Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

Abstract

BackgroundPrevious reviews have identified 44 risk factors for poor early child development (ECD) in low‐ and middle‐income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.MethodsWe conducted path analyses of factors associated with 18‐month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid‐Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.ResultsOut of 42 indicators of the 34 factors examined, 6 were associated with 18‐month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.ConclusionsKey elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.

Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

“…Although this is the first study to describe child development in a MAM population, our findings concur with a prospective study among 4,205 children in Ghana, Malawi, and Burkina Faso, where identified predictors of motor and language development included linear and ponderal growth, Hb, and iron status (Prado et al, ). A strong association between linear growth and development was also seen in this MAM population, where HAZ was the strongest anthropometric correlate of motor and language development.…”

A Path Analysis of Nutrition, Stimulation, and Child Development Among Young Children in Bihar, India

“…Similar significant associations between LAZ and motor development, and LAZ and language development, have been reported in a study of children 5-19 months of age living in Zanzibar (Olney et al, 2009). Direct associations between linear growth and motor and language development have also been reported in a study of children from Ghana, Malawi, and Burkina Faso (Prado et al, 2017). Strength, muscle mass, and endurance are important in children 6-24 months of age who are learning to crawl, walk, and run (Adolph, Vereijken, & Denny, 1998).…”

“…A weak, but significant, direct or indirect (through motor development) association with hemoglobin was observed for language, personal-social development, and memory. Others have also reported significant associations between hemoglobin and motor development (Olney et al, 2009(Olney et al, , 2013Prado et al, 2017). Research in Chilean children showed that greater severity of anemia and duration of anemia of more than 3 months was associated with decreased psychomotor development scores (Walter, 1989).…”

“…Similar to our findings, no significant association was seen between hemoglobin and language development in Zanzibari children (Olney et al., , ). On the other hand, a combined analysis of children from three African countries reported significant associations between hemoglobin at 6 months of age, as well as hemoglobin change from 6 to 18 months of age, and language development at 18 months of age (Prado et al., ). The measurement of language development in two of the three countries was performed using a parent‐reported 100‐word vocabulary checklist (Prado et al., ), different from the DMC–II used in this study which also includes measures of receptive language.…”

“…Many studies have investigated individual associations between diet, nutritional status, stimulation, and mental development (Barros, Matijasevich, Santos, & Halpern, ; Grantham‐McGregor et al., ; Hadley, Tegegn, Tessema, Asefa, & Galea, ; Servili et al., ; Sudfeld et al., ). Yet only a few have examined the relations simultaneously (Olney et al., , ; Pollitt, Jahari, & Walka, ; Prado et al., ; Walka & Pollitt, ). Furthermore, a comprehensive examination of these influences has not been performed for specific cognitive functions.…”