Early Childhood Development Index Research Articles

Unlevel Playing Field: Socioeconomic Determinants of Early Childhood Development in Turkiye

AbstractWe investigate the socioeconomic determinants of early childhood development (ECD) in Türkiye, focusing on maternal education and household wealth, using representative microdata from the 2018 Türkiye Demographic and Health Survey (TDHS), which collected data on the developmental status of young children aged 36–59 months for the first time. Using this data, we construct an ECD index based on four developmental domains (i.e., literacy-numeracy, physical development, learning readiness and socio-emotional). Our results suggest that 74 percent of children (70.3 percent of boys and 78 percent of girls) are developmentally on track. We find that while over 96 percent of children are developmentally on track in physical and learning readiness domains, only 14.5 percent and 73.6 percent are in the literacy-numeracy and socio-emotional development domains, respectively. The multivariate regression results suggest both maternal education and household wealth improve children’s ECD outcomes but the latter has a stronger effect. In fact, we find that mother’s schooling is only positively and statistically associated with ECD once mothers have at least a high school education. Kindergarten attendance, which stands at a meagre 11.3 percent, is only likely for children from well-to-do and educated households. As a result, we find large gaps in ECD and its components between children with low and high socioeconomic backgrounds. We conclude that leveling the playing field is only possible via a nationwide multisectoral initiative that can support and educate caregivers and children simultaneously.

Exploring the interplay: Maternal electronic health literacy and its impact on early childhood development and parenting practices.

Mothers need a competent electronic health literacy (eHL) skill for beneficial gains for the health of their children in the virtual environment, which is a new health platform. We predict that a competent eHL of mothers who play a central role in early childhood will positively affect the health of their children. This study aimed to determine the level of eHL of mothers of young children and investigate the relationship between mothers' eHL and early childhood development (ECD) and early parenting practices (EPP). This cross-sectional study was conducted on mothers with children aged 36-59 months using eHealth. Sociodemographic and personal characteristics form, Early Childhood Development Module and eHealth Literacy Scale were administered to the participating mothers. The data from 440 mother-child pairs were analysed. Children of mothers with sufficient eHL levels were more likely to be Early Childhood Development Index (ECDI)-on-track, adjusted odds ratio (AOR), 95% confidence interval (CI): 2.16 (1.29-3.61); have adequate support in learning, AOR (%95 CI): 3.23 (1.69-6.18); and have adequate daily meals and snacks, AOR (%95 CI): 2.43 (1.56-3.78). These results revealed that there is a need for interventions that will contribute to child health by improving mothers' eHL levels.

Examining the Utility of the Early Childhood Development Index (ECDI) among Children in the Nigeria Context.

An estimated 6 million children under the age of five in Nigeria (out of nearly 31 million) risk not reaching their full developmental potential. The dearth of context-relevant measures poses a challenge to the planning and implementation of effective interventions. This study assesses the utility of the Early Childhood Development Index (ECDI) in Nigeria. We used the Multiple Indicator Cluster Surveys to track progress among 3- to 4-year-old children (n = 11,073); 3-year-old, 51%; female, 49%. Using random calibration samples, the results from psychometric tests indicate that while over half of the children were on track in their development based on the ECDI, the instrument had low to average internal consistency and weak face validity, suggesting an inadequacy in capturing ECD information of value. At the outset of the launch of the new ECDI2030, the results of this study point to the need for continued discourse and advocacy for the use of culturally appropriate measures of child development, and a child-centered community engagement approach. This is essential in ensuring accountability and responsive interventions for the children served and their families.

Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys.

Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.

Examining the influence of child nutritional disorders on early childhood development in Bangladesh: insights from the multiple indicator cluster survey.

The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh. We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models. Bangladesh. Data of 9,455 children aged 3 and 4 years. Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI. Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.

