Early childhood development in Pakistan: the relative contributions of neighbourhood, socioeconomic inequalities and home environment to growth and psychomotor development

Abstract

Background: Child Development is a process of positive change in psychomotor, cognitive, linguistic, social, emotional, and behavioural aspects in a well nourished child. The word psychomotor refers to the psychological and motor aspects of action. Psychomotor abilities have a pivotal role in the achievement of holistic development of well balanced children during the early phases of life. Many children live in the underprivileged conditions prevailing in the developing countries. About 11 million under 5 children die every year, while a large proportion of children who survive are prone to developmental delays, socio-emotional difficulties, and growth faltering. It has been estimated that at least 200 million children are developmentally delayed in the developing countries. Aims and objectives: The overall aim was to evaluate the relative contributions of socio-economic status, rural-urban neighbourhood and sensory stimulation to the psychomotor development of the child. In addition, to explore whether physical growth is in the causal pathways of the influence of these factors on psychomotor development. Methodology: A cross-sectional study involving 1244 0-3 year old children living in Sindh, Pakistan was conducted from May to November 2002. Children were assessed at home visits using: Bayley's Infant Developmental Scale for psychomotor development, the Home Observations for Measurement of the Environment inventory (HOME) to assess sensory stimulation available at home, basic anthropometry for growth status, and a questionnaire covering a variety of data including socio-economic status. A socio-economic index was created based on principle component analysis and multiple linear regression techniques were applied to assess study hypotheses. Key findings: Socio-economic inequalities have an immense impact on early child growth and development. Children in rural neighbourhoods have poor psychomotor development compared with urban areas; the association is statistically very robust. In contrast, rural urban differences in physical growth are mediated by socio-economic status. Physical growth is a significant determinant of psychomotor development, especially in the presence of a combination of poor anthropometric indicators. Sensory stimulation available at home is strongly linked with physical growth and psychomotor development. However, its effect on psychomotor development is only marginally mediated via the nutritional status of the child. Implications: The study highlights the fact that improvement in socio-economic conditions is vital to achieve optimal growth and development during early childhood. However, attention to the contextual needs, especially rural urban neighbourhood, is required in formulation and implementation in early child care and development interventions. The study also draws our attention to the fact that efforts to improve physical growth are mandatory in order to achieve optimal child development. Last but not least the study provides substantial evidence that sensory stimulation should be promoted as a strategy to make a positive difference to the growth and development status of children.