Association of Sociodemographic Factors and Maternal Educational Attainment with Child Development among Families Living below the Poverty Line in the State of Ceará, Northeastern Brazil.

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6-3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study.

Parenting practices have been identified as a key determinant of children's developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study included data on 3566 caregiver−child pairs, and the children were aged 0−66 months. Positive parenting behaviors (PPBs) were conceptualized in areas of interactive play, social development, and speech and language interactions. Child development was evaluated using the Brazilian Ages and Stages Questionnaire. Linear regression analysis was used to assess the relationships. We found that a greater number of PPBs was associated with better child development domain scores. Among infants < 1 year, each additional PPB was associated with a 0.32 standardized mean difference (SMD) greater communication (95% CI: 0.24−0.41) and 0.38 SMD greater problem-solving scores (95% CI: 0.24−0.52). Among children aged 4−6 years old, each additional PPB was associated with improved communication (SMD: 0.22; 95% CI: 0.13−0.32), problem solving (SMD: 0.21; 95% CI: 0.10−0.32) and personal−social domain scores (SMD: 0.26; 95% CI: 0.17−0.36). Our findings indicate that PPB were robustly associated with better outcomes across developmental domains among Brazilian children. Programs and interventions that support PPB can contribute to improvements in development outcomes.

Undernutrition and short duration of breastfeeding association with child development: a population-based study

Abstract Objective: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. Methods: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazi (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. Results: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR2,08 (1,38-3,12)) was also associated. Conclusions: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Undernutrition and short duration of breastfeeding association with child development: a population-based study.

OBJECTIVE: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. METHODS: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazil (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. RESULTS: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR 2,08 (1,38-3,12)) was also associated. CONCLUSIONS: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Maternal and neonatal factors associated with child development in Ceará, Brazil: a population-based study.

BACKGROUND: The first 1000 days of life are a critical period when the foundations of child development and growth are established. Few studies in Latin America have examined the relationship of birth outcomes and neonatal care factors with development outcomes in young children. We aimed to assess the association between pregnancy and neonatal factors with children's developmental scores in a cross-sectional, population-based study of children in Ceará, Brazil. METHODS: Population-based, cross-sectional study of children aged 0-66 months (0-5.5 years) living in Ceará, Brazil. We examined the relationship of pregnancy (iron and folic acid supplementation, smoking and alcohol consumption) and neonatal (low birth weight (LBW) gestational age, neonatal care interventions, and breastfeeding in the first hour) factors with child development. Children's development was assessed with the Ages and Stages Questionnaire (ASQ-BR). We used multivariate generalized linear models that accounted for clustering sampling to evaluate the relationship of pregnancy and neonatal factors with development domain scores. FINDINGS: A total of 3566 children were enrolled. Among pregnancy factors, children whose mothers did not receive folic acid supplementation during pregnancy had lower fine motor and problem-solving scores (p-values< 0.05). As for neonatal factors, LBW was associated with 0.14 standard deviations (SD) lower (CI 95% -0.26, - 0.02) communication, 0.24 SD lower (95% CI: - 0.44, - 0.04) fine motor and 0.31 SD lower (CI 95% -0.45, - 0.16) problem-solving domain scores as compared to non-LBW children (p values < 0.05). In terms of care, newborns that required resuscitation, antibiotics for infection, or extended in-patient stay after birth had lower development scores in selected domains. Further, not initiating breastfeeding within the first hour after birth was associated with lower gross motor and person-social development scores (p-values < 0.05). CONCLUSION: Pregnancy and neonatal care factors were associated with later child development outcomes. Infants at increased risk of suboptimal development, like LBW or newborns requiring extended in-patient care, may represent groups to target for supplemental intervention. Further, early integrated interventions to prevent adverse pregnancy and newborn outcomes may improve child development outcomes.

Adverse Childhood Experiences and Child Development Outcomes in Ceará, Brazil: A Population-based Study.

INTRODUCTION: More than 200 million children fail to reach their full developmental potential in low- and middle-income countries. Adverse childhood experiences, maternal mental health, and intimate partner violence are negatively associated with child development outcomes. The relationship of these risk factors with child communication, gross motor, fine motor, problem-solving, and personal-social development scores in Brazil are assessed. METHODS: A population-based, cross-sectional study of preschool children living in the state of Ceará, Brazil, in 2017 was conducted. Child development was assessed with the Ages and Stages Questionnaire. Adverse childhood experiences for children were self-reported by the participants' mothers using the Centers for Disease Control and Prevention Adverse Childhood Experiences Study‒adapted metric. Maternal mental health and intimate partner violence were evaluated using validated questionnaires. Sample-adjusted multivariable generalized linear models with interaction terms were used to determine the association of intimate partner violence, maternal mental health, and adverse childhood experiences with developmental outcomes and identify possible moderators. Data were analyzed between 2019 and 2020. RESULTS: Children exposed to ≥3 adverse childhood experiences had -0.12 (95% CI= -0.24, 0) lower communication, -0.25 (95% CI= -0.46, -0.03) lower gross motor, -0.27 (95% CI= -0.47, -0.07) lower fine motor, and -0.17 (95% CI= -0.3, -0.03) lower personal-social domain scores than children with no adverse childhood experiences. Furthermore, the greater number of adverse childhood experiences was linearly associated with lower developmental scores. Maternal mental health and intimate partner violence were also associated with lower development scores. CONCLUSIONS: Adverse childhood experiences were independently associated with developmental outcomes in Brazilian children. Community-based interventions to reduce the impact of adverse childhood experiences, intimate partner violence, and maternal mental health may benefits child development outcomes.