Gender similarities and differences in early childhood development in low- and middle-income countries

Gender differences in early childhood development are under-researched in low- and middle-income countries (LMICs) where almost 90% of the world’s young children live. This study examines the direction, magnitude, and variation of gender similarities and differences in 3- and 4-year-olds’ early childhood development in 71 low- and middle-income countries (LMICs). Moreover, we explore whether country-level gender inequality correlates with gender differences in early development. We analyzed Early Childhood Development Index (ECDI) data from UNICEF’s Multiple Indicators Cluster Surveys and the Demographic and Health Surveys between 2010 and 2019 (n = 226,980). Using logistic regression, we estimated children’s odds of being developmentally on track in literacy-numeracy, approaches to learning, social-emotional, and physical domains. We also used meta-analytic regression to examine associations between early childhood development and country-level indicators of gender inequality. In approximately one-half of LMICs, odds of being developmentally on track did not significantly differ for girls and boys; in countries with significant differences, girls were more likely to be on track than boys (odds ratio [OR] = 1.21, 95% confidence interval [CI] = [1.18–1.24], p < .001). Differences favoring girls were largest in the social-emotional domain (OR = 1.27, 95% CI = [1.24–1.30], p < .001). Country-level gender development index explained a substantial amount of variation in gender differences across countries. Overall, findings suggest that when gender differences exist, girls are more likely than boys to be developmentally on track, particularly in the social-emotional domain and in countries with greater gender equality.

Establishing performance standards for child development: learnings from the ECDI2030

BackgroundStandards of early childhood development (ECD) are needed to determine whether children living in different contexts are developmentally on track. The Early Childhood Development Index 2030 (ECDI2030) is a population-level measure intended to be used in household surveys to collect globally comparable data on one of the indicators chosen to monitor progress toward target 4.2 of the Sustainable Development Goals: The proportion of children aged 24–59 months who are developmentally on track in health, learning and psychosocial well-being.MethodsTo define performance cut-scores for the ECDI2030 we followed a criterion-referenced standard setting exercise using the modified Angoff method. The exercise gauged the expectations from 15 global experts in ECD and was informed by representative population data collected in Mexico and the State of Palestine. The final calibrated age-specific performance cut-scores were applied to these data to estimate the proportion of children developmentally on track, disaggregated by background characteristics, including the child's sex and attendance to early childhood education.ResultsThrough a process of standard setting, we generated robust performance standards for the ECDI2030 by establishing five age-specific cut-scores to identify children as developmentally on track.ConclusionsThis paper demonstrated how the standard setting methodology, typically applied to measures in the health and education fields, could be applied to a measure of child development. By creating robust criterion-referenced standards, we have been able to ensure that the cut-scores related to age for the ECDI2030 are based on performance standards set by global experts in the ECD field for defining on and off track development.

Effects of parental migration on early childhood development of left-behind children in Bangladesh: Evidence from a nationally representative survey.

In Bangladesh, as in other low- and middle-income countries, parents frequently migrate to other areas, often for employment opportunities, leaving their children behind with the hope that their earnings will contribute to securing a better future for them. However, the absence of parents due to migration can have negative implications for the well-being of these left-behind children. Despite the existence of studies investigating this phenomenon, the evidence thus far has produced inconclusive findings, with no specific data available from Bangladesh. Therefore, the objective of this study was to examine the effects of parental migration on the early childhood development of left-behind children in Bangladesh. The present study utilized data from the Bangladesh Multiple Indicator Cluster Survey (MICS) conducted in 2019. A sample of 8,833 children aged 3-4 years was included in the analysis. The Early Childhood Development Index (ECDI) and its individual domains served as the outcome variables of interest. The primary explanatory variables considered in the analysis were father migration, mother migration, migration of both parents, and migration of either parent. To assess the association between the outcomes and explanatory variables, multilevel logistic regression analysis was employed, controlling for relevant covariates. Approximately 29% of all children in the study were not developmentally on track, as measured by the ECDI. When examining the individual domains of the ECDI, only 9% of the total children demonstrated developmental progress in the learning domain. Regarding the association between parental migration and ECDI outcomes, we observed a 26% decrease in the likelihood of overall ECDI among children with a migrated father (OR: 0.74, 95% CI: 0.54-0.93). This decrease became even more pronounced, reaching 37% (OR: 0.63, 95% CI: 0.48-0.97), among children with both parents migrated, compared to children with neither parent migrated. The findings of this study indicate that parental migration, especially when both parents are involved, has a substantial negative impact on the likelihood of achieving favourable ECDI outcomes for children in Bangladesh. To ensure the optimal development of children with migrating parents, it is crucial to strengthen early childhood development education programs and implement robust social safety nets. These efforts should specifically target the unique needs and challenges faced by children with migrated parents, providing them with the necessary support and resources for their holistic development.

