Early Childhood Development Programs Research Articles

Early Childhood Development Programs in Nepal: Opportunities and Challenges

This article presents a comprehensive examination of the contemporary landscape of Early Childhood Development (ECD) initiatives in Nepal, focusing on both their quality and accessibility. Through a meticulous analysis of secondary data, this study scrutinizes the current state of Early Childhood Education and Development (ECED) centers, the pivotal roles of educators, and the efficacy and caliber of ECD programs, thereby elucidating the prevailing opportunities and obstacles. A high-quality ECD program is fundamental in extending developmental prospects to all children, including those facing adversities, by furnishing them with requisite care, support, and safeguarding. Realizing this necessitates concerted efforts from diverse stakeholders, entailing heightened investments in ECD and the advocacy of its developmental imperatives. Paramount among these stakeholders is the family, serving as the primary gateway to ECD interventions, underscoring the imperative for tailored interventions within familial contexts. Moreover, communities wield significant potential in augmenting ECD initiatives. Thus, a decentralized approach to ECD delivery across all strata of governance emerges as imperative. The realization of quality ECD hinges upon the convergence of multifaceted inputs, harmonized across various domains. By fostering synergy among these inputs, ECD programs can achieve their utmost efficacy and impact, thereby fostering holistic child development.

Disruptions to early childhood preschool services during a pandemic: Evidence from India

Much less is known about the impacts of the COVID-19 pandemic on the provision of early childhood preschool services relative to research on school closures. We conducted surveys of more than 5000 early childhood service providers and leverage temporal and spatial variation in India’s intensity of lockdowns to quantify disruptions to preschool services under the world’s largest early childhood development program between areas with different strictness of lockdown measures. We document a 23 percentage point reduction in the provision of preschool services in red zone lockdown areas (strictest measures) relative to green zone lockdown areas (least strict measures). We find that pre-COVID measures of high worker locus of control and public service motivation offset the reduction in differential preschool service provision by 27–37%.

Beyond Schools: Multisensory Learning and Knowledge Acquisition in Informal Contexts—Perspectives from Rural Indonesia

It is not a new finding that much human learning takes place implicitly outside of educational institutions in informal, everyday contexts, yet these learning processes receive comparatively little systematic attention within the current anthropology of learning, education and schools. Based on long-term social anthropological research in a peasant community in rural Indonesia (Sulawesi), the article will address the complex multisensory forms of learning through which children acquire a large part of their competencies and their extensive environmental and agricultural knowledge. I will focus on the mixed-age “communities of practices” in which this knowledge is transmitted and acquired and show that affective bonds to peers and adults influence to a large extent which out-of-school areas of competence a child acquires. Building on the “embodied capital theory.” I argue that children in rural areas obtain a complex form of “ecological literacy” that encompasses not only a rich knowledge about the local ecosystems and agri- as well as horticultural processes but also a particular formation of the senses and the physical body in general (muscle size and memory, physical strength, coordination, balance, and motor skills). I shall conclude with some critical reflections on the general devaluation of the extra-curricular, non-formal, and environmental forms of learning, which can be observed not only in Indonesia but also worldwide and seems to be closely related to the global spread of Western psychological theory models about the healthy socio-emotional and cognitive development of children, supported by global institutions like UNICEF, World Bank, and Save the Children. For years, a constant increase of early childhood development programs can be observed, which aim at improving children’s school readiness, particularly in low-income countries, in order to enhance the future prospect of children. These programs, however, go hand in hand with the devaluation and oppression of indigenous knowledge systems and thus often worsen the future prospects of younger people.

The Role of Childcare Programs and Family Involvement in Enhancing Child Development in Pre-primary Schools in Iganga District, Uganda

