Family play, reading, and other stimulation and early childhood development in five low-and-middle-income countries.

This paper used longitudinal data from five studies conducted in Bangladesh, Bhutan, Cambodia, Ethiopia, and Rwanda to examine the links between family stimulation and early childhood development outcomes (N = 4904; Mage = 51.5; 49% girls). Results from random-effects and more conservative child-fixed effects models indicate that across these studies, family stimulation, measured by caregivers' engagement in nine activities (e.g., reading, playing, singing), predicted increments in children's early numeracy, literacy, social-emotional, motor, and executive function skills (standardized associations ranged from 0.05 to 0.11 SD). Study-specific models showed variability in the estimates, with null associations in two out of the five studies. These findings indicate the need for additional research on culturally specific ways in which caregivers may support early development and highlight the importance of promoting family stimulation to catalyze positive developmental trajectories in global contexts. RESEARCH HIGHLIGHTS: Research on the links between family stimulation and early childhood development in low-and-middle-income countries (LMICs) is limited. We used longitudinal data from studies conducted in five LMICs to examine the links between family stimulation and early childhood development outcomes. Results suggest that family stimulation predicted increments in children's numeracy, literacy, social-emotional, motor, and executive function skills. We found variability in the observed estimates, with null associations in two out of the five studies, suggesting the need for additional research in LMICs.

Birth, stillbirth and death registration data completeness, quality and utility in population-based surveys: EN-INDEPTH study.

BACKGROUND: Birth registration is a child's first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. METHODS: The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017-2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. RESULTS: Almost all women, irrespective of their baby's survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4-5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27-1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37-5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. CONCLUSIONS: Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.

Global estimates of the implications of COVID-19-related preprimary school closures for children's instructional access, development, learning, and economic wellbeing.

Observational data collected prior to the pandemic (between 2004 and 2019) were used to simulate the potential consequences of early childhood care and education (ECCE) service closures on the estimated 167 million preprimary-age children in 196 countries who lost ECCE access between March 2020 and February 2021. COVID-19-related ECCE disruptions were estimated to result in 19.01 billion person-days of ECCE instruction lost, 10.75 million additional children falling "off track" in their early development, 14.18 million grades of learning lost by adolescence, and a present discounted value of USD 308.02 billion of earnings lost in adulthood. Further burdens associated with ongoing closures were also forecasted. Projected developmental and learning losses were concentrated in low- and lower middle-income countries, likely exacerbating long-standing global inequities.

Child marriage among boys in high-prevalence countries: an analysis of sexual and reproductive health outcomes.

BACKGROUND: While the determinants and impacts of child marriage among girls have been well documented, little research exists on the practice among boys. This paper explores the sociodemographic profile of men who married by age 18 and assesses whether they are more or less advantaged than their peers in terms of their sexual and reproductive health outcomes. METHODS: This analysis used the most recent data from nationally representative household surveys for the 15 countries with the highest prevalence of marriage by age 18 among men aged 20-24 at the time of the survey. The prevalence of child marriage was then explored for the full cohort of men aged 20-49 through descriptive statistics and bivariate analysis. Available reproductive health indicators were explored, comparing men who married during childhood and men who married in adulthood. For the youngest and oldest cohorts, the total number of children fathered and the total ideal number of children were compared based on whether men married by age 18. RESULTS: For this subset of countries, the prevalence of child marriage among men aged 20-24 ranges from 8.4 to 27.9%. The practice appears most common among respondents living in the poorest households and in rural areas, and with no education or only primary schooling. Men who married as children appear less likely to have comprehensive knowledge of HIV than their peers who married in adulthood. Little difference among men who married by age 18 and those who married in adulthood was observed regarding knowledge or use of modern methods of contraception. In almost all countries with data, the odds of having fathered three or more children among men aged 20-29 are higher for those who married as children compared to their peers. In four countries, the odds of exceeding one's ideal family size among men aged 40-49 also appear higher among those who married during childhood compared to men who married at older ages. CONCLUSION: These results highlight the need for further research to identify drivers of the practice and short- and long-term outcomes for men who married during childhood, specifically concerning fatherhood, fertility preferences, and completed family size.

