scholarly journals Maternal mental health modifies the association of food insecurity and early child development

2020 ◽  
Vol 16 (4) ◽  
Author(s):  
Jéssica Pedroso ◽  
Gabriela Buccini ◽  
Sonia Isoyama Venancio ◽  
Rafael Pérez‐Escamilla ◽  
Muriel Bauermann Gubert
2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 280-280
Author(s):  
Jessica Silva ◽  
Fernando José Herkrath ◽  
Gabriela Buccini ◽  
Sonia Isoyama Venancio ◽  
Rafael Pérez-Escamilla ◽  
...  

Abstract Objectives The aim of the study was to evaluate whether maternal mental health and infant's diet mediate the association between Household Food Insecurity (HFI) and Early Child Development (ECD) using Structural Equation Modeling (SEM). We hypothesized a priori that both maternal mental health and infant's diet would mediate the association between HFI and ECD. Methods A cross-sectional study was carried out with 474 mother-infant dyads at Primary Health Centers in the Federal District, Brazil. Mothers answered a questionnaire that evaluated variables through validated instruments. SEM analyses were conducted including the following observed variables: HFI, ECD, consumption of a healthy and diverse diet, presence of a partner in the household, wanted pregnancy and current breastfeeding. Latent variables were included to evaluate mental health (created from maternal depression, trait anxiety and state anxiety), poverty (created from maternal educational level, household per capita income and participation in the Brazilian cash transfer program) and infant health (created from preterm birth, hospitalization after birth and Neonatal Intensive Care Unit needed after birth). Results Poor maternal mental health mediated the relationship between HFI and ECD (β = –0.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower ECD scores directly (β = 0.21) and indirectly (β = 0.02). Not having a partner (β = 0.05) and having an unwanted pregnancy (β = 0.02) predicted indirectly lower ECD scores. Conclusions Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood and unwanted pregnancy through different pathways. Therefore, it is necessary that public policies and interventions that aim to promote an optimal ECD also approach these aspects. Longitudinal cohort studies are needed to determine causality and identify promising approaches to improve parenting skills and ECD outcomes in the context of HFI. Funding Sources This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) (Finance Code 001, CAPES scholarship Programa Doutorado Sanduíche no Exterior Process number 88,881.189710/2018–01).


2021 ◽  
Vol 6 (3) ◽  
pp. e004307
Author(s):  
Helen O Pitchik ◽  
Fahmida Tofail ◽  
Mahbubur Rahman ◽  
Fahmida Akter ◽  
Jesmin Sultana ◽  
...  

IntroductionIn low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.MethodsWe conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.ResultsIn July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54).ConclusionOur findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.Trial registration numberThe trial is registered in ISRCTN (ISRCTN16001234).


BJGP Open ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. bjgpopen18X101593 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Syeda Somyyah Owais ◽  
Shazia Maqbool ◽  
Sehrish Ishaq ◽  
Haroon Jehangir Khan ◽  
...  

BackgroundIn Pakistan, high prevalence of delays in early child development (ECD) is associated with poverty and lack of mothers’ caregiving skills. GP clinics, the main sources of care in poor urban localities, lack quality ECD care delivery. A contextualised intervention was developed and tested to enable GPs to deliver clinic-based, tool-assisted ECD counselling of mothers on a quarterly basis.AimTo assess the effectiveness of delivering a contextualised ECD mother-counselling intervention.Design & settingClustered randomised controlled trial, in poor urban localities of Pakistan. Locality clusters were allocated to intervention and control arm using simple randomisation.MethodA total of 2327 mother–child pairs were recruited at 32 GP clinics, one from each cluster-locality; 16 GP clinics per arm. The clinic-based counselling intervention covering child stimulation, nutrition, and maternal mental health was delivered mainly by clinic assistants to mothers at ≤6 weeks, and 3, 6, and 9 months of child age. At 12 months of child age, each mother–child pair was assessed for the primary outcome, that is, delays in the five development domains (determined by Ages and Stages Questionnaire-3 [ASQ-3] score); and secondary outcomes, namely the prevalence of stunting and maternal depression (determined by Patient Health Questionnaire-9 [PHQ-9] score). The outcome assessors were blinded to the cluster–arm allocation. Outcome analyses were calculated on cluster-level.ResultsAt 12 months, the number of children with delay in two or more development domains was significantly lower in the intervention arm (-0.17 [95% confidence interval {CI} = -0.26 to -0.09]; P<0.001) compared to the control arm. The difference in the prevalence of child stunting and maternal depression were also significant at -0.21% (95% CI = -0.30 to -0.13; P<0.001) and -0.23% (95% CI = -0.29 to -0.18; P = 0.000) respectively.ConclusionContextualised ECD care, when delivered at GP clinics in poor urban localities, can effectively reduce the developmental delays during the first 12 months of the child's life.


BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100677 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Syeda Somyyah Owais ◽  
Claire Blacklock ◽  
Shirin Anil ◽  
Sehrish Ishaq ◽  
...  

BackgroundEarly childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression.AimTo assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities.Design & settingA clustered randomised trial in Pakistan.MethodThe intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother–child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child’s age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted.DiscussionThis trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public–private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective.Trial registrationThe trial has been registered with the Current Controlled Trials ISRCTN48032200.


2012 ◽  
Author(s):  
J. Wendland ◽  
E. Lemoine ◽  
M. Cazenave ◽  
E. Gacoin ◽  
C. Lasseron ◽  
...  

2009 ◽  
Author(s):  
Heather A. Keefe ◽  
Sharnail D. Bazemore ◽  
Kate Farr ◽  
James F. Paulson

Author(s):  
Onwaba Makanjana ◽  
Ashika Naicker

Despite the numerous efforts to improve the nutritional status of children, a high prevalence of malnutrition still exists in South Africa. This study aimed to determine the nutritional status of children attending Early Child Development centres in South Africa. In this baseline study, we randomly selected two Early Child Development centres comprising 116 children aged 24–60 months, separated into two cohorts, of 24–47 months and 48–60 months. Dietary intake was measured through the 24 hDR and analysed using Food Finder software. The food frequency questionnaire was used to calculate the food variety and food group diversity scores. Anthropometric measurements were taken and the WHO Anthro software was used to convert it to nutritional data indices. Blood samples were collected through dried blood spot cards in order to determine serum retinol and haemoglobin levels and they were assessed using WHO indicators. The findings showed that participants between 24 and 47 months had a high mean energy intake (4906.2 kJ and 4997.9 kJ for girls and boys, respectively). For the 48–60 months age group, energy intake was lower than the EER (5936.4 kJ and 5621.2 kJ; p = 0.038). There was low fruit and vegetable consumption (24–47 months; 63.8 g and 69.5 g (p = 0.037), 48–60 months; 68.3 g and 74.4 g (p = 0.038) and the top five foods consumed were carbohydrate rich foods for girls and boys, respectively. Stunting was noted in 7% and 20% (48–60 months) (p = 0.012) and overweight in 8% and 17% (24–47 months) and 17% and 13% (48–60 months) (p = 0.041) in girls and boys, respectively. Low serum retinol levels (<0.070 µmol/L) were found in 9.1% of boys (24–47 months), and 8% and 7.4% of girls and boys (48–60 months), respectively. Low haemoglobin levels (<11.0 g/dL) were found in 50.0% and 30.4% (24–47 months) and 8.6% and 39.3% (48–60 months) of girls and boys, respectively. Malnutrition, despite many national and provincial initiatives, still exists in Early Childhood Development centres in South Africa, calling for the application of contextualized nutrition interventions to suit resource-poor settings.


2021 ◽  
Vol 197 ◽  
pp. 111168
Author(s):  
Ming-Lun Zou ◽  
Chuen-Bin Jiang ◽  
Yi-Hua Chen ◽  
Chih-Da Wu ◽  
Shih-Chun Candice Lung ◽  
...  

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