The study sought to establish the role of childcare programs and family involvement in enhancing child development in pre-primary schools in Nakalama and Bumalamagi sub-counties of Iganga District, Uganda. The study was guided by the following objectives: How do childcare programs and family involvement support child development, the challenges hindering the role of childcare programs and family involvement in promoting child development in pre-primary schools, the strategies that can be used to overcome the challenges facing childcare programs in promoting child development and how can family involvement be enhanced in promoting child development in pre-primary schools in Iganga District. The study used descriptive survey design that included both quantitative and qualitative methods. Purposive and random sampling techniques were used to sample the 77 key respondents drawn from the district, sub-counties, and institutions. Specifically reviewed literature, observation, focus group discussion, and interviews were used during data collection. The findings revealed that childcare programs and family involvement help children develop physically, socially, intellectually, and spiritually. Some of the challenges hindering the role of childcare programs and family involvement in promoting child development were; Shortage of trained and qualified teachers in pre-primary schools and Lack of public awareness in enhancing child development. It is recommended that the government refocus its strategy on addressing the country's education crisis and confronting issues at the grassroots level and intensifying the training of Caregivers for Early Child Development programs including embarking on implementing ECD programs in all government aided primary schools.

Early childhood development and its association with women's empowerment in the context of urban poverty in Ethiopia

BackgroundEmpowered women, with increased access to and control over resources, stronger social networks, greater decision-making power, and a more positive gender attitude, significantly contribute to better family well-being. While there is ample evidence regarding the association between child nutrition and women's empowerment, studies examining the association between early childhood development (ECD) and women's empowerment are scarce. AimsThe aim of this study was to estimate the prevalence of ECD delays among 12–36 months old and investigate its association with women's empowerment among the urban poor in Ethiopia. MethodsThe study included a sample of 432 women who were unemployed or had irregular employment during the data collection period, along with their children in urban Ethiopia. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), a tool designed to accurately identify developmental delays in infants and young children and categorized as on track, needs monitoring, and possible delays. Women's empowerment was measured using a multidimensional index that captured access to and control over resources, decision-making power, and social capital, and then categorized into lowest, medium, and highest empowerment levels. The association between ECD domains and women's empowerment was analyzed using ordinal logistic regression, after adjusting for confounders. ResultsThe study found a high prevalence of delays in ECD domains, with fine motor domain accounting for the largest delay (40.6 %). Children of less empowered mothers are more likely to have the highest development delays in communication (OR=2.22; 95 % CI: 1.36; 3.62), gross motor (OR=1.69; 95 % CI: 1.04; 2.76), problem solving (OR=1.85; 95 % CI: 1.15; 2.98), and personal-social (OR=2.59; 95 % CI: 1.62; 4.15) skills compared to children of more empowered mothers. ConclusionsThe study highlights the significance of women's empowerment in promoting ECD, especially in developing countries where ECD programs are fragmented and lacks coordination. Therefore, targeted interventions that improve women's empowerment could lead to improved ECD outcomes.

Willingness-to-pay for early childhood development: A field experiment in Western China

Given the size of the problem and the scientific evidence that timely intervention can improve long-term outcomes, an important question is how to best scale-up early childhood development (ECD) interventions in low- and middle-income countries (LMICs). A key component of the solution is financing. However, there has been little research on the question of whether cost-sharing models can equitably and sustainably finance ECD programs at scale in LMICs. We built parenting centers in two rural communities of Western China to teach caregivers how to stimulate child development through fun and interactive activities. We used the Becker-Degroot-Marschak (BDM) mechanism to elicit the household willingness-to-pay (WTP) for a one-month pass to the parenting centers. The results of the BDM suggest that a cost-sharing model would not be suitable for China's rural population at least in the short-run. Demand was found to be highly elastic. In addition, we found limited evidence of selection effects. We also found no evidence of sunk-cost effects.

Maternal and child health policy: A global review of current practices and future directions

Maternal and child health remains a paramount concern worldwide, with policy frameworks playing a pivotal role in shaping outcomes for mothers and children. This paper provides a concise overview of the global landscape of maternal and child health policies, encompassing current practices and outlining key directions for the future. Current practices in maternal and child health policies vary significantly across regions and nations. Successful policies often integrate evidence-based interventions that span the continuum of care, from preconception to postpartum and early childhood. Maternal health policies typically focus on ensuring access to quality antenatal care, skilled birth attendance, and postnatal support. Child health policies emphasize immunization, nutrition, and early childhood development programs. However, disparities persist, reflecting the need for targeted interventions to address specific regional challenges. Future directions in maternal and child health policies emphasize a holistic and integrated approach. The global community recognizes the importance of addressing social determinants, promoting gender equity, and strengthening health systems to ensure comprehensive care for mothers and children. Innovations in digital health, community engagement, and cross-sectoral collaborations are identified as crucial components for improving policy effectiveness. Additionally, a life-course perspective, extending beyond childbirth to adolescence and beyond, is gaining prominence to address the evolving health needs of women and children. This paper provides a snapshot of the intricate landscape of maternal and child health policies globally. By understanding current practices and identifying future directions, policymakers, healthcare professionals, and stakeholders can contribute to advancing maternal and child health outcomes on a global scale.

Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis

In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across the RE-AIM dimensions (Reach, Effectiveness or Efficacy, Adoption, Implementation and Maintenance) during the COVID-19 pandemic. This comparative case study analysis selected five contrasting municipalities based on population size, region of the country, implementation model, and length of time implementing the PCF. We conducted 244 interviews with PCF municipal team (municipal managers, supervisors, home visitors), families, and cross-sectoral professionals. A rapid qualitative analysis was used to identify themes across RE-AIM dimensions. Families' limited knowledge and trust in PCF goals were a barrier to its reach. While the perceived benefit of PCF on parenting skills and ECD enabled reach, the lack of referral protocols to address social needs, such as connecting food-insecure families to food resources, undermined effectiveness. Questions about whether the social assistance sector should be in charge of PCF challenged its adoption. Implementation barriers exacerbated by the COVID-19 pandemic included low salaries, temporary contracts, high turnover, infrequent supervision, lack of an effective monitoring system, and nonexistence or non-functioning multisectoral committees. The absence of institutionalized funding was a challenge for sustainability. Complex intertwined system-level barriers may explain the unsuccessful implementation of PCF. These barriers must be addressed for Brazil to benefit from the enormous reach of the PCF and the evidence-based nurturing care principles it is based upon. NIH/NICHD.

Implementation research in the area of early childhood: scoping review

Objective To systematically map implementation research focusing on interventions aimed at early childhood development, its main characteristics and implementation strategies. Methods A scoping review of the global literature was planned and performed in accordance with recommendations of the Joanna Briggs Institute. The search was carried out in nine electronic databases (PubMed, Scopus, Embase, Health System Evidence, Social Systems Evidence, Cochrane, ERIC and CINHAL and VHL) from the beginning of indexing until August 2021. Results The searches mapped 4,105 references, 2,805 of which were unrepeated. After screening, 211 studies were read in full and 82 included. The health sector was the most frequent in interventions, followed by education and social services. Programs aimed at childhood development and strategies focused on parenting, family and nutrition were the main interventions. In total, 89.0% presented children as direct beneficiaries of the strategies. The average duration of interventions was 14.5 months and 25.6% of studies based their methodology on frameworks to analyze the implementation of interventions. Half analyzed adaptations of interventions or programs, while 29.3% cited equity aspects of implementation. Conclusion This scoping review allowed the analysis of a set of interventions aimed at early childhood, demonstrating the potential of implementation research on early childhood development programs, identifying more appropriate strategies to the contexts and the reach of intended objectives, based on incorporation of implementation outcomes.

Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial.

Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. DERR1-10.2196/50371.

Assessment of the Influence of Teaching Methods on Learners Preparedness for Primary Education in Kenya

The purpose of this research was to compare and contrast the efficacy of different teaching methods in preparing pre-primary school students for success in elementary school. Participants in the study included Curricula Support Officers (CSOs), Section Heads, Early Childhood Development and Education (ECDE) center administrators, and educators. The study took a descriptive survey approach. The sample size of 215 was determined by Yamane's (1967) formula and was reached by the use of a systematic sampling technique. Focus group discussions (FGD), questionnaires, and in-depth interviews were all used to compile the data. Quantitative data was analyzed using descriptive statistics, and the results were presented in tables, while qualitative data underwent content analysis and was presented narratively. Parametric and non-parametric tests were utilized in inferential statistics, and a 5% significance threshold was applied in a logistic regression analysis to assess the null hypothesis. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to check for normality. Since the calculated p-value of 0.042 was less than the required significance threshold of 0.05, the null hypothesis was rejected, suggesting that teaching practices had a sizeable impact on students' readiness for academic success. These results can be used by the County Government to provide better Early Childhood Development (ECD) programs. The National Government can use this information in policymaking and regulation to better track and control schools, which will improve students' readiness for the classroom. The results of this study may prove useful to teachers because they provide a variety of suggestions for improving the educational preparation of their students through ECDE programs.

Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system.

Early childhood development (ECD) programmes are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. This study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention to improve ECD outcomes through positive parent-child relationships. Cost-effectiveness analysis of ECD interventions is challenging given their potential to have multiple benefits. We propose a cost-effectiveness method using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions. The trial intervention cost US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems. The cost-effectiveness analysis suggests that while SM generated a relatively small impact on markers of early development, it did so efficiently. The observed improvements in cognitive development per home-visit are similar to other home-visiting interventions of longer duration. SM by focusing on the family had benefits beyond ECD, including reductions in violence against children and intermate partner violence, further analysis is needed to include these returns in the economic evaluation.

Workforce preparation for delivery of nurturing care in low- and middle-income countries: Expert consensus on critical multisectoral training needs.

Services to support nurturing care through early childhood development (ECD) in low- and middle-income countries are hampered by significant workforce challenges. The global early childhood workforce is both diverse and complex, and it supports the delivery of a wide range of services in extremely diverse geographical and social settings. In the context of contemporary global goals for the universal provision of quality early childhood provision, there is an urgent need to build appropriate platforms for strengthening and supporting this workforce. However, the evidence base to support this work is severely limited. To contribute to evidence on how to strengthen the ECD workforce in low- and middle-income countries, this study used a Delphi methodology involving three rounds of data collection with 14 global experts, to reach consensus on the most critical training needs of three key early childhood workforce groups: (i) health; (ii) community-based paraprofessionals, and (iii) educational professionals working across ECD programmes. The study identified a comprehensive set of shared, as well as distinct, training needs across the three groups. Shared training needs include the following: (i) nurturing dispositions that facilitate work with children and families in complex settings; (ii) knowledge and skills to support responsive, adaptable delivery of ECD programmes; and (iii) systems for ECD training and professional pathways that prioritise ongoing mentoring and support. The study's detailed findings help to address a critical gap in the evidence on training needs for ECD workers in low-resource contexts. They provide insights into how to strengthen content, systems, and methods of training to support intersectoral ECD work in resource-constrained contexts.

Stakeholders’ Perspectives of Enablers and Barriers to Successfully Implementing an Integrated Early Childhood Development Program in an Informal Urban Settlement in Kenya

Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely.

Neurodevelopment among children exposed to HIV and uninfected in sub-Saharan Africa.

The population of 16 million children exposed to HIV and uninfected (CHEU) under 15 years of age continues to expand rapidly, and the estimated prevalence of CHEU exceeds 20% in several countries in sub-Saharan Africa with high HIV prevalence. Some evidence suggests that CHEU experience suboptimal neurodevelopmental outcomes compared to children born to women without HIV. In this commentary, we discuss the latest research on biologic and socio-behavioural factors associated with neurodevelopmental outcomes among CHEU. Some but not all studies have noted that CHEU are at risk of poorer neurodevelopment across multiple cognitive domains, most notably in language and motor skills, in diverse settings, ages and using varied assessment tools. Foetal HIV exposure can adversely influence infant immune function, structural brain integrity and growth trajectories. Foetal exposure to antiretrovirals may also influence outcomes. Moreover, general, non-CHEU-specific risk factors for poor neurodevelopment, such as preterm birth, food insecurity, growth faltering and household violence, are amplified among CHEU; addressing these factors will require multi-factorial solutions. There is a need for rigorous harmonised approaches to identify children at the highest risk of delay. In high-burden HIV settings, existing maternal child health programmes serving the general population could adopt structured early child development programmes that educate healthcare workers on CHEU-specific risk factors and train them to conduct rapid neurodevelopmental screening tests. Community-based interventions targeting parent knowledge of optimal caregiving practices have shown to be successful in improving neurodevelopmental outcomes in children and should be adapted for CHEU. CHEU in sub-Saharan Africa have biologic and socio-behavioural factors that may influence their neurodevelopment, brain maturation, immune system and overall health and wellbeing. Multidisciplinary research is needed to disentangle complex interactions between contributing factors. Common environmental and social risk factors for suboptimal neurodevelopment in the general population are disproportionately magnified within the CHEU population, and it is, therefore, important to draw on existing knowledge when considering the socio-behavioural pathways through which HIV exposure could impact CHEU neurodevelopment. Approaches to identify children at greatest risk for poor outcomes and multisectoral interventions are needed to ensure optimal outcomes for CHEU in sub-Saharan Africa.

Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development.

Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.

Evaluation of healthcare services of integrated childhood development services (ICDS) in a district of Western India

Background: Early years of the life are the most crucial period for the physical, mental, social, emotional, language development and lifelong learning. Integrated child development services (ICDS) program maintained its uniqueness as early childhood development program of the world. The objectives of study were to (1) evaluate the ICDS services & its utilization by the beneficiaries & (2) find out differences in health care services between rural & urban anganwadi centres (AWCs). Method: A cross sectional study involving selected 120 AWCs of Jamnagar was carried out using a pro forma having questions related to health care services provided under ICDS. Results: 67% of beneficiaries were regular in pre-school education (PSE). Percentage of mild, moderate & severe malnutrition varied between 82-85%, 7-12% &6-8% in children between 6m-6 years respectively. Referral services, nutrition and health care session, vaccination services, routine healthcare check-up of children at every 1-3 month and Minimum 4 ANC visits were provided in 60%, 82.5%, 62.5%, 75% and 77.5% AWCs respectively. Conclusion: About 2/3rd beneficiaries were regularly attending PSE with higher prevalence in urban than rural AWCs. Percentage of mild, moderate & severe malnutrition varied between 82-85%, 7-12% & 6-8% in children of 6 months to 6 years respectively. Rural AWCs had more ‘mild malnourished’ child & urban AWCs had more ‘severely malnourished child’.

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.

The association between parental risks and childhood development: findings from a community-based survey in East China

BackgroundNurturing care is necessary for optimal early childhood development. This study aimed to investigate the prevalence of parental risks in rural East China and assess their impacts on early development in children younger than three years old.MethodsThis community-based cross-sectional survey was conducted among 3852 caregiver-child pairs in Zhejiang Province from December 2019 to January 2020. Children aged 0 to 3 years were recruited from China’s Early Childhood Development Program (ECD). Local child health care providers conducted face-to-face interviews with the primary caregivers. Demographic information of the participants was collected by questionnaire. Each child was screened for parental risk through the Parental Risk Checklist designed by the ECD program. The Ages and Stages Questionnaire (ASQ) was used to identify children with potential developmental delays. Multinomial logistic regression model and linear trend test were applied to assess the association between parental risks and suspected developmental delays.ResultsAmong the 3852 children included in the analyses, 46.70% had at least one parental risk and 9.01% presented suspected developmental delays in any domain of ASQ. Parental risk was statistically associated with the overall suspected developmental delay in young children (Relative Risk Ratio (RRR): 1.36; 95% confidence interval (CI): 1.08, 1.72; P = 0.010) after adjusting potential confounders. Compared with children with no parental risk, children exposed to 3 or more parental risks had 2.59, 5.76, 3.95, and 2.84 times higher risk of the suspected developmental delay in overall ASQ, communication, problem-solving, and personal-social domain, respectively (P values < 0.05). The linear trend tests found that the more parental risks, the higher possibility of developmental delay (P values < 0.05).ConclusionsParental risks are prevalent among children under three years in rural East China, which may increase the risk of developmental delays in children. Meanwhile, parental risk screening can be used to recognize poor nurturing care in primary health care settings. Targeted interventions are warranted to improve nurturing care for optimal early childhood development.

The Mental Health of Caregivers and Young Children in Conflict-Affected Settings

We analyze the effects of conflict-related violence on the mental health of caregivers and young children, as well as the role of caregivers' mental health in explaining the toll of conflict on early childhood mental health. Although an upcoming body of work has demonstrated the link between caregivers' and children's mental health, the role of caregivers' psychological constraints has been largely ignored in research and programming in conflict-affected settings. We demonstrate how these constraints play a role in the intergenerational transmission of mental health problems and emphasize the urgency of addressing caregivers' mental health within early childhood development programs in conflict-affected settings.