Violence against children in Latin America and the Caribbean: What do available data reveal about prevalence and perpetrators?

OBJECTIVE: To describe the prevalence of recent physical, sexual, and emotional violence against children 0 - 19 years of age in Latin America and the Caribbean (LAC) by age, sex, and perpetrator. METHODS: A systematic review and analysis of published literature and large international datasets was conducted. Eligible sources from first record to December 2015 contained age-, sex-, and perpetrator-specific data from LAC. Random effects meta-regressions were performed, adjusting for relevant quality covariates and differences in violence definitions. RESULTS: Seventy-two surveys (2 publications and 70 datasets) met inclusion criteria, representing 1 449 estimates from 34 countries. Prevalence of physical and emotional violence by caregivers ranged from 30% - 60%, and decreased with increasing age. Prevalence of physical violence by students (17% - 61%) declined with age, while emotional violence remained constant (60% - 92%). Prevalence of physical intimate partner violence (IPV) ranged from 13% - 18% for girls aged 15 - 19 years. Few or no eligible past-year estimates were available for any violence against children less than 9 years and boys 16 - 19 years of age; sexual violence against boys (any age) and girls (under 15 years); IPV except for girls aged 15 - 19 years; and violence by authority figures (e.g., teachers) or via gangs/organized crime. CONCLUSION: Past-year physical and emotional violence by caregivers and students is widespread in LAC across all ages in childhood, as is IPV against girls aged 15 - 19 years. Data collection must be expanded in LAC to monitor progress towards the sustainable development goals, develop effective prevention and response strategies, and shed light on violence relating to organized crime/gangs.

Risk factors associated with the practice of child marriage among Roma girls in Serbia.

BACKGROUND: Relatively little research on the issue of child marriage has been conducted in European countries where the overall prevalence of child marriage is relatively low, but relatively high among marginalized ethnic sub-groups. The purpose of this study is to assess the risk factors associated with the practice of child marriage among females living in Roma settlements in Serbia and among the general population and to explore the inter-relationship between child marriage and school enrollment decisions. METHODS: The study is based on data from a nationally representative household survey in Serbia conducted in 2010 - and a separate survey of households living in Roma settlements in the same year. For each survey, we estimated a bivariate probit model of risk factors associated with being currently married and currently enrolled in school based on girls 15 to 17 years of age in the nationally representative and Roma settlements samples. RESULTS: The practice of child marriage among the Roma was found to be most common among girls who lived in poorer households, who had less education, and who lived in rural locations. The results of the bivariate probit analysis suggest that, among girls in the general population, decisions about child marriage school attendance are inter-dependent in that common unobserved factors were found to influence both decisions. However, among girls living in Roma settlements, there is only weak evidence of simultaneous decision making. CONCLUSION: The study finds evidence of the interdependence between marriage and school enrollment decisions among the general population and, to a lesser extent, among the Roma. Further research is needed on child marriage among the Roma and other marginalized sub-groups in Europe, and should be based on panel data, combined with qualitative data, to assess the role of community-level factors and the characteristics of households where girls grow up on child marriage and education decisions.

Health of the world's adolescents: a synthesis of internationally comparable data.

Adolescence and young adulthood offer opportunities for health gains both through prevention and early clinical intervention. Yet development of health information systems to support this work has been weak and so far lagged behind those for early childhood and adulthood. With falls in the number of deaths in earlier childhood in many countries and a shifting emphasis to non-communicable disease risks, injuries, and mental health, there are good reasons to assess the present sources of health information for young people. We derive indicators from the conceptual framework for the Series on adolescent health and assess the available data to describe them. We selected indicators for their public health importance and their coverage of major health outcomes in young people, health risk behaviours and states, risk and protective factors, social role transitions relevant to health, and health service inputs. We then specify definitions that maximise international comparability. Even with this optimisation of data usage, only seven of the 25 indicators, covered at least 50% of the world's adolescents. The worst adolescent health profiles are in sub-Saharan Africa, with persisting high mortality from maternal and infectious causes. Risks for non-communicable diseases are spreading rapidly, with the highest rates of tobacco use and overweight, and lowest rates of physical activity, predominantly in adolescents living in low-income and middle-income countries. Even for present global health agendas, such as HIV infection and maternal mortality, data sources are incomplete for adolescents. We propose a series of steps that include better coordination and use of data collected across countries, greater harmonisation of school-based surveys, further development of strategies for socially marginalised youth, targeted research into the validity and use of these health indicators, advocating for adolescent-health information within new global health initiatives, and a recommendation that every country produce a regular report on the health of its adolescents.

Ending violence against children: A new international standard to foster data availability.

Interest in data on violence against children has been gathering momentum in recent years. Nevertheless, data collection efforts overall are sporadic and national data systems remain underdeveloped. What is more, definitions of violence are inconsistent and unclear. What 'counts' as violence against children varies across data collection efforts, negatively impacting data quality. Significant investment - in the form of guidance as well as tools and other resources for capacity-building - is urgently required to respond to countries' data needs. The newly released International Classification of Violence against Children (ICVAC) holds potential for bringing the world one step closer to filling data gaps and thus promoting accountability towards the ambitious global goal of ending violence against children.

Anxiety and Depression Signs Among Adolescents in 26 Low- and Middle-Income Countries: Prevalence and Association With Functional Difficulties.

PURPOSE: The aim of this study is to describe the occurrence of signs of depression and anxiety among adolescents from 26 low- and middle-income countries and explore the extent to which these are associated with difficulties across other functional domains. METHODS: We analyzed randomly selected, nationally representative data from 26 countries with a total sample size of 123,975 adolescents aged 10-17 years. Data on functional difficulties, including signs of depression and anxiety, were collected by the Child Functioning Module, an instrument validated to identify the population of children with disabilities through household surveys. We estimated percentages and 95% confidence intervals of adolescents with difficulties across 11 domains of functioning, and of signs of depression and/or anxiety. We used multinomial regressions to estimate the association between difficulties in the different domains and having signs of depression only, signs of anxiety only, and signs of both depression and anxiety, relative to not presenting signs of depression or anxiety. RESULTS: In total, 5.5% of adolescents were reported to have had signs of anxiety, 3.1% signs of depression, and 2.3% co-occurring signs of anxiety and depression. Compared to adolescents without functional difficulties, those with difficulties in one or more domains were three times more likely to have signs of depression and anxiety. The likelihood of presenting signs of depression only or signs of both depression and anxiety was significantly higher across all domains, and the highest among adolescent with difficulties to self-care and communicating. The likelihood of presenting signs of anxiety only was significantly higher across all domains except seeing and hearing, and the highest among adolescent with difficulties communicating and accepting changes. DISCUSSION: Adolescents with functional difficulties in all domains analyzed, across different contexts, are more likely to experience depression and anxiety signs than those without such difficulties. Increasing the availability of population-level data on adolescent functional difficulties, including those related to depression and anxiety, is important in promoting inclusivity, participation, and the right of children to equal opportunities.

Inequities in birth registration, violent discipline, and child labour by disability status and sex: Evidence from the Multiple Indicator Cluster Surveys in 24 countries.

Nearly 240 million children are estimated to have a disability globally. We describe inequities by disability status and sex in birth registration, child labour, and violent discipline outcomes. Data come from Round 6 of the Multiple Indicator Cluster Survey programme and includes 323,436 children, aged 2-17 years in 24 countries. We estimated non-registration of birth, child labour, and violent discipline, stratified by sex and disability in each country. We estimated age-adjusted prevalence ratios and prevalence differences, accounting for survey design, to calculate inequities by disability. There was large variation across countries in the percentage of children with disabilities (range: 4% to 28%), in non-registration (range: 0% to73%), child labour (range: 2% to 40%), and violent discipline (range: 48% to 95%). We found relative inequities by disability in birth registration in two countries among girls and one country among boys, and in birth certification in two countries among girls and among boys. Child labour was higher among girls with disabilities in two countries and among boys in three countries. We found larger and more prevalent inequities by disability in hazardous labour in six countries among girls (aPR range: 1.23 to 1.95) and in seven countries among boys (aPR range: 1.24 to 1.80). Inequities in the prevalence of violent discipline by disability were significant in four countries among girls (aPR range: 1.02 to 1.18) and among boys (aPRs: 1.02 to 1.15) and we found inequities in severe punishment nine countries among girls (aPR range: 1.12 to 2.27) and in 13 countries among boys (aPRs: 1.13 to 1.95). Context specific research is needed to understand the large variations in inequities by disability status and sex within and across countries. Monitoring inequities in child rights by disability status and sex is important to achieve the SDGs and ensure child protection programs reduce inequities.

Global tracking of access and quality in early childhood care and education.

Investments in early childhood care and education (ECCE) have contributed to a growing demand for internationally comparable data. Yet data on access to quality ECCE are not routinely collected in many countries, leading to limited information on equitable access to ECCE, quality of provision, and the impact on learning and wellbeing outcomes. This paper outlines the current status of global measurement of access to quality ECCE and identifies issues with definitions, availability, and accuracy of ECCE data across countries and outlines paths forward. We argue that estimates of access to ECCE should be based on children's participation in quality ECCE across multiple program types, rather than enrollment or attendance alone, given the critical importance of dosage and participation for ensuring positive benefits from ECCE. Governments, international organizations, and researchers all have roles to play in setting standards to define and monitor ECCE, generating workable tools for measuring nationally, and globally investing in national monitoring systems and routine household surveys to obtain accurate estimates of access to quality ECCE.

Prevalence of children under five with disabilities in Sierra Leone in 2017: Insights from a population-based multiple indicator cluster survey.

BACKGROUND: Children with disabilities have been low on the agenda of child health, including in Sierra Leone, and there are still many gaps in our knowledge and understanding of the issue. OBJECTIVE: To estimate the prevalence of children with disabilities in Sierra Leone using functional difficulty as a proxy and to understand the factors associated with disabilities among children two to four years living in Sierra Leone. METHODS: We used cross-sectional data from the Sierra Leone 2017 Multiple Indicator Cluster Survey. Disability was defined using a functional difficulty definition with additional thresholds used to define children with severe functional difficulty and multiple disabilities. Logistic regression models estimated odds ratios (ORs) of childhood disability and how they were associated with socioeconomic factors and living conditions. RESULTS: Prevalence of children with disabilities was 6.6% (95% confidence interval (CI) 5.8-7.6%) and there was a high risk of comorbidity between different functional difficulties. Children with disabilities were less likely to be girls (adjusted odds ratio (AOR) 0.8 (CI 0.7-1.0) and older (AOR 0.3 (CI 0.2-0.4)), but more prone to be stunted (AOR 1.4 (CI 1.1-1.7)) and have younger caregivers (AOR 1.3 (CI 0.7-2.3)). CONCLUSION: The prevalence of disabilities in young Sierra Leonean children was comparable to other countries in West and Central Africa when using the same measure of disability. Preventive as well as early detection and intervention efforts are recommended to be integrated with other programs, e.g vaccinations, nutrition, and poverty reducing programs.

Establishing performance standards for child development: learnings from the ECDI2030.

BACKGROUND: Standards of early childhood development (ECD) are needed to determine whether children living in different contexts are developmentally on track. The Early Childhood Development Index 2030 (ECDI2030) is a population-level measure intended to be used in household surveys to collect globally comparable data on one of the indicators chosen to monitor progress toward target 4.2 of the Sustainable Development Goals: The proportion of children aged 24-59 months who are developmentally on track in health, learning and psychosocial well-being. METHODS: To define performance cut-scores for the ECDI2030 we followed a criterion-referenced standard setting exercise using the modified Angoff method. The exercise gauged the expectations from 15 global experts in ECD and was informed by representative population data collected in Mexico and the State of Palestine. The final calibrated age-specific performance cut-scores were applied to these data to estimate the proportion of children developmentally on track, disaggregated by background characteristics, including the child's sex and attendance to early childhood education. RESULTS: Through a process of standard setting, we generated robust performance standards for the ECDI2030 by establishing five age-specific cut-scores to identify children as developmentally on track. CONCLUSIONS: This paper demonstrated how the standard setting methodology, typically applied to measures in the health and education fields, could be applied to a measure of child development. By creating robust criterion-referenced standards, we have been able to ensure that the cut-scores related to age for the ECDI2030 are based on performance standards set by global experts in the ECD field for defining on and off track development.

COVID-19 and violence against children: A review of early studies.

BACKGROUND: Throughout the course of the COVID-19 pandemic, researchers across the globe have attempted to understand how the health and socioeconomic crisis brought about by the coronavirus is affecting children's exposure to violence. Since containment measures have disrupted many data collection and research efforts, studies have had to rely on existing data or design new approaches to gathering relevant information. OBJECTIVE: This article reviews the literature that has been produced on children's exposure to violence during the pandemic to understand emerging patterns and critically appraise methodologies to help inform the design of future studies. The article concludes with recommendations for future research. PARTICIPANTS AND SETTING: The study entailed a search of working papers, technical reports, and journal articles. METHODS: The search used a combination of search terms to identify relevant articles and reports published between March 1 and December 31, 2020. The sources were assessed according to scope and study design. RESULTS: The review identified 48 recent working papers, technical reports, and journal articles on the impact of COVID-19 on violence against children. In terms of scope and methods, the review led to three main findings: 1) Studies have focused on physical or psychological violence at home and less attention has been paid to other forms of violence against children, 2) most studies have relied on administrative records, while other data sources, such as surveys or big data, were less commonly employed, and 3) different definitions and study designs were used to gather data directly, resulting in findings that are hardly generalizable. With respect to children's experience of violence, the review led to four main findings: 1) Studies found a decrease in police reports and referrals to child protective services, 2) mixed results were found with respect to the number of calls to police or domestic violence helplines, 3) articles showed an increase in child abuse-related injuries treated in hospitals, and 4) surveys reported an increase in family violence. CONCLUSIONS: This review underscores the persistent challenges affecting the availability and quality of data on violence against children, including the absence of standards for measuring this sensitive issue as well as the limited availability of baseline data. Future research on COVID-19 and violence against children should address some of the gaps identified in this review.

Violence against children during COVID-19: Assessing and understanding change in use of helplines.

BACKGROUND: Many of the measures taken by countries to contain the spread of COVID-19 have resulted in disruptions to child protection services. Despite this, many countries have worked to ensure that child helplines remain operational, making such mechanisms even more critical for reporting and referring cases of violence and for providing support to victims. OBJECTIVE: The purpose of this paper is to document what has occurred, and been reported, to child helplines during the COVID-19 pandemic. PARTICIPANTS AND SETTING: The study entailed primary data collection from child helplines and a search of media articles and news stories. METHODS: Child helplines submitted data on the contacts received during the first six months of 2020. Data on contacts related to violence were also available from 2019, and used as baseline. The media search used a combination of search terms to identify relevant articles and news stories published between March 1 and June 17, 2020. RESULTS: Overall, the number of contacts to child helplines seems to have drastically increased since the beginning of the pandemic. However, the number of contacts related to violence has increased in some countries, while it decreased in others. CONCLUSIONS: While a mixed picture emerges with respect to violence, the increase in overall contacts made to child helplines provides evidence that such services are a critical lifeline for many children and women during times of crisis. Child helplines should be strengthened; and child protection services should be designated as essential during emergencies to ensure children receive the support they need.

Modelling the effect of the COVID-19 pandemic on violent discipline against children.

BACKGROUND: The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns. OBJECTIVE: This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models. PARTICIPANTS: Children aged 1-14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included. METHODS: A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a "high restrictions" pandemic scenario, approximating conditions expected during a period of intense response measures, and a "lower restrictions" scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores. RESULTS: Under a "high restrictions" scenario there would be a 35%-46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a "lower restrictions" scenario there would be between a 4%-6% increase in violent discipline scores in these countries. CONCLUSION: Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.