Monitoring early childhood development at the population level: The ECDI2030

Population-level monitoring of early childhood development (ECD) can inform research and guide national policy. One approach to population-level monitoring is through the design of surveys that (a) are feasible and cost-effective to implement at scale, (b) yield well-validated summaries of children's holistic development, and (c) can ideally support comparisons across national and cultural contexts. The Early Childhood Development Index 2030 (ECDI2030) is a caregiver-reported household survey designed to achieve these goals for children aged 24-59 months. This paper describes how the ECDI2030 was developed and provides initial results on its reliability, concurrent validity, and gender equity in nationally representative samples from Mexico (N = 1641) and Palestine (N = 1099). Overall, the results support the use of the ECDI2030 for population-level monitoring, but also suggest that the conceptualization of social-emotional development warrants further attention from researchers. Recommendations are made about statistical analyses that can be undertaken to ensure the quality of data collected from ECD assessments in international settings.

Reading, singing, and storytelling: the impact of caregiver-child interaction and child access to books and preschool on early childhood development in Ghana

Optimal early childhood development (ECD) is crucial in shaping future academic and economic accomplishments. Recognising its profound influence, the United Nations has included a specific target and indicator related to ECD in the Sustainable Development Goals to ensure universal access to high-quality ECD for all preschoolers by 2030. This study investigated whether caregiver-child engagements, early stimulation, and learning opportunities are associated with ECD among children aged 36–59 months. Data on 6752 children were pooled from the 2011 and 2017 Ghana Multiple Indicator Cluster Surveys. The ECD outcomes of interest were literacy-numeracy, social-emotional, learning-cognitive, and physical development, measured with UNICEF's Early Childhood Development Index (ECDI). Binary logistic regression assessed the effects of various caregiver-child engagements and early learning opportunities on the ECD outcomes. We found that most children were developmentally on track in the physical (95.0%) and learning-cognitive (86.4%) domains, but fewer were on track in the literacy-numeracy (36.7%) and social-emotional (68.6%) domains. Reading to or with a child (aOR 1.72; 95% CI 1.35–2.19), telling them stories (aOR 1.61; 95% CI 1.26–2.04), counting or drawing with them (aOR 1.63; 95% CI 1.30–2.04) and a child’s attendance at preschool (aOR 4.62; 95% CI 3.34–6.38) were associated with a higher odds for on track literacy-numeracy development. Playing with a child was associated with higher odds of on-track social-emotional development (aOR 1.29; 95% CI 1.04–1.59), physical development (aOR 1.61; 95% CI 1.01–2.55), and learning-cognitive development (aOR 1.51; 95% CI 1.14–2.00). However, singing songs to or with a child (aOR 0.78; 95% CI 0.62–0.89) and taking a child outside the home (aOR 0.78; 95% CI 0.64–0.95) were associated with lower odds for on track social-emotional development. Access to children's books at home was associated with higher odds for on track literacy-numeracy and social-emotional development. In subgroup analysis, some observed associations varied depending on a child's residence (urban or rural). Our findings confirmed that caregiver-child interaction and early learning opportunities could increase a child’s likelihood of achieving early developmental milestones.

Home environment factors associated with early childhood development in rural areas of Bangladesh: evidence from a national survey.

Knowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4 years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4 years. We used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4 years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally "on track". The findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children's activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08-1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09-1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4 years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts. Home environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study's findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context.

