Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 190
Filtrar
1.
BMJ Glob Health ; 4(6): e001724, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31803508

RESUMO

Introduction: Early childhood development can be described by an underlying latent construct. Global comparisons of children's development are hindered by the lack of a validated metric that is comparable across cultures and contexts, especially for children under age 3 years. We constructed and validated a new metric, the Developmental Score (D-score), using existing data from 16 longitudinal studies. Methods: Studies had item-level developmental assessment data for children 0-48 months and longitudinal outcomes at ages >4-18 years, including measures of IQ and receptive vocabulary. Existing data from 11 low-income, middle-income and high-income countries were merged for >36 000 children. Item mapping produced 95 'equate groups' of same-skill items across 12 different assessment instruments. A statistical model was built using the Rasch model with item difficulties constrained to be equal in a subset of equate groups, linking instruments to a common scale, the D-score, a continuous metric with interval-scale properties. D-score-for-age z-scores (DAZ) were evaluated for discriminant, concurrent and predictive validity to outcomes in middle childhood to adolescence. Results: Concurrent validity of DAZ with original instruments was strong (average r=0.71), with few exceptions. In approximately 70% of data rounds collected across studies, DAZ discriminated between children above/below cut-points for low birth weight (<2500 g) and stunting (-2 SD below median height-for-age). DAZ increased significantly with maternal education in 55% of data rounds. Predictive correlations of DAZ with outcomes obtained 2-16 years later were generally between 0.20 and 0.40. Correlations equalled or exceeded those obtained with original instruments despite using an average of 55% fewer items to estimate the D-score. Conclusion: The D-score metric enables quantitative comparisons of early childhood development across ages and sets the stage for creating simple, low-cost, global-use instruments to facilitate valid cross-national comparisons of early childhood development.

2.
Pediatrics ; 136(2): 272-80, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26148947

RESUMO

OBJECTIVE: More than 200 million children globally do not attain their developmental potential. We hypothesized that a parent training program could be integrated into primary health center visits and benefit child development. METHODS: We conducted a cluster randomized trial in the Caribbean (Jamaica, Antigua, and St Lucia). Fifteen centers were randomly assigned to the control (n = 250 mother-child pairs) and 14 to the intervention (n = 251 mother-child pairs) groups. Participants were recruited at the 6- to 8-week child health visit. The intervention used group delivery at 5 routine visits from age 3 to 18 months and comprised short films of child development messages, which were shown in the waiting area; discussion and demonstration led by community health workers; and mothers' practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child cognition, language, and hand-eye coordination and secondary outcomes were caregiver knowledge, practices, maternal depression, and child growth, measured after the 18-month visit. RESULTS: Eight-five percent of enrolled children were tested (control = 210, intervention = 216). Loss did not differ by group. Multilevel analyses showed significant benefits for cognitive development (3.09 points; 95% confidence interval: 1.31 to 4.87 points; effect size: 0.3 SDs). There were no other child benefits. There was a significant benefit to parenting knowledge (treatment effect: 1.59; 95% confidence interval: 1.01 to 2.17; effect size: 0.4). CONCLUSIONS: An innovative parenting intervention, requiring no additional clinic staff or mothers' time, was integrated into health services, with benefits to child cognitive development and parent knowledge. This is a promising strategy that merits further evaluation at scale.


Assuntos
Desenvolvimento Infantil , Intervenção Educacional Precoce , Poder Familiar , Atenção Primária à Saúde , Feminino , Humanos , Lactente , Jamaica , Masculino , Mães
3.
J Nutr ; 145(4): 823-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25833785

