Determinants of Developmental Milestones in Infants and Young Children in Bihar, India

Abstract

Approximately 200 million children globally fail to fulfill their developmental potential. Children in Bihar, India may be at particularly high risk as the extensive malnutrition in the region could have important implications for brain development. The objectives of this study are to use baseline data from an ongoing cluster randomized effectiveness trial of home fortification with micronutrient powders in Bihar to 1) validate a modified version of the Developmental Milestones Checklist II (DMC‐II) and 2) determine nutritional and socioeconomic risk factors for mental and motor development of infants and young children.Cross‐sectional data from 4360 children 6–18 months of age living in West Champaran district of Bihar, India, were used to determine the predictive validity of the modified DMC‐II by comparing scores by age, nutritional status, and maternal education. Multivariate regression was used to examine determinants of child development score.The mean score on the modified DMC‐II was 40.9 (95%CI 40.6, 41.3) out of 82.0. The overall score and scores for each subscale (motor, language, personal‐social, and cognitive) were significantly associated with child age and maternal education. After adjustment for age, overall and all subscale scores were each significantly associated with height‐for‐age, weight‐for‐age, and weight‐for‐height z‐scores. A multivariate linear model for the child's overall modified DMC‐II scores (R2=0.60) revealed significant associations (P<0.05) with age (coefficient (SE): 2.49 (0.05)), gender (−0.84 (0.28)), height‐for‐age z‐score (0.57 (0.15)) weight‐for‐age z‐score (1.10 (0.17)), dietary diversity score (1.00 (0.14)), timely initiation of complementary foods (1.00 (0.29)), no use of prelacteal feeds (0.67 (0.29)), Family Care Indicators or home stimulation (0.56 (0.04)), and maternal education (0.97 (0.30)). Recent morbidity (fever, cough, or diarrhea) was not significantly associated with DMC‐II scores in the multivariate model.Predictive validity of the DMC‐II was established in this population. Comparison of standardised regression coefficients identified weight‐for‐age z‐score, Family Care Indicators, and dietary diversity as the strongest determinants of the child's overall score on the developmental milestones; length‐for‐age z‐score, weight‐for‐age z‐score, and weight‐for‐length z‐score were the strongest predictors of score on the motor development subscale. Strategies to improve child development should simultaneously address these issues.Support or Funding InformationFunding support provided by a BMGF grant through a subcontract with CARE‐India