Environmental, Socioeconomic, Maternal, and Breastfeeding Factors Associated with Childhood Overweight and Obesity in Ceará, Brazil: A Population-Based Study.

Childhood obesity is now an epidemic in many countries worldwide and is known to be a multifactorial condition. We aimed to examine the relationship of environmental, socioeconomic, and nutritional factors with childhood overweight and obesity. We conducted a population-based cross-sectional study of children from 2 to 6 years of age in Ceará, Brazil. Children's nutritional status was assessed by body mass index (BMI) Z scores categorized as overweight and obesity. Ordinal logistic regression models were used to assess the relationship between the factors with overweight and obesity. A total of 2059 children participated, of which 50.4% were male. The mean age was 46 ± 17 months, with a prevalence of overweight and obesity of 12.0% (95% CI 10.7-13.6) and 8.0% (6.7-9.5), respectively. In multivariate analysis, the probability of childhood obesity increased as family income increased (adjusted hazard ratio (aHR) 0.6 (95% CI 0.37-0.95), p-value = 0.03). Moreover, families with fewer children had more than 30% fewer overweight children (aHR 0.68; 95% CI 0.48-0.96). Environmental, socioeconomic, and child nutritional factors were associated with overweight and obesity. The results provided could be used to design integrated interventions spanning from conception, or earlier, through the first years of life and may improve child nutritional outcomes.

Hospital mortality rates of infants with birth weight less than or equal to 1.500 g in the northeast of Brazil

OBJETIVO: Obter informações sobre a mortalidade de recém-nascidos com peso de nascimento menor ou igual a 1.500 g em Fortaleza e comparar com a Rede Vermont Oxford, uma das melhores referências de cuidados neonatais. MÉTODOS: Estudo de coorte prospectivo. Incluídos todos os recém-nascidos com peso de nascimento menor ou igual a 1.500 g em Fortaleza no período de 01/03/02 a 28/02/03 em todos os hospitais-maternidades com unidade de terapia intensiva neonatal. Os recém-nascidos foram seguidos do nascimento até a alta domiciliar ou morte hospitalar, utilizando o questionário da Rede Vermont Oxford. RESULTADOS: Foram analisados 774 recém-nascidos. O coeficiente de mortalidade neonatal foi de 477‰, e o coeficiente de mortalidade pós-neonatal foi de 35‰, elevando o coeficiente de mortalidade hospitalar total para 512‰. O coeficiente de mortalidade neonatal precoce foi de 335‰, e o coeficiente de mortalidade neonatal tardio foi de 142‰. Para todas as faixas de peso, os coeficientes de mortalidade em Fortaleza foram superiores aos da rede Vermont Oxford e também aos de Montevidéu, excetuando-se a faixa de peso menor ou igual a 600 g. CONCLUSÕES: Os resultados mostram elevadas taxas de mortalidade hospitalar de recém-nascidos de muito baixo peso com uma maior concentração na primeira semana de vida, sugerindo tanto deficiência na assistência prestada nas unidades de terapia intensiva neonatal quanto na atenção antenatal e no momento do parto.

OBJECTIVE: To obtain information on the hospital mortality of infants born in Fortaleza with birth weight less than or equal to 1,500 g, and to compare it with data from the Vermont Oxford Network, a center of excellence for neonatal care. METHODS: Prospective cohort study, enrolling all infants with birth weight less than or equal to 1,500 g born in Fortaleza between March 1, 2002 and February 28, 2003 from all the hospitals and maternity units with neonatal intensive care units. Infants were followed from birth until hospital discharge or hospital death, using the Vermont Oxford Network questionnaire.. RESULTS: A total of 774 newborn infants were analyzed. The neonatal mortality coefficient was 477‰, and the postneonatal mortality coefficient was 35‰, taking the hospital mortality coefficient to 512‰. The coefficient of early neonatal mortality was 335‰, and the coefficient of late neonatal mortality was 142‰. Mortality coefficients were higher in Fortaleza for all weight ranges than on the Vermont Oxford Network and were also, with the exception of the less than or equal to 600 g weight range, higher than in Montevideo. CONCLUSIONS: The results demonstrate high rates of hospital mortality among very low birth weight infants, with a greater concentration during the first week of life, suggesting that not only the care provided at the neonatal intensive care units is deficient, but also that prenatal and delivery-room care is inadequate.

Hospital mortality rates of infants with birth weight less than or equal to 1,500 g in the northeast of Brazil.

OBJECTIVE: To obtain information on the hospital mortality of infants born in Fortaleza with birth weights less than or equal to 1,500 g, and to compare it with data from the Vermont Oxford Network, a center of excellence for neonatal care. METHODS: Prospective cohort study, enrolling all infants with birth weight less than or equal to 1,500 g born in Fortaleza between March 1, 2002 and February 28, 2003 from all the hospitals and maternity units with neonatal intensive care units. Infants were followed from birth until hospital discharge or hospital death, using the Vermont Oxford Network questionnaire. RESULTS: A total of 774 newborn infants were analyzed. The neonatal mortality coefficient was 477 per thousand, and the postneonatal mortality coefficient was 35 per thousand, taking the hospital mortality coefficient to 512 per thousand. The coefficient of early neonatal mortality was 335 per thousand, and the coefficient of late neonatal mortality was 142 per thousand. Mortality coefficients were higher in Fortaleza for all weight ranges than on the Vermont Oxford Network and were also, with the exception of the less than or equal to 600 g weight range, higher than in Montevideo. CONCLUSIONS: The results demonstrate high rates of hospital mortality among very low birth weight infants, with a greater concentration during the first week of life, suggesting that not only the care provided at the neonatal intensive care units is deficient, but also that prenatal and delivery-room care is inadequate.