RESUMO

BACKGROUND: Linear growth retardation (stunting) is associated with lower adult cognition, educational attainment, and income. These effects, together with possible effects of stunting on birth weight and subsequent growth of offspring, suggest that stunting could be associated with poor development in the next generation of children. OBJECTIVE: The objective was to compare developmental levels in children born to parents who were stunted or nonstunted in early childhood. METHODS: This is a prospective cohort study of the children of participants in the Jamaica supplementation and stimulation study. The analysis compared children born to a parent who was stunted at age 9-24 mo, and did not receive the stimulation intervention, with children born to a parent in the nonstunted group. Developmental levels were measured with the Griffiths mental development scales between ages 12 and 72 mo. Mixed model regression analyses were conducted to allow for clustering of children within families and child (repeat assessments). The analyses included 89 children with a total of 156 assessments. Caregiver and home characteristics associated with the developmental quotient (DQ) or any of the subscales were included in the regressions. RESULTS: Children born to a stunted parent had lower DQs (-5.29 points; 95% CI: -9.06, -1.52 points; P = 0.01) and lower scores on the cognitive subscale (-5.77 points; 95% CI: -10.68, -0.87 points; P = 0.022). The offspring of stunted parents had lower height-for-age (-0.61 z scores; 95% CI: -1.13, -0.10 z scores; P = 0.021). In analyses, adjusting for child height-for-age or birth weight, the developmental differences remained significant. CONCLUSIONS: To our knowledge, this is the first report comparing the development of offspring of persons stunted in early childhood to the development of offspring of nonstunted parents. The findings suggest that the impact of stunting on development continues in the next generation of children. If replicated, these findings have important implications for estimation of the cost of stunting to social and economic development.


Assuntos
Transtornos Cognitivos/epidemiologia , Transtornos do Crescimento/epidemiologia , Adulto , Peso ao Nascer , Criança , Pré-Escolar , Cognição/fisiologia , Transtornos Cognitivos/etiologia , Feminino , Seguimentos , Transtornos do Crescimento/complicações , Humanos , Lactente , Jamaica , Masculino , Estudos Prospectivos , Análise de Regressão , Fatores Socioeconômicos
4.
BMJ ; 349: g5785, 2014 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-25266222

RESUMO

OBJECTIVE: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels. DESIGN: Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. SETTING: 96 municipalities in Colombia, located across eight of its 32 departments. PARTICIPANTS: 1420 children aged 12-24 months and their primary carers. INTERVENTION: Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. MAIN OUTCOME MEASURES: Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. RESULTS: Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. CONCLUSIONS: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160.


Assuntos
Desenvolvimento Infantil/fisiologia , Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Suplementos Nutricionais , Programas Nacionais de Saúde , Desempenho Psicomotor/fisiologia , Adulto , Pré-Escolar , Análise por Conglomerados , Cognição/fisiologia , Colômbia , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Lactente , Masculino , Micronutrientes/administração & dosagem , Jogos e Brinquedos/psicologia , Análise de Regressão
5.
Pediatrics ; 134(4): e1001-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25266433

RESUMO

OBJECTIVE: We aimed to determine the timing and size of the cognitive deficit associated with poverty in the first 5 years of life and to examine the role of parental characteristics, pre- and postnatal growth, and stimulation in the home in Bangladeshi children. We hypothesized that the effect of poverty on cognition begins in infancy and is mainly mediated by these factors. METHODS: We enrolled 2853 singletons, a subsample from a pregnancy supplementation trial in a poor rural area. We assessed mental development at 7, 18, and 64 months; anthropometry at birth, 12, 24, and 64 months; home stimulation at 18 and 64 months; and family's socioeconomic background. In multiple regression analyses, we examined the effect of poverty at birth on IQ at 64 months and the extent that other factors mediated the effect. RESULTS: A mean cognitive deficit of 0.2 (95% confidence interval -0.4 to -0.02) z scores between the first and fifth wealth quintiles was apparent at 7 months and increased to 1.2 (95% confidence interval -1.3 to -1.0) z scores of IQ by 64 months. Parental education, pre- and postnatal growth in length, and home stimulation mediated 86% of the effects of poverty on IQ and had independent effects. Growth in the first 2 years had larger effects than later growth. Home stimulation had effects throughout the period. CONCLUSIONS: Effects of poverty on children's cognition are mostly mediated through parental education, birth size, growth in the first 24 months, and home stimulation in the first 5 years.


Assuntos
Desenvolvimento Infantil , Transtornos Cognitivos/economia , Transtornos Cognitivos/epidemiologia , Pobreza/economia , Pobreza/tendências , Adulto , Antropometria/métodos , Bangladesh/epidemiologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Transtornos Cognitivos/psicologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino , Pobreza/psicologia , Gravidez , Fatores Socioeconômicos , Adulto Jovem
6.
Ann N Y Acad Sci ; 1308: 11-32, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24673166