Relations of maternal health literacy and parenting practices with early childhood development: a cross-sectional study

ABSTRACT This study aimed to examine the relations of early childhood development with maternal health literacy and mothers’ early parenting practices. This cross-sectional study was conducted on mothers with children aged 36–59 months (n = 503) with a survey form, Early Childhood Development Index (ECDI) and Turkish Health Literacy Scale-32. Children of mothers with sufficient/excellent health literacy levels, children who are breastfed for 12 months and longer, and children with a screen time of 2 h or less were more likely to be ECDI-on-track (AOR (CI) = 2.52 (1.53–4.15); 2.28 (1.41–3.70); 2.04 (1.18–3.50); respectively). In conclusion, children whose mothers were adequately health literate, who were breastfed longer and who had less screen time were better on ECDI indicators. Increasing the knowledge and skills of mothers on early parenting practices and supporting them to be good health literacy will contribute positively to the early development of children.

Unwanted or Mistimed Pregnancy and Developmental Issues in Ecuadorian Children Aged 3 to 5: A Doubly Robust Estimate Using Data from the National Health and Nutrition Survey 2018.

Past studies in high-income countries have shown an association between unintended (unwanted or mistimed) pregnancy and child development; no national-level studies in low-and-middle-income countries have been conducted. Moreover, extant studies often adjust for potential mediators, underestimating the average population effect. We aimed to estimate the effect of unintended pregnancy on early childhood development in Ecuadorian children aged 3 to 5, participating in the National Health and Nutrition Survey 2018. We used a design-based doubly robust estimate. First, we used propensity score matching (1:1) to identify a subsample equally likely to come from a desired vs. unintended pregnancy based on geographic area, household income, paternal intendedness, the mother's current marital status, age, ethnicity, and educational level, depressive symptoms, and the child's gender and age. Then, we used a logistic regression model to explore the relation of maternal pregnancy intentions with adequate development, as defined by the Early Childhood Development Index (ECDI). While exempt from review by an Institutional Review Board, this secondary research was conducted in accord with prevailing ethical principles. Among 1694 observations representing 162,285 Ecuadorian children, unintended pregnancy associated with inadequate development (odds ratio: 1.56; 95% confidence interval: 1.06; 2.29), after adjusting for all relevant confounders. Unintended pregnancy was also negatively associated with all four ECDI domains, socio-emotional development being the most affected. Our doubly robust design found evidence of the relation between the maternal perception of pregnancy and early child development. Addressing this relation to achieve reproductive justice entails considering a wide spectrum of population health and legal interventions to allow adequate access to education, contraception, and safe abortion. Moreover, pre- and post-natal check-ups could screen for unintended pregnancy and provide support accordingly.

Association of household food insecurity with developmental delay in preschool children: 2018 Ecuadorian Nutrition and Health National Survey.

We investigated the association of household food insecurity (HFI) with developmental delays in 36-59-month-old preschool children (n 7005) using cross-sectional data from the 2018 Ecuadorian National Health and Nutrition Survey. HFI was assessed with the Food Insecurity Experience Scale and developmental delays with the Early Childhood Development Index. Log-binomial regression models estimated the association of HFI with global (overall) developmental delay (GDD) and delays in four individual developmental domains, adjusting for covariates. Nearly half of the children lived in households with marginal (24⋅5 %) or moderate-severe HFI (21⋅7 %). Eighteen percent were identified with GDD. Delays in the individual domains of literacy-numeracy, social-emotional, physical and cognitive development were identified for 64, 21⋅5, 3⋅3 and 3⋅1 %, respectively. GDD was more likely among preschool children from households with marginal (aPR = 1⋅29; 95 % C.I. = 1⋅10, 1⋅49) and moderate-severe HFI (aPR = 1⋅30; 95 % C.I. = 1⋅11, 1⋅51). Social-emotional development delays were also more likely among those from households with marginal (aPR = 1⋅36; 95 % C.I. = 1⋅19, 1⋅56) and moderate-severe HFI (aPR = 1⋅33; 95 % C.I. = 1⋅15, 1⋅54) different from the other three domains. Several other potentially modifiable risk (violent discipline, maternal depressive symptoms) and protective factors (adequate child stimulation, higher maternal education, handwashing with soap/detergent) were also independently associated with GDD and/or literacy-numeracy and cognitive delays. Our findings suggest that HFI is an independent risk factor for GDD and social-emotional developmental delays in Ecuadorian preschoolers. They underscore the importance of strengthening and expanding poverty reduction, food security and early childhood development policies and interventions to improve the opportunities for children to achieve their full developmental potential.

Variations in risk, resilience, and protective factors for cognitive and socioemotional development among 3- to 4-year-old children in Nigeria: A multilevel modeling

This study used multilevel modeling to examine the dynamics between the layers of influence associated with literacy, cognitive, and socioemotional outcomes of 3- to 4-year-old children in Nigeria. The study used data from the fifth round of the Multiple Indicator Cluster Survey (MICS), and adapted the social-ecological model of child development and the social determinants of health framework to investigate the interaction between a child's microsystem, engagement with the mesosystem, the politico-cultural climate, and how they are associated with selected Early Childhood Development Index (ECDI) domains. The final sample of 11,207 mother-child dyads (n=22,414; state mean = 303; ethnicities – Hausa 48%, Yoruba 10%, Igbo 11%, and others combined 31%) comprised three-year-old children (51%), females (49%). Results indicated a 29% variation in child outcomes accounted for by the grouping structure of the states, that diminished with the addition of household-level predictors. On average, a child not attending early education (-1.93), not having books (-1.32), being in the poorer wealth quintiles (-.91), mother having informal or no education (.82), and ethnicity, specifically being Hausa (-.21) were associated with predicted lower child development outcome score. At the state level, low maternal education was the most significant predictor of child development outcomes.Findings will add value to policy interventions as states reconsider their strategy and funding obligations to ECD, addressing poverty at the family level, and promotion of girl/maternal education.

Measuring indicators of Sustainable Development Goal Target 4.2.1: factor structure of a direct assessment tool in four Asian countries

ABSTRACT Sustainable Development Goal Target 4.2.1 is monitored by determining the proportion of children aged 24 to 59 months who are developmentally on track in the domains of health, learning, and psychosocial well-being. UNICEF has developed a caregiver report measure, the Early Childhood Development Index 2030 (ECDI2030), to measure progress towards this target. This paper examines whether a newly developed tool, the Early Childhood Development Assessment Scale-Direct Assessment (ECDAS-DA) can add value to the measurement of Target Indicator 4.2.1 by complementing UNICEF’s ECDI2030, and explores the psychometric properties of the ECDAS-DA. A total of 956 children (476 girls) aged 3 to 5 years from Bangladesh, China, India and Myanmar were administered the ECDAS-DA in individual sessions. Caregivers provided responses to a survey based on UNICEF’s ECDI2030. Confirmatory Factor Analyses indicated that learning, health, and psychosocial well-being domains of the ECDAS-DA were three component parts of one underlying construct of early child development. Significant correlations between the ECDAS-DA and the caregiver-reported ECDI2030 survey were found in the learning and health domains but findings were mixed for the psychosocial well-being domain. Multiple measures of early development could be important in measuring SDG Target 4.2.1 and the ECDAS-DA has the potential to complement UNICEF’s ECDI2030.

EPIDEMIOLOGICAL PROFILE AND GLOBAL DEVELOPMENT OF CHILDREN FROM 0 TO 5 YEARS OF AGE IN A DISTRICT IN THE INTERIOR OF BAHIA

Introduction: Early childhood corresponds to the period from birth to 6 years of age, it is during this period that the child gains fundamental skills for the full development of various skills. However, many factors can influence this development, such as physical, family and social issues, social isolation, for example, caused a process of transformation of the domestic environment, which started to add a set of activities related to work, school and even even physical activity. The current context of the pandemic has generated impacts on education, family life, economic and global development of children, because with isolation, many activities were restricted, as well as the functioning of daycare centers and schools, which often played a fundamental role. in the nutrition of some children. Objective: To profile the global development of children aged 0 to 5 years in a district in the interior of Bahia. Materials and methods: The research was carried out in Capoeiruçu, district of Cachoeira-Ba, and children from 0 to 5 years old living in the district were included in the study. epidemiological; Ages &amp; Stages Questionaires -3, and the Early Childhood Development Index 2030. The collected data were tabulated in a database in the Statistical Software Package for the Social Sciences (SPSS) version 22. Results: According to the analysis, about 47.20% of families survive with 2 or less minimum wages per month and 32.4% of parents have completed high school. In addition, 55.9% of mothers had health problems during pregnancy, such as anemia and hypertension. Another impacting factor is that 41.20% of these parents and caregivers were unemployed in the pandemic, reporting that 64.7% of these families were infected with the COVID-19 virus. Of the total number of families interviewed, 55.9% reported that their children became more dependent on activities such as playing, running or anything else. Conclusion: According to the results presented, we can point out that, although some of these children have some factors that may influence a deficit in global development, they still had a good income, as these qualities may be linked to the fact that the community is composed mainly by university students in the health area, which favors obtaining more information on issues related to the typical development of children.

Investigating the direct and indirect associations between birth intervals and child growth and development: A cross-sectional analysis of 13 Demographic and Health Surveys

There is considerable literature on the associations of short birth intervals with adverse perinatal outcomes. However, less is known about the associations with child growth and development. In this study, we investigated the associations between birth intervals and child growth and development and examined child illness, child diet, and maternal stimulation as potential mechanisms. We pooled Demographic and Health Survey data on 8300 children aged 36–59 months from 13 countries (Benin, Burundi, Cambodia, Cameroon, Chad, Congo, Haiti, Honduras, Rwanda, Senegal, Timor-Leste, Togo, and Uganda). Longer birth interval was defined as a preceding birth interval ≥33 months. Child growth was assessed using height-for-age Z-score (HAZ). Child cognitive and socio-emotional development were measured using the Early Childhood Development Index. Child morbidity was defined as any illness in the past two weeks. Child diet was assessed using dietary diversity score and maternal stimulation by the number of stimulation activities. We used generalised linear models to estimate associations between longer birth intervals and child growth and development. Structural equation modelling was used to assess direct and indirect effects. In our sample, 44% of children had a preceding birth interval ≥33 months, 42% were stunted, 25% were cognitively off-track, and 33% socio-emotionally off-track. Longer birth intervals were associated with higher HAZ (mean difference 0.23 (95% CI 0.14, 0.32)) and socio-emotional development (relative risk (RR) 1.04 (95% CI 1.00, 1.09), but not cognitive development (RR 1.02 (95% CI 0.98, 1.06). We observed no significant indirect effects via child illness, child dietary diversity, or maternal stimulation. Although longer birth intervals were beneficial for child growth and socio-emotional development, we found no empirical support for the biological and behavioural mechanisms we explored. Additional research is needed to investigate alternative mechanisms to elucidate underlying processes and inform future interventions.

Early childhood development and its association with maternal parity.

Maternal parity, which is usually measured as the number of children born to a mother, has a substantial impact on the social and environmental factors around children and their development. This paper estimates the Early Childhood Development Index (ECDI) of 3- and 4-year-old children in Bangladesh and examines the relationship between maternal parity and early childhood development. The study analysed nationally representative data from the Bangladesh Multiple Indicator Cluster Survey 2019. The dataset had 9453 children aged from 36 to 59 months. The ECDI was computed following the UNICEF's approach involving psychometric computation of four domains of development: physical, literacy-numeracy, learning and social-emotional. Since the dataset has a hierarchical structure, we used multilevel logistic regression. A quarter (25%) of the children were not on track in their early childhood development. Seventy-one percent were not developmentally on track in the literacy-numeracy domain, 27% were not in the social-emotional and smaller percentages were not in learning (9%) and physical (1%) domains. There was a significant negative association between maternal parity and ECDI (adjusted odds ratio [AOR] 0.95; 95% CI: 0.91-0.99). Attendance at early childhood education programmes was significantly associated with early childhood development (AOR 1.73; 95% CI: 1.47-2.03). Also, female children, those who were not stunted, located in rural areas, received parental stimulation activities, lived in relatively wealthy households or had mothers who had received secondary or further education were more likely than others to be on track of early childhood development. Early childhood development is negatively correlated with maternal parity. The literacy-numeracy domain constitutes the major developmental delay. Programmes for parental awareness should be widely expanded.

Associations between household air pollution and early child development among children aged 36–59 months in Bangladesh

BackgroundHousehold air pollution (HAP) from solid fuel use (SFU) for cooking may impact child health in low-resources countries. This study examined the associations between HAP and early childhood development (ECD)...