Socioeconomic inequalities in early child development in children aged under 36 months in South Asia: A systematic review

Abstract

BackgroundIn South Asia, 89 million children under 5 are at risk of not reaching their developmental potential. Household socioeconomic position (SEP) is a determinant of early child development (ECD). However, synthesised evidence for the association between ECD and SEP in young children in South Asia is not available. Therefore, this review synthesises evidence on the relationship of household SEP with ECD in children under 36 months of age in South Asia.MethodPubMed, Cochrane Library, MEDLINE and Scopus were systematically searched to identify studies from South Asian countries that reported evidence on the association between SEP and ECD. Search terms included items related to motor, cognitive, language and socioemotional development. Study quality was assessed using the QualSyst tool, with three quality levels (high/medium/low), and a narrative review for each ECD outcome was constructed (PROSPERO registration: CRD42019131533).ResultsTwelve of the 950 publications screened met the inclusion criteria (nine from India, two Nepal and one Bangladesh). The majority (n = 10, 83%) reported language development on its own or alongside another ECD outcome. Fewer articles assessed cognitive (n = 6, 50%), motor (n = 7, 58%) or socioemotional development (n = 3, 25%). Higher SEP was associated with better ECD for one third of the associations reported. One ECD outcome (socioemotional development) was negatively associated (with socioeconomic status) based on low quality evidence. Mother's education and family income were the major SEP constructs associated with ECD. One, four and seven studies were rated as having a low, medium and high risk of bias, respectively.ConclusionThis review reveals the scarcity of evidence exploring associations between household SEP and ECD in children under 36 months in South Asia, especially outside of India. Enhancing evidence for associations between ECD and SEP is needed for evidence‐based policy making to reduce developmental delays associated with a disadvantaged SEP in the South Asian region.

Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6–23 months in South Asia: a decomposition analysis

“…The increased inequality in these regions can be attributed to constrained access to quality education and human capital development, challenges in land ownership and agrarian structures. Varying degrees of industrialisation and urbanisation, coupled with potential labour exploitation, also play a role 39. These underlying factors may exert an indirect impact on MDD, as evidenced in our study by the observed lower attainment rate 34 35…”

“…Varying degrees of industrialisation and urbanisation, coupled with potential labour exploitation, also play a role. 39 These underlying factors may exert an indirect impact on MDD, as evidenced in our study by the observed lower attainment rate. 34 35 …”

“…Explanatory variables were grouped into the following categories: maternal and family factors, factors related to media exposure, factors related to health services use, and child factors. Maternal and family factors included the age group of mothers in years,11 15–46 the mother’s and partner’s education level (no education, primary, secondary, higher), mother’s employment (yes, no), partner’s occupation (agriculture, services, others), household wealth status, which was used to calculate the concentration index (CIX) of dietary diversity, was determined to be one of the primary explanatory variables (poorest, poorer, middle, higher, highest) and place of residence (urban, rural). Watching television (TV) and reading newspapers/magazines (yes, no) were also taken into consideration when conducting the decomposition and regression model as factors related to media exposure.…”