RESUMO

We conducted a systematic review of studies that examined the effect of interventions combining a child development component with a nutrition one; in some cases the nutrition interventions also included health-promotion components. Only papers with both child development and nutrition outcomes and rated as moderate-to-good quality were included. Eleven efficacy and two nonrandomized trials, and eight program evaluations were identified. Only six trials examined interventions separately and combined. The trials showed nutritional interventions usually benefited nutritional status and sometimes benefited child development. Stimulation consistently benefited child development. There was no significant loss of any effect when interventions were combined, but there was little evidence of synergistic interaction between nutrition and stimulation on child development. Only three trials followed up the children after intervention. All at-scale program evaluations were combined interventions. Five benefited child development, but one did not, and two showed deficits. There was generally little benefit of at-scale programs to nutritional status. We found no rigorous evaluations of adding stimulation to health and nutrition services at scale and there is an urgent need for them. There is also a need to establish quality-control mechanisms for existing scaled-up programs and to determine their long-term effects. There is also a need to determine if there are any sustained benefits for the children after programs finish.


Assuntos
Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Intervenção Educacional Precoce , Intervenção Médica Precoce , Promoção da Saúde , Humanos , Estado Nutricional , Avaliação de Programas e Projetos de Saúde
7.
J Nutr ; 143(6): 885-93, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23616511

RESUMO

Young children with iron deficiency anemia (IDA) usually have poor development, but there is limited information on their response to psychosocial intervention. We aimed to compare the effects of psychosocial stimulation on the development of children with IDA and children who were neither anemic nor iron deficient (NANI). NANI (n = 209) and IDA (n = 225) children, aged 6-24 mo, from 30 Bangladeshi villages were enrolled in the study. The villages were then randomized to stimulation or control, and all children with IDA received 30 mg iron daily for 6 mo. Stimulation comprised 9 mo weekly play sessions at home. We assessed children's development at baseline and after 9 mo by using the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-II, and rated their behavior during the test. When we controlled for socioeconomic background, the IDA and NANI groups did not differ in their Bayley scores and behavior at baseline. After 9 mo, the IDA group had improved in iron status compared with baseline but had lower PDI scores and were less responsive to the examiner than the NANI group. Random-effects multilevel regressions of the final Bayley scores of the IDA and NANI groups showed that stimulation improved children's MDI [B ± SE = 5.7 ± 1.9 (95% CI: 2.0, 9.4), P = 0.003], and the interaction between iron status and stimulation showed a suggestive trend (P = 0.10), indicating that children with IDA and NANI responded differently to stimulation, with the NANI group improving more than the IDA group. In addition to iron treatment, children with IDA may require more intense or longer interventions than NANI children.


Assuntos
Anemia Ferropriva/fisiopatologia , Anemia Ferropriva/psicologia , Desenvolvimento Infantil/fisiologia , Desempenho Psicomotor/fisiologia , Anemia Ferropriva/tratamento farmacológico , Bangladesh , Pré-Escolar , Cognição/fisiologia , Emoções/fisiologia , Humanos , Lactente , Ferro/administração & dosagem , Jogos e Brinquedos/psicologia , Socialização
8.
Environ Health Perspect ; 120(10): 1462-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22759600

RESUMO

BACKGROUND: Cadmium is a commonly occurring toxic food contaminant, but health consequences of early-life exposure are poorly understood. OBJECTIVES: We evaluated the associations between cadmium exposure and neurobehavioral development in preschool children. METHODS: In our population-based mother-child cohort study in rural Bangladesh, we assessed cadmium exposure in 1,305 women in early pregnancy and their children at 5 years of age by measuring concentrations in urine (U-Cd), using inductively coupled plasma mass spectrometry. Children's IQ at 5 years of age, including Verbal (VIQ), Performance (PIQ), and Full-Scale IQ (FSIQ), were measured by Wechsler Preschool and Primary Scale of Intelligence. Behavior was assessed by the Strengths and Difficulties Questionnaire (SDQ). RESULTS: In multiple linear regression models, adjusted for sex, home stimulation, socioeconomic status (SES), and maternal and child characteristics, a doubling of maternal U-Cd was inversely associated with VIQ (-0.84 points; 95% confidence interval: -1.3, -0.40), PIQ (-0.64 points; -1.1, -0.18), and FSIQ (-0.80 points; -1.2, -0.39). Concurrent child U-Cd showed somewhat weaker association with VIQ and FSIQ, but not PIQ. Stratification by sex and SES indicated slightly stronger associations with PIQ and FSIQ in girls than in boys and in higher-income compared with lower-income families. Concurrent U-Cd was inversely associated with SDQ-prosocial behavior and positively associated with SDQ-difficult behavior, but associations were close to the null after adjustment. Quantile regression analysis showed similar associations across the whole range of each developmental outcome. CONCLUSION: Early-life low-level cadmium exposure was associated with lower child intelligence scores in our study cohort. Further research in this area is warranted.


