The impact of shared parental/family interaction on domains of early childhood development beyond language is unclear. We investigate the association between parental/family interaction (through shared reading/playing) and early childhood development at age 2. We used data from the 4th wave of a cohort following mothers and babies born between July and August 2020, named IRACEMA-Covid. Information on parental/family interaction was self-reported, and domains of child development were measured using the Caregiver Reported Early Development Instrument (CREDI). Descriptive statistics were performed using means and standard deviations. Inferential analyses were conducted using x2, Kruskal-Wallis, and crude and adjusted linear regression models. Family/parental interaction, as represented by playing/reading together, was associated with better development not only in language (0.81), as measured by CREDI, but also in cognition (0.62), motor (0.69), socio-emotional (0.80), and overall (0.75) domains. The results suggest that promoting shared play and reading in child intervention programs would be beneficial.
Shamyr Sulyvan de Castro, Márcia Maria Tavares Machado, Simone Farías-Antúnez et al.
Traditional understandings of federalism suggest that states are likely to take varying approaches to important policy questions, particularly in areas as sensitive as family law. And indeed, there are patterns of convergence and divergence in state approaches to supporting early childhood development. Surprisingly, however, the divergences do not always follow predictable political lines. These similarities and differences raise a puzzle that deserves attention by scholars and advocates.
In the United States, differences in early childhood play a key role in replicating poverty. Clear evidence establishes that child development in the first five years of life lays essential groundwork for future learning and the acquisition of life skills. In today’s economy, educational achievement is strongly correlated with adult earnings, but children from low-income families begin school at a significant disadvantage. Differences in early childhood explain much of the income-based achievement gap in education. And disadvantage during early childhood has a particularly pernicious effect on boys’ academic achievement. Early interventions can make a difference for all children, but these interventions must start early. And they must involve both parents and children, because one of the central insights of the literature on early childhood development is that children do not develop in a vacuum. Instead, child development is dependent on the relationship between a parent or other long-term caregiver and a child.
As compared with other wealthy countries, the United States makes limited investments in families with young children. Indeed, the level of public investment in children from birth to age three is inversely related to the importance of this period for child development. Public investments are highest for school-age children and lowest for children from birth to age three. Investments for children from ages three to five fall in between. Many wealthy countries mediate the impact of poverty on child development by providing universal health care, including prenatal care, home visiting for new parents, heavily subsidized childcare and preschool, and, most fundamentally, a child allowance, which ensures families have money to care for children. The United States does offer prenatal care and health care to virtually all low- and moderate-income citizens, as well as some food assistance and income support, largely through the Earned Income Tax Credit. But in most other areas, including housing, childcare, preschool, and basic income guarantees, government support for families falls far short of the need. Additionally, the support available to non-citizen families, especially undocumented individuals, is far more limited.
Numerous scholars and advocates have called for greater investments in families—and early childhood in particular—but rather than revisiting these arguments, this chapter takes a different tack, exploring the investments that are made and focusing on the web of funding across levels of government. As this chapter describes, the bulk of money available to support child development from the prenatal period until age three comes from the federal government, and there is limited variation in how this money is spent across the states. For the period from age three until entrance to kindergarten, the federal government and states largely share the cost of supporting early childhood development, leading to significant differences among the states, particularly in access to preschool for three- and four-year-olds. This chapter explores these funding differences, emphasizing the political economy of state choices and noting that, perhaps surprisingly, some red states are making a substantial effort to invest in early childhood education, especially for four-year-olds. The chapter closes with insights for both advocates and scholars.
