Dataset Information

Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries?

ABSTRACT:

Background

Growth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5?years in low- and middle-income countries.

Methods

A secondary analysis of nationally representative data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5?years from the randomly selected households was ascertained using a 10-item scale which assessed four developmental domains: language-cognitive, physical, socio-emotional, and approaches to learning with a total development score ranging from 0 (the least optimal) to 10 (the most optimal). Children's growth, the height-for-age Z score (HAZ), was calculated using the WHO Child Growth Standards. Unadjusted (Pearson's correlation coefficient, r) and adjusted estimations (standardised mean difference (SMD) adjusted for child sex, child age, and household wealth index) of the magnitude of the association between HAZ and ECD scores were calculated for each country.

Results

Data contributed by 178,393 children aged 36 to 59?months from 55 countries were included in the analyses. The pooled r between HAZ and standardised ECD scores was 0.12 and the pooled adjusted SMD was 0.06. The r ranged from ~?0 in Barbados, Lebanon, and Moldova to 0.32 in Pakistan and 0.36 in Nigeria. Overall, 47/55 countries had correlation coefficients less than the cut-off for a small association. The adjusted SMDs were ~?0 in 20 countries. All SMDs were lower than the cut-off for a small effect size. The magnitudes of the association were highest in South Asia and lowest in Middle East and North Africa, and lowest in the highest HDI group.

Conclusions

The association between growth and development in early childhood appears to be primarily a co-occurrence because the magnitude of the association varies among settings from no association in higher-income countries to a moderate level in low-income countries. In low-income countries, interventions targeting child growth and ECD should be integrated given their common risks frequency in these settings. Overall, growth is not a sensitive and therefore suitable indicator of child development.

SUBMITTER: Tran TD

PROVIDER: S-EPMC6686501 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries?

Tran Thach Duc TD Holton Sara S Nguyen Hau H Fisher Jane J

BMC pediatrics 20190808 1

<h4>Background</h4>Growth and early development (ECD) are vital outcomes for children. This study aimed to examine the association between child growth and overall development in children aged 3 to 5 years in low- and middle-income countries.<h4>Methods</h4>A secondary analysis of nationally representative data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS) and national Demographic and Health Surveys (DHS). The early development of children aged 3 to 5 years from the randomly se ...[more]

PMID: 31395035

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Project description:BackgroundThe causes of early childhood linear growth faltering (known as stunting) in low-income and middle-income countries remain inadequately understood. We aimed to determine if the progressive postnatal decline in mean height-for-age Z score (HAZ) in low-income and middle-income countries is driven by relatively slow growth of certain high-risk children versus faltering of the entire population.MethodsDistributions of HAZ (based on WHO growth standards) were analysed in 3-month age intervals from 0 to 36 months of age in 179 Demographic and Health Surveys from 64 low-income and middle-income countries (1993-2015). Mean, standard deviation (SD), fifth percentiles, and 95th percentiles of the HAZ distribution were estimated for each age interval in each survey. Associations between mean HAZ and SD, fifth percentile, and 95th percentile were estimated using multilevel linear models. Stratified analyses were performed in consideration of potential modifiers (world region, national income, sample size, year, or mean HAZ in the 0-3 month age band). We also used Monte Carlo simulations to model the effects of subgroup versus whole-population faltering on the HAZ distribution.FindingsDeclines in mean HAZ from birth to 3 years of age were accompanied by declines in both the fifth and 95th percentiles, leading to nearly symmetrical narrowing of the HAZ distributions. Thus, children with relatively low HAZ were not more likely to have faltered than taller same-age peers. Inferences were unchanged in surveys regardless of world region, national income, sample size, year, or mean HAZ in the 0-3 month age band. Simulations showed that the narrowing of the HAZ distribution as mean HAZ declined could not be explained by faltering limited to a growth-restricted subgroup of children.InterpretationIn low-income and middle-income countries, declines in mean HAZ with age are due to a downward shift in the entire HAZ distribution, revealing that children across the HAZ spectrum experience slower growth compared to the international standard. Efforts to mitigate postnatal linear growth faltering in low-income and middle-income countries should prioritise action on community-level determinants of childhood HAZ trajectories.FundingBill & Melinda Gates Foundation.

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Project description:BackgroundPromotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs).ObjectiveThe objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations.Data sourcesA systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature.Study eligibility criteriaCost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria.Study appraisal and synthesis of methodsScreening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed.ResultsThe majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost-utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil.LimitationsMeta-analysis was not performed due to heterogeneity of the studies.Conclusions and recommendationsEconomic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas.Prospero registration numberCRD42018099856.

Dataset Information

Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries?

Background

Methods

Results

Conclusions

Publications

Physical growth: is it a good indicator of development in early childhood in low- and middle-income countries?

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