Assuntos
Cádmio/toxicidade , Comportamento Infantil , Exposição Ambiental , Poluentes Ambientais/toxicidade , Exposição Materna , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adulto , Bangladesh/epidemiologia , Cádmio/urina , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Relação Dose-Resposta a Droga , Monitoramento Ambiental , Poluentes Ambientais/urina , Feminino , Humanos , Modelos Lineares , Masculino , Espectrometria de Massas , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Saúde da População Rural , Fatores Sexuais , Classe Social , Escalas de Wechsler , Adulto Jovem
9.
Food Nutr Bull ; 31(2 Suppl): S198-206, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20715604

RESUMO

BACKGROUND: In developing countries, it is often important to have measures of development in children under 3 years of age in large-scale surveys or evaluations of nutrition and stimulation programs. However, there is a lack of suitable instruments with established validity. OBJECTIVE: To develop a language test for children aged 12 to 18 months based on mothers' report, suitable for use in large-scale surveys, and examine its concurrent and predictive validity. To determine whether the test is sensitive to home stimulation and nutritional status and compare the test with the Bayley Scales of Infant Development (BSID). METHODS: A subsample of participants in a large, prospective cohort study in rural Bangladesh (MINIMat) was selected for a study of child development (n = 2,852). A total of 2,418 participants were interviewed concerning their children's expressive and receptive vocabulary, and children were tested using the BSID. RESULTS: The language test had reasonable short- and long-term reliability between 12 and 18 months (r = 0.50) and concurrent validity with the Bayley Mental Development Index (MDI) (r = 0.32 language comprehension to 0.41 language expression). Its predictive validity with IQ at age 5 years was similar to that of the Bayley MDI (r = 0.37 to 0.41 for language and r = 0.37 for MDI). Child language was independently associated with postnatal growth, stimulation in the home, gestational age, and socioeconomic status, and a similar set of variables predicted the Bayley MDI. CONCLUSIONS: The language test was reliable, had acceptable concurrent and predictive validity, and was sensitive to environmental and child characteristics. Mothers' reports of language could be useful in large-scale programs.


Assuntos
Inteligência , Desenvolvimento da Linguagem , Transtornos da Linguagem/diagnóstico , Mães , Bangladesh , Desenvolvimento Infantil , Linguagem Infantil , Educação Infantil , Estudos de Coortes , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Testes de Inteligência , Testes de Linguagem , Masculino , Estado Nutricional , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , População Rural/estatística & dados numéricos , Fatores Socioeconômicos
10.
Dev Med Child Neurol ; 52(7): e148-54, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20187877

RESUMO

AIM: The aim of this study was to determine whether psychosocial stimulation up to the age of 2 years benefits cognition and behaviour at age 6 years in low-birthweight, term-born (LBW-T) children (gestational age > or =37 wk, birthweight <2500g), and to compare LBW-T and normal-birthweight (NBW) children. METHOD: LBW-T Jamaican infants were randomized at birth to a control group or an intervention group. Children in the intervention group received psychosocial stimulation for 2 years. LBW-T infants were also compared with NBW infants born in the same hospital. IQ, cognitive function, and behaviour were measured at age 6 years in 109 LBW-T infants. The LBW-T group were divided into the intervention group (55 out of 70 enrolled, 32 females, 23 males; mean birthweight 2190g, SD 200g; and the control group (54 out of 70 enrolled, 33 females, 21 males; birthweight 2240g, SD 180g]. These were compared with 73 out of 94 enrolled NBW infants (38 females 35 males; birthweight 3130g, SD 330g). RESULTS: Among the LBW-T children performance IQ scores were higher in the intervention group than in the control group (regression coefficient [B] 4.06, 95% confidence interval [CI] 0.01-7.98) as were visual-spatial memory scores (B 1.12, 95% CI 0.45-1.87). Children in the intervention group also exhibited fewer behavioural difficulties (B -2.21, 95% CI -4.13 to -0.10) than children in the control group. Compared with NBW children, LBW-T children in the control group had poorer selective attention (B=-3.35, 95% CI -5.59 to -1.26) and visual-spatial memory (B=-0.76, 95% CI -1.54 to 0.00), but there were no differences in IQ, language, or behaviour. INTERPRETATION: Stimulation had sustained benefits in LBW-T infants. Finding few differences between LBW-T and NBW school-aged children concurs with results from other developing countries.


Assuntos
Transtornos Cognitivos/prevenção & controle , Recém-Nascido de Baixo Peso , Transtornos Mentais/prevenção & controle , Relações Mãe-Filho , Jogos e Brinquedos , Reforço Social , Comportamento , Criança , Cognição , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Inteligência , Testes de Inteligência , Jamaica , Masculino , Testes Psicológicos , Resultado do Tratamento
11.
J Health Popul Nutr ; 28(1): 23-33, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20214083

RESUMO

Poor stimulation in the home is one of the main factors affecting the development of children living in poverty. The family care indicators (FCIs) were developed to measure home stimulation in large populations and were derived from the Home Observations for Measurement of the Environment (HOME). The FCIs were piloted with 801 rural Bangladeshi mothers of children aged 18 months. Five subscales were created: 'play activities' (PA), 'varieties of play materials' (VP), 'sources of play materials', 'household books', and 'magazines and newspapers' (MN). All subscales had acceptable short-term reliability. Mental and motor development of the children was assessed on the Bayley Scales of Infant Development and their language expression and comprehension by mothers' report. After controlling for socioeconomic variables, VP and PA independently predicted four and three of the developmental outcomes respectively, and MN predicted both the Bayley scores. The FCI is promising as a survey-based indicator of the quality of children's home environment.


Assuntos
Cuidadores/estatística & dados numéricos , Desenvolvimento Infantil , Jogos e Brinquedos , Meio Social , Inquéritos e Questionários , Análise de Variância , Bangladesh , Feminino , Humanos , Lactente , Desenvolvimento da Linguagem , Estudos Longitudinais , Masculino , Relações Pais-Filho , Desempenho Psicomotor , Reprodutibilidade dos Testes , Fatores Socioeconômicos
12.
Int J Epidemiol ; 39(5): 1206-16, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20085967

RESUMO

BACKGROUND: Exposure to arsenic through drinking water has been associated with impaired cognitive function in school-aged children in cross-sectional studies; however, there are few longitudinal studies and little information on effects of exposure in early life when the brain is generally most vulnerable. METHODS: A longitudinal cohort study beginning in early pregnancy was conducted in rural Bangladesh, where arsenic concentrations in well water vary considerably. We assessed the effects of pre- and postnatal arsenic exposure on development of 2112 children at 18 months of age with Bayley Scales of Infant Development-II (mental and psychomotor development indices), Wolke's Behavior Rating Scale and maternal report of language. We related the measures of child development to arsenic concentrations in maternal urine in gestational weeks 9 and 30 and child's urinary arsenic at 18 months of age. Details of socio-economic background, home stimulation and anthropometric measurements of mothers and children were also available. RESULTS: Median maternal urinary arsenic concentration averaged over early and late gestation was 96 µg/l, whereas children's urine contained 35 µg/l of arsenic. There was no significant effect of any of the arsenic exposure measures on any of the child development measures after controlling for social and economic confounders, child's age and sex. CONCLUSION: Contrary to expectations, we found no indications of adverse effects of pre- or postnatal arsenic exposure on child development at 18 months. It remains possible that duration of exposure is critical and that effects will become apparent later in childhood.


Assuntos
Arsênico/toxicidade , Desenvolvimento Infantil/efeitos dos fármacos , Exposição Materna , Efeitos Tardios da Exposição Pré-Natal , Arsênico/urina , Intoxicação por Arsênico/epidemiologia , Intoxicação por Arsênico/urina , Bangladesh/epidemiologia , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Feminino , Nível de Saúde , Humanos , Lactente , Estudos Longitudinais , Saúde Mental , Gravidez , População Rural , Fatores Socioeconômicos , Poluentes Químicos da Água/urina , Poluição Química da Água/análise , Abastecimento de Água
13.
J Nutr ; 139(9): 1765-71, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19605526