A large literature demonstrates the long-term individual and societal benefits of investing resources in children during early childhood because of the powerful influence of the environment during early life on child neurological development. Therefore, early childhood presents an unrivaled opportunity for policy intervention, and is a critical component of child and family policy. This dissertation uses three different types of policy research to examine child well-being between birth and kindergarten. Chapter 1 is a program evaluation of a school-based outreach intervention to identify and enroll uninsured low-income children in publicly funded health insurance programs in North Carolina. Chapter 2 is a state policy evaluation examining how variations in state governance of early child care and education policy affects children's well-being. Chapter 3 is an example of testing and applying theory from economics to examine how parent characteristics and behaviors contribute to child cognitive development throughout early childhood. Each paper is interdisciplinary, implementing different methods for causal inference to address the unique challenges of each approach using statewide and nationally representative child data with several indicators of well-being. In chapter one, there were no significant differences in public health insurance enrollment and preventive care use for kindergarten-aged children between counties that received the outreach intervention treatment from those who did not. However, the findings from the qualitative work in this study may be helpful in implementing other school-based outreach efforts to enroll children in public health insurance. The findings from chapter two indicate that there is a nontrivial positive effect of policy dispersion on children's reading, math, and fine motor skills in kindergarten. Future research in this area should explore the specific mechanisms through which policy governance translates into meaningful differences in children's well-being. The findings from chapter three show that when parents read books, sing songs, and engage in supportive parent-child interactions as early as 9 months of age, this has an important effect on children's reading skills in kindergarten in addition to the effect of maternal education and ability, and family income. These behaviors are important inputs in the development process because they are amenable to policy intervention
In order to estimate the current coverage rate among all children in Greenland, we conducted an observational cross-sectional study identifying all children in Greenland eligible for a vaccination between 1 March 2018 and 16 June 2019. we found an overall national coverage of 85.4%. The national coverage for the vaccinations given at birth was 97.1%, dropping to 94.3%, 87.7% and 83.6% at ages 3, 5 and 12 months. Among children eligible for the Measles, Mumps and Rubella-vaccinations, the national coverage was 76.9% for children aged 15 months and 64.1% for children aged 4 years, but dropping to 40.9% in the districts. At preschool, the national coverage was 79.9%. Among the 12-year-old, the national coverages of the two vaccinations against Human Papilloma Virus were 88.4% and 71.6%, respectively, and for the three Hepatitis B-vaccinations 89.8%, 84.1% and 69.6%. A subgroup-analysis and test of an SMS-reminder system in Nuuk improved the coverage from 57.8% to 75.5% locally. Overall, we found a high national coverage rate among the newborn in Greenland. The national coverage rates of the remaining vaccinations were below the WHO-recommendations, however with great regional differences.Abbreviations: CVP: Children Vaccination Programme; BCG: Bacille Calmette–Guerin; EMR: Electronic medical Record system; DTPHiB: Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenza B; HBV: Hepatitis B; HPV: Human Papilloma Virus; MMR: Measles, Mumps, Rubella; SMS: Short Text Message; WHO: World Health Organization; GVAP: Global Vaccine Action Plan; EVAP: The WHO European Vaccine Action Plan.
Nadja Albertsen, Anna Rask Lynge, Nils Skovgaard et al.
OBJECTIVES: This study investigated the association between vaccine stockout and immunisation coverage, and infant/under 5 mortality rates. DESIGN: A retrospective cohort study. SETTING: Low-income and middle-income countries. PARTICIPANTS: A cohort of 131 low-income and middle-income countries from 2004 to 2019. PRIMARY OUTCOME MEASURES: Main outcomes included immunisation coverages of (1) diphtheria-tetanus-pertussis containing vaccine (DTP), (2) measles containing vaccine (MCV), (3) BCG and (4) oral polio vaccine (OPV). We also included infant and under 5 mortality rates as secondary outcomes. RESULTS: The countries that experienced national-level stockouts of DTP and MCV had 3.7 and 4 percentage points lower coverage rates of DTP3 and MCV1, respectively, compared with the countries without the stockout events (p<0.01). Moreover, the statistically significant differences in the immunisation coverage rates across the countries with and without the stockout events are 2.4 percentage points and 2.6 percentage points for BCG and OPV, respectively (p<0.01). CONCLUSION: Our findings show that the incidence of vaccine stockout events is associated with the decreased immunisation coverages for children in low-income and middle-income countries. However, we did not observe a statistically significant association between the increasing frequency of vaccine stockout and infant and under 5 mortality rates.
Donghoon Lee, Manuel Celestino Lavayen, Taeksoo Ted Kim et al.
