0.11, p = 0.015]. Children who had been hospitalized during the first month of life had also lower cognitive and motor composite scores than those who had not been hospitalized. Parental reports of physical punishment and lack of spontaneous vocalization were associated with poor cognitive and language composite scores, respectively. The statistical models with the various subscale scores as dependent variables explained between 8 to 16 percent of the variability in the cognitive developmental outcomes.ConclusionOur findings reveal important determinants for developmental scores in infancy, and underline the role of biological risk factors faced by marginalized children in low and middle income countries such as in Nepal.
Highlights
Children in low and middle income countries (LMIC) are at risk of not developing according to their potential, and this represents a major public health problem (McDonald and Rennie, 2011)
Known biological risk factors for poor cognitive function that are common in LMICs include short gestational duration (Gutbrod et al, 2000; Espel et al, 2014), low birth weight (Tong et al, 2006; Gill et al, 2013; Donald et al, 2019; Sania et al, 2019; Upadhyay et al, 2019), anemia (Sungthong et al, 2002) and stunting (Haile et al, 2016; Woldehanna et al, 2017)
28% of the study children had a history of diarrhea 1 month prior to enrollment and 9% were hospitalized mainly related to their low birth weight or because of jaundice during the first month of life
Summary
Children in low and middle income countries (LMIC) are at risk of not developing according to their potential, and this represents a major public health problem (McDonald and Rennie, 2011). The South Asian and sub-Saharan African regions have multiple poverty related risks such as malnutrition, poor health and poor quality of stimulation and learning environment for many children (Grantham-McGregor et al, 2007). In these settings, identifying the predictors for early child development will help in initiating early intervention plans to prevent developmental delays (Persha et al, 2007). Children in low and middle income countries may have many risk factors for poor cognitive development, and are at a high risk of not reaching their developmental potential. Determinants for cognitive development in early life can be found among biological and socioeconomic factors, as well as in stimulation and learning opportunities
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