RESUMO

Undernutrition in early childhood is associated with poor cognitive development and some changes in behavior. However, there is little information on their temperament. Our objective in this study was to determine whether undernourished children aged 6-24 mo had different temperament traits than better-nourished children. Two hundred and twelve undernourished children (weight for age < -2 Z-scores) attending community nutrition centers in 20 villages in rural Bangladesh and 108 better-nourished children (weight-for-age > or = -2 Z-scores) matched for age, sex, and village participated in the study. Temperament was assessed through an interviewer-administered maternal questionnaire consisting of 7 subscales: manageability, activity, emotionality, sociability, attention, soothability, and fear. After adjusting for significant covariates, the undernourished children were less sociable [regression coefficient (B) = -0.96; 95% CI = -0.04, -1.88], less attentive (B = -0.94; 95% CI = -0.19, -1.69), more fearful (B = 1.43; 95% CI = 2.44, 0.42), and had more negative emotionality (B = -1.08; 95% CI = 0.006, -2.16). In conclusion, these undernourished children had comprehensive differences in temperament traits, which may increase their risk of developing behavioral and mental health problems in later childhood.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/psicologia , Temperamento , Atenção , Bangladesh , Coleta de Dados , Emoções Manifestas , Medo , Feminino , Humanos , Lactente , Masculino , Valores de Referência , Análise de Regressão , População Rural , Ajustamento Social , Inquéritos e Questionários
14.
Environ Health Perspect ; 117(2): 288-93, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19270801

RESUMO

BACKGROUND: Exposure to arsenic-contaminated drinking water during pregnancy is associated with low birth weight and fetal loss, and there is concern that the infants' development may be affected. OBJECTIVE: We assessed the effects of in utero arsenic exposure during pregnancy on infants' problem-solving ability and motor development. METHODS: We conducted a large population-based study of nutritional supplementation with 4,436 pregnant women in Matlab, Bangladesh, an area of high-arsenic-contaminated tube wells. We measured arsenic concentration in spot urine specimens at 8 and 30 weeks of pregnancy. We assessed a subsample of 1,799 infants, born to these mothers, at 7 months of age on two problem-solving tests (PSTs), the motor scale of the Bayley Scales of Infant Development-II, and behavior ratings. RESULT: Arsenic concentrations in maternal urine were high, with a median (interquartile range) of 81 microg/L (37-207 microg/L) at 8 weeks of gestation and of 84 microg/L (42-230 microg/L) at 30 weeks. Arsenic exposure was related to many poor socioeconomic conditions that also correlated with child development measures. Multiple regressions of children's motor and PST scores and behavior ratings, controlling for socioeconomic background variables, age, and sex, showed no significant effect of urinary arsenic concentration on any developmental outcome. CONCLUSION: We detected no significant effect of arsenic exposure during pregnancy on infant development. However, it is possible that other effects are as yet unmeasured or that effects will become apparent at a later age.


Assuntos
Arsênico/toxicidade , Desenvolvimento Infantil/efeitos dos fármacos , Exposição Materna , Arsênico/urina , Bangladesh , Cognição/efeitos dos fármacos , Feminino , Idade Gestacional , Humanos , Lactente , Comportamento do Lactente/efeitos dos fármacos , Recém-Nascido , Atividade Motora/efeitos dos fármacos , Gravidez
15.
Am J Clin Nutr ; 87(3): 704-11, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18326610

RESUMO

BACKGROUND: Few data exist for the effects of multiple micronutrient (MM) or food supplementation to undernourished pregnant women on their offsprings' development. OBJECTIVE: We aimed to compare the effects on infant development of early (8-10 wk gestation) or usual ( approximately 17 wk gestation) supplementation with food and MM, 30 mg Fe + 400 microg folate, or 60 mg Fe + 400 microg folate. DESIGN: A large, randomized, controlled trial of pregnancy supplementation was conducted in Bangladesh. A subsample of infants (n = 2853) were assessed on 2 problem-solving tests (support and cover tests), the motor index of the Bayley Scales of Infant Development, and Wolke's behavior ratings at 7 mo of age. RESULTS: There were no significant effects of any intervention in the group as a whole. However, infants of undernourished mothers [body mass index (BMI; in kg/m2) < 18.5] who received early food supplementation performed slightly but significantly (P = 0.035) better on the support test than did infants of mothers who received usual food supplementation (z score: 0.17; 95% CI: 0.01, 0.33). There were no benefits in infants of higher-BMI mothers (P = 0.024 for BMI x food interaction). Children of low-BMI mothers who received MMs had slightly better motor scores (z score: 0.28; 95% CI: 0.08, 0.48) and activity ratings (z score: 0.24; 95% CI: 0.037, 0.45) than did those who received 30 mg Fe + 400 microg folate, whereas other children did not benefit (P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients). CONCLUSIONS: Small benefits from early food and MM supplementation were found in infants of low-BMI but not of high-BMI mothers. However, the benefits were of doubtful functional importance, and longer follow-up is required to determine programmatic implications.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Micronutrientes/administração & dosagem , Fenômenos Fisiológicos da Nutrição Pré-Natal/fisiologia , Resolução de Problemas/efeitos dos fármacos , Desempenho Psicomotor/efeitos dos fármacos , Adulto , Análise de Variância , Antropometria , Bangladesh , Índice de Massa Corporal , Desenvolvimento Infantil/fisiologia , Feminino , Ácido Fólico/administração & dosagem , Humanos , Lactente , Ferro na Dieta/administração & dosagem , Estado Nutricional , Gravidez , Resolução de Problemas/fisiologia , Desempenho Psicomotor/fisiologia , Fatores de Tempo
16.
J Nutr ; 137(11): 2464-9, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17951486

