Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth.

Abstract

Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under-stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height-for-age at 2 and 4years. The Pakistan Early Child Development Scale-up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4years of age. In total, 1302 children were followed up from birth to 4years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height-for-age at 4years, including maternal depressive symptoms, mother-child interaction quality, diarrhoeal illness and height-for-age at 2years. Our final model had excellent model fit (comparative fix index = 0.999, Tucker-Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother-child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height-for-age at 4years via its longitudinal stability from 2years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1year post partum on children's height-for-age at 4years via the longitudinal stability of height-for-age z-score from 2years of age onwards (β = -0.007, p = 0.019). The quality of early caregiving experience mediated the association between both interventions and height-for-age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors.