Abstract
BackgroundIt has been estimated that more than 200 million children under the age of five do not reach their full potential in cognitive development. Much of what we know about brain development is based on research from high-income countries. There is limited evidence on the determinants of early child development in low-income countries, especially rural sub-Saharan Africa. The present study aimed to identify the determinants of cognitive development in children living in villages surrounding Haydom, a rural area in north-central Tanzania.MethodsThis cohort study is part of the MAL-ED (The Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development) multi-country consortium studying risk factors for ill health and poor development in children. Descriptive analysis and linear regression analyses were performed. Associations between nutritional status, socio-economic status, and home environment at 6 months of age and cognitive outcomes at 15 months of age were studied. The third edition of the Bayley Scales for Infant and Toddler Development was used to assess cognitive, language and motor development.ResultsThere were 262 children enrolled into the study, and this present analysis included the 137 children with data for 15-month Bayley scores. Univariate regression analysis, weight-for-age and weight-for-length z-scores at 6 months were significantly associated with 15-month Bayley gross motor score, but not with other 15-month Bayley scores. Length-for-age z-scores at 6 months were not significantly associated with 15-month Bayley scores. The socio-economic status, measured by a set of assets and monthly income was significantly associated with 15-month Bayley cognitive score, but not with language, motor, nor total 15-month Bayley scores. Other socio-economic variables were not significantly associated with 15-month Bayley scores. No significant associations were found between the home environment and 15-month Bayley scores. In multivariate regression analyses we found higher Bayley scores for girls and higher Bayley scores in families with more assets. Adjusted R-squared of this model was 8%.ConclusionWe conclude that poverty is associated with a slower cognitive development in children and malnutrition is associated with slower gross motor development. This information should encourage authorities and other stakeholders to invest in improved welfare and nutrition programmes for children from early infancy.
Highlights
It has been estimated that more than 200 million children under the age of five do not reach their full potential in cognitive development
There were 262 presumably healthy singleton children enrolled into the study, and we included the 135 children who had data for 15-month Bayley Scales of Infant Development (Bayley) scores; 77 (56.2%) were girls (Table 1)
In univariate regression analysis weight-for-age and weight-for-length z-scores at 6 months were significantly associated with 15-month Bayley gross motor score, but not with other 15-month Bayley scores (Table 2)
Summary
There is limited evidence on the determinants of early child development in low-income countries, especially rural sub-Saharan Africa. It has been estimated that more than 200 million children under the age of five do not reach their full potential in cognitive development This phenomenon is largely due to mechanisms that can be influenced; such as poverty, Ribe et al Child Adolesc Psychiatry Ment Health (2018) 12:18 on to future generations and the gap of health inequities grows. One study from rural Kenya analyzed the prevalence and risk factors of neurological disability and impairment in 6–9 year-olds They found that moderate to severe cognitive impairment was present in 3% of children, and neonatal insult was the only risk factor identified [9]. To our knowledge, there is limited evidence on the determinants of early child development of the general population in low-income countries, and from rural sub-Saharan Africa
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