RESUMO

Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.


Assuntos
Transtornos da Nutrição Infantil/psicologia , Transtornos do Crescimento/psicologia , Apoio Nutricional , Ludoterapia , Psicologia do Adolescente , Comportamento Social , Adolescente , Adulto , Criança , Estudos de Coortes , Suplementos Nutricionais , Emoções , Humanos , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Autoimagem , Apoio Social , Inquéritos e Questionários
17.
J Nutr ; 136(10): 2645-52, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16988140

RESUMO

Undernutrition in early childhood is associated with poor mental development and affects 45% of children in Bangladesh. Although limited evidence shows that psychosocial stimulation can reduce the deficits, no such interventions have been reported from Bangladesh. The Bangladesh Integrated Nutrition Program (BINP) has provided nutrition supplementation to undernourished children through community nutrition centers (CNCs). We added psychosocial stimulation to the treatment of undernourished children in a randomized controlled trial to assess the effects on children's development and growth and mothers' knowledge. Twenty CNCs were randomly assigned to intervention or control groups with 107 children in each group. We also studied 107 nonintervened better-nourished children from the same villages. Pre- and postintervention measurements included children's height, weight, development assessed on Bayley Scales, behavior ratings during the test, and a questionnaire on mothers' knowledge of childrearing. The intervention comprised home visits and group meetings with mothers and children for 12 mo. Intervention benefited children's mental development (4.6 +/- 2.0, P = 0.02), vocalization (0.48 +/- 0.23, P = 0.04), cooperation (0.45 +/- 0.16, P = 0.005), response-to-examiner (0.50 +/- 0.15, P = 0.001), emotional tone (0.33 +/- 0.15, P = 0.03), and mothers' knowledge (3.5 +/- 0.49, P < 0.001). At the end, undernourished controls had poorer mental (-4.6 +/- 2.0, P = 0.02) and motor (-6.6 +/- 2.2, P = 0.003) development, were more inhibited (-0.35 +/- 0.16, P = 0.03), fussier (-0.57 +/- 0.16, P < 0.001), less cooperative (-0.48 +/- 0.17, P = 0.005), and less vocal (-0.76 +/- 0.23, P = 0.001) than better-nourished children. Intervened children scored lower only in motor development (-4.4 +/- 2.3, P = 0.049). Neither group of undernourished children improved in nutritional status, indicating that treatment had no effect. In conclusion, adding child development activities to the BINP improved children's development and behavior and their mothers' knowledge; however, the lack of improvement in growth needs to be examined further.


Assuntos
Desenvolvimento Infantil/fisiologia , Desnutrição/psicologia , Desnutrição/terapia , Antropometria , Bangladesh , Índice de Massa Corporal , Serviços de Saúde Comunitária , Suplementos Nutricionais , Humanos , Lactente , Comportamento do Lactente , Desnutrição/fisiopatologia , Mães , Estado Nutricional , Desempenho Psicomotor , População Rural , Inquéritos e Questionários , Resultado do Tratamento
18.
Acta Paediatr ; 95(10): 1249-57, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16982498

