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Development of children at risk for adverse outcomes participating in early intervention in developing countries: a
Jan L Wallander1, Carla M Bann, Fred J Biasini
1University of California, Merced, CA, USA.
Insights
Early developmental intervention (EDI) improved cognitive development in children in developing countries by age 36 months. This intervention shows promise for addressing long-term poverty and developmental disparities.
Area of Science:
- Developmental Psychology
- Global Health
- Pediatrics
Background:
- Early developmental intervention (EDI) shows positive effects in developing countries.
- Limited research exists on longitudinal effects, differential outcomes based on risk factors, and country-specific impacts of EDI.
- Birth asphyxia as a risk factor for developmental outcomes has been understudied.
Purpose of the Study:
- To test if EDI leads to differential developmental trajectories compared to a health education intervention in children in rural India, Pakistan, and Zambia.
- To examine the influence of risk factors, maternal resources, child gender, and country on intervention outcomes.
Main Methods:
- A randomized controlled trial involving 376 children with and without birth asphyxia.
- Intervention: Parents received training for biweekly home visits (EDI) from before 1 month to 36 months.
- Developmental assessments using Bayley Scales of Infant Development and Ages & Stages Questionnaire at 12, 24, and 36 months by blinded evaluators.
Main Results:
- EDI significantly improved cognitive abilities over 36 months, irrespective of risk condition, maternal resources, child gender, or country.
- Similar positive trends were observed for psychomotor and general development, though not statistically significant between groups.
- Statistically significant developmental differences favoring EDI emerged at 36 months of age.
Conclusions:
- Early developmental intervention (EDI) is a promising strategy for enhancing child development in diverse settings and risk conditions within developing countries.
- EDI can contribute to addressing long-term developmental outcomes and the intergenerational cycle of poverty.
- The findings support the integration of EDI into public health initiatives to improve child development globally.
Background:
Previous research has indicated positive effects of early developmental intervention (EDI) on the development of children in developing countries. Few studies, however, have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation. Also, birth asphyxia as a risk condition has not been well studied. To address these limitations, we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India, Pakistan, and Zambia.
Methods:
Children with and without birth asphyxia were randomized to EDI or control intervention, which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months. Development was assessed in 376 children at ages 12, 24, and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition.
Results:
Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities, regardless of risk condition, maternal resources, child gender, or country. Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities, but were not statistically different between intervention conditions. Developmental differences were observed first at 36 months of age.
Conclusion:
Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions. EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty.
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