BACKGROUND: Extreme weather events, including droughts, are expected to increase in parts of sub-Saharan Africa and are associated with a number of poor health outcomes; however, to the best of our knowledge, the link between drought and childhood vaccination remains unknown. The objective of this study was to evaluate the relationship between drought and vaccination coverage. METHODS AND FINDINGS: We investigated the association between drought and vaccination coverage using a retrospective analysis of Demographic and Health Surveys data in 22 sub-Saharan African countries among 137,379 children (50.4% male) born from 2011 to 2019. Drought was defined as an established binary variable of annual rainfall less than or equal to the 15th percentile relative to the 29 previous years, using data from Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) data. We evaluated the association between drought at the date of birth and receipt of bacillus Calmette-Guérin (BCG), diphtheria-pertussis-tetanus (DPT), and polio vaccinations, and the association between drought at 12 months of age and receipt of measles vaccination. We specified logistic regression models with survey fixed effects and standard errors clustered at the enumeration area level, adjusting for child-, mother-, and household-level covariates and estimated marginal risk differences (RDs). The prevalence of drought at date of birth in the sample was 11.8%. Vaccination rates for each vaccination ranged from 70.6% (for 3 doses of the polio vaccine) to 86.0% (for BCG vaccination); however, only 57.6% of children 12 months and older received all recommended doses of BCG, DPT, polio, and measles vaccinations. In adjusted models, drought at date of birth was negatively associated with BCG vaccination (marginal RD = -1.5; 95% CI -2.2, -0.9), DPT vaccination (marginal RD = -1.4; 95% CI -2.2, -0.5), and polio vaccination (marginal RD = -1.3; 95% CI -2.3, -0.3). Drought at 12 months was negatively associated with measles vaccination (marginal RD = -1.9; 95% CI -2.8, -0.9). We found a dose-response relationship between drought and DPT and polio vaccinations, with the strongest associations closest to the timing of drought. Limitations include some heterogeneity in findings across countries. CONCLUSIONS: In this study, we observed that drought was associated with lower odds of completion of childhood BCG, DPT, and polio vaccinations. These findings indicate that drought may hinder vaccination coverage, one of the most important interventions to prevent infections among children. This work adds to a growing body of literature suggesting that health programs should consider impacts of severe weather in their programming.
Jason M. Nagata, Adrienne Epstein, Kyle T. Ganson et al.
Introduction Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs. Methods PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR). Results 18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I2=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I2=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040). Conclusion Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage. PROSPERO registration number CRD42021225843.
Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.
Dayana Rodrigues Farias, Luiz Antônio dos Anjos, Maiara Brusco de Freitas et al.
We assessed the development, nutritional status, and complementary feeding of 12- to 23-month-old children from Cuenca, Ecuador in 2013. Ecuador, an upper-middle-income country, developed a child policy in accordance with World Health Organization (WHO) guidelines. We collected cross-sectional survey data. Child development was assessed using the Integrated Management of Childhood Illness Guide–2011. The nutritional status was defined with WHO Child Growth Standards−2006. We investigated nutrient density, WHO Infant and Young Child Feeding Indicators, and nutrient supplementation intake of the complementary feeding. In all, 11.7% of children had “possible developmental delay,” stunting was identified in 29.4% of the children, and 25.3% faced overnutrition (overweight risk/overweight/obesity). The complementary feeding composition can be summarized as having adequate fat, high energy (MJ/day) and protein, and low iron and zinc. Children with “possible developmental delay” received less iron ( P < .05) than children with normal development. Overall, 30.4% of children had minimum dietary diversity. A total of 47.7% of children received nutrient supplementation. This epidemiological profile of infants remains a challenge for Ecuador’s health programs.
Lourdes Huiracocha, Adriana Monserrath Orellana-Paucar, Victoria Abril-Ulloa et al.
There is an urgent need for an improved empirical understanding of the relationship among biodiverse marine resources, human health and development outcomes. Coral reefs are often at this intersection for developing nations in the tropics-an ecosystem targeted for biodiversity conservation and one that provides sustenance and livelihoods for many coastal communities. To explore these relationships, we use the comparative development contexts of Haiti and the Dominican Republic on the island of Hispaniola. We combine child nutrition data from the Demographic Health Survey with coastal proximity and coral reef habitat diversity, and condition to empirically test human benefits of marine natural resources in differing development contexts. Our results indicate that coastal children have a reduced likelihood of severe stunting in Haiti but have increased likelihoods of stunting and reduced dietary diversity in the Dominican Republic. These contrasting results are likely due to the differential in developed infrastructure and market access. Our analyses did not demonstrate an association between more diverse and less degraded coral reefs and better childhood nutrition. The results highlight the complexities of modelling interactions between the health of humans and natural systems, and indicate the next steps needed to support integrated development programming.