RESUMO

AIM: To investigate the development and behaviour of low-birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW). METHODS: Two parallel cohorts of LBW infants (1500-2499 g) and ABW controls (3000-3499 g) were enrolled at birth in northeast Brazil. At 8 y, 164 children were assessed using clinical and psychological tests. RESULTS: The LBW group had lower IQ scores than ABW children on the Weschler Intelligence Scale for Children; differences were larger on the performance (5 points, p = 0.04) than the verbal scale (3 points, p = 0.11). LBW children had poorer dynamic balance (p = 0.03) and eye-hand coordination (p = 0.02), but better selective attention (p = 0.02). Hyperactivity and conduct problems were common in both groups, but fewer LBW children had peer problems (p = 0.04). After controlling for social background, IQ was not significantly associated with birthweight (p = 0.10). Significant determinants were maternal education, home stimulation and type of school attended. The effect of birthweight on coordination and selective attention remained significant. Birth head circumference and growth in head size in the first 6 mo had independent effects on IQ. CONCLUSION: After controlling for social background, LBW term infants did not differ from ABW infants in cognition at school age. Head circumference at birth and 6 mo was a better predictor than birthweight of IQ.


Assuntos
Transtornos do Comportamento Infantil/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Atenção , Brasil/epidemiologia , Criança , Transtornos Cognitivos/epidemiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino , Análise Multivariada , Fatores de Risco , Fatores Socioeconômicos
19.
BMJ ; 333(7566): 472, 2006 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-16877454

RESUMO

OBJECTIVE: To determine whether dietary supplementation or psychosocial stimulation given to growth retarded (stunted) children age 9-24 months has long term benefits for their psychosocial functioning in late adolescence. DESIGN: Sixteen year follow-up study of a randomised controlled trial. SETTING: Poor neighbourhoods in Kingston, Jamaica. PARTICIPANTS: Of 129 stunted children identified at age 9-24 months, 103 adolescents aged 17-18 were followed up. INTERVENTION: Supplementation with 1 kg milk based formula each week or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years. MAIN OUTCOME MEASURES: Anxiety, depression, self esteem, and antisocial behaviour assessed by questionnaires administered by interviewers; attention deficit, hyperactivity, and oppositional behaviour assessed by interviews with parents. RESULTS: Primary analysis indicated that participants who received stimulation had significantly different overall scores from those who did not (F = 2.047, P = 0.049). Supplementation had no significant effect (F = 1.505, P = 0.17). Participants who received stimulation reported less anxiety (mean difference - 2.81, 95% confidence interval - 5.02 to - 0.61), less depression (- 0.43, - 0.78 to - 0.07), and higher self esteem (1.55, 0.08 to 3.02) and parents reported fewer attention problems (- 3.34, - 6.48 to - 0.19). These differences are equivalent to effect sizes of 0.40-0.49 standard deviations. CONCLUSIONS: Stimulation in early childhood has sustained benefits to stunted children's emotional outcomes and attention.


Assuntos
Suplementos Nutricionais , Transtornos do Crescimento/terapia , Transtornos Mentais/prevenção & controle , Ludoterapia/métodos , Adolescente , Estudos de Coortes , Seguimentos , Humanos , Lactente , Jamaica , Autoimagem , Comportamento Social
20.
Lancet ; 366(9499): 1804-7, 2005 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-16298218

RESUMO

Growth retardation affects about a third of children younger than age 5 years in developing countries and is associated with poor development. Previously, we did a trial of nutritional supplementation and psychosocial stimulation in stunted children aged 9-24 months. Non-stunted children were also assessed. Both types of intervention improved development. We now present the effects of early interventions on cognition and education in 103 of the 129 stunted children and compare them with 64 of the 84 non-stunted children now aged 17-18 years. We recorded no significant effects of nutritional supplementation. Compared with no intervention, stimulation resulted in higher full scale IQ scores (coefficient 0.38, 95% CI 0.06-0.71, p=0.02) and higher scores on the verbal subscale (0.37, 0.07-0.68, p=0.02), Peabody picture vocabulary test (7.84, 0.73-14.95, p=0.03), verbal analogies (0.26, 0.03-0.49, p=0.03), and reading tests (4.73, 1.31-8.14, p=0.007, and 2.7, 1.12-4.37, p=0.001). Overall, stunted non-stimulated participants had significantly poorer scores than the non-stunted group on 11 of 12 cognitive and educational tests. Stunting in early childhood is associated with cognitive and educational deficits in late adolescence, which are reduced by stimulation at a young age.


Assuntos
Logro , Cognição , Transtornos do Crescimento/terapia , Apoio Nutricional , Apoio Social , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Testes de Inteligência , Jamaica , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA