Patrice L. Engle

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries

Patrice L. Engle et al. — Fri, 04 Nov 2011 15:48:26 PDT

This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrollment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children’s educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrollment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrollment rate and discount rate.

Use of Family Care Indicators and Their Relationship with Child Development in Bangladesh

Jena D. Hamadani et al. — Mon, 17 May 2010 16:07:36 PDT

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.

The Role of Men in Families: Achieving gender equity and supporting children

Patrice L. Engle — Fri, 17 Jul 2009 11:24:13 PDT

Fathers and men in families represent one of the most important resources for children’s well-being. Social services, including development interventions in the South, have hitherto failed to take into consideration the major role of men in families, and its effects on women, on children, and on the men themselves.

Nutrition and Mental Development in Children

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:52:07 PDT

Infant Feeding Styles: Barriers and Opportunities for Good Nutrition in India

Patrice L. Engle — Thu, 04 Jun 2009 08:52:06 PDT

India has the lion’s share of malnourished children in the world. Poverty and social exclusion contribute to this rate of malnutrition, but care practices also play a role.Breastfeeding is rarely exclusive, sanitation tends to be limited, complementary feeding often begins late, and the quantities are small. In the past, government programs have focused on the supply of food rather than caring practices. A research agenda will include both operational research on the nutrition programs, and formative and intervention research to improve caring practices, particularly those around infant and young child feeding.

Strategies to Avoid the Loss of Developmental Potential in More than 200 Million Children in the Developing World

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:52:05 PDT

This paper is the third in the Child Development Series. The first paper showed that more than 200 million children under 5 years of age in developing countries do not reach their developmental potential. The second paper identified four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria. This paper assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential. The most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality, and high intensity, and are integrated with family support, health, nutrition, or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.

Views of Cesarean Birth Among Primiparous Women of Mexican Origin in Los Angeles

Laura H. Cummins et al. — Thu, 04 Jun 2009 08:52:04 PDT

This study examined data from a larger project on the cultural context of first birth among low-income women of Mexican origin giving birth in Los Angeles. Data on knowledge of cesarean birth and perceptions of the cesarean birth experience were collected. In addition, differences in perceptions of the experience between women giving birth vaginally and those giving birth by cesarean as reported in the literature were assessed. Five hundred eighteen women were surveyed, of whom 58 had a cesarean birth. Statistical analyses revealed few significant differences between the two groups with regard to childbirth knowledge and attitudes, which may indicate that Latinas are different from the Anglo women discussed in the literature. In their postnatal assessment, 28 percent of the women giving birth by cesarean reported dissatisfaction with the experience, the majority regarded cesareans as “normal, ’’ and 11 percent thought they were at an advantage to have had cesarean births. These results suggest that cultural beliefs and attitudes may affect a woman’s perceptions of the childbirth experience. The findings discussed here have implications for cross-cultural research on childbirth for childbirth educators and for health care providers working in multicultural settings.

The Relationship of Prior Ability and Family Characteristics to School Attendance and School Achievement in Rural Guatemala

Marc Irwin et al. — Thu, 04 Jun 2009 08:52:03 PDT

Data from a longitudinal study in progress were used to investigate the relationships between intellectual ability prior to schooling opportunities and characteristics of family and home environment, and elementary school attendance and performance in 3 rural Guatemalan communities. Pre-school- ing mental test performances, family SES level, and indices of parental values concerning education were all associated with attending or not attending school. Length of school attendance was predicted by pre-schooling mental test scores for girls and by family SES level and parental values for boys. Age at first enrollment was predicted by both pre-schooling mental test scores and family SES level for both sexes. School grades were predicted by pre-schooling mental test scores and intellectual stimulation provided in the home but not by family SES level. It is argued that schooled and non-schooled peers in most semi-illiterate communities are unlikely to be originally comparable, and that conclusions based on previous studies of the effects of formal schooling on intellectual development must be reconsidered.

The Effect of Poverty on Child Development and Educational Outcomes

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:52:02 PDT

Poverty affects a child’s development and educational outcomes beginning in the earliest years of life, both directly and indirectly through mediated, moderated, and transactional processes. School readiness, or the child’s ability to use and profit from school, has been recognized as playing a unique role in escape from poverty in the United States and increasingly in developing countries. It is a critical element but needs to be supported by many other components of a poverty alleviation strategy, such as improved opportunity structures and empowerment of families. The paper reviews evidence from interventions to improve school readiness of children in poverty, both in the United States and in developing countries, and provides recommendations for future research and action.

Care and Nutrition: Concepts and Measurement

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:52:00 PDT

Care is the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members. The significance of care has best been articulated in the framework developed by the United Nations Children's Fund (UNICEF). This paper extends the UNICEF model of care and summarizes the literature on the relationship of care practices and resources to child nutrition. The paper also summarizes attempts to measure the various dimensions of care. The concept of care is extended in two directions: first, we define resources needed by the caregiver for care and, second, we show that the child's own characteristics play a role in the kind of care that he or she receives. The literature summary and methodological recommendations are made for six types of resources for care and for two of the least studied care practices: complementary feeding and psychosocial care. The other care practices are care for women, breast-feeding, food preparation, hygiene, and home health practices. Feeding practices that affect a child's nutritional status include adaptation of feeding to the child's abilities (offering finger foods, for example); responsiveness of the caregiver to the child (perhaps offering additional or different foods); and selection of an appropriate feeding context. Psychosocial care is the provision of affection and attention to the child and responsiveness to the child's cues. It includes physical, visual, and verbal interactions.

Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights

Theodore D. Wachs et al. — Thu, 04 Jun 2009 08:51:59 PDT

Depressive disorders are a common source of disability among women. In addition to the economic and human costs of maternal depression, children of depressed mothers are at risk for health, developmental, and behavioral problems. Although most of the research examining the evidence and intergenerational aspects of maternal depression has been conducted in high-income countries, recent evidence suggests that rates of maternal depression may be higher in low- and middle-income countries, where nearly 90% of the world’s children live. This review examines the evidence from low- and middle-income countries that links maternal depression with children’s health, development, and behavior. We present recommendations for future policies and intervention programs related to maternal depression and examine how maternal depression affects the rights of millions of children living in these countries.

Maternal Employment, Child Care, and Nutritional Status of 12-18-Month-Old Children in Managua, Nicaragua

Jessica F. Lamontagne et al. — Thu, 04 Jun 2009 08:51:58 PDT

Relationships among women's employment, child care strategies, and nutritional status of children 12–18 months of age were examined in 80 Nicaraguan households sampled by randomized block design in 10 low income urban communities. Multiple regression analyses showed that children of employed mothers (56%) fared better in weight/height than those whose mothers were not employed. with and without controlling for socioeconomic status and maternal education, paternal financial support, child care adequacy, and sex and age of the child. Children with inadequate alternate child care (care by a preteen or care at the work place) had lower height for age, even controlling for the same variables and for maternal employment. Differences in 10 caregiving behaviors between families as a function of work status of the mother and adequacy of child care were examined. In families with working mothers, caregivers were less likely to be observed washing their hands, suggesting that the positive associations of work for earnings might be due to income rather than improved care. Inadequate care was associated with less food variety, less use of health care, and marginally less hand-washing. Inadequate child care, which tends to be associated with informal work, nuclear families and poverty, should be a concern for child welfare.

Policies to Reduce Undernutrition Include Child Development

Mauren M. Black et al. — Thu, 04 Jun 2009 08:51:57 PDT

Review of A Critical Link: Interventions for Physical Growth and Psychological Development

Gretel Pelto et al. — Thu, 04 Jun 2009 08:51:56 PDT

An extensive scientific review showing that psychological interventions to support psychological development and nutrition interventions to support physical growth are effective and that combined interventions to improve both growth and psychological development have synergistic effects.

Child Development: Vulnerability and Resilience

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:51:55 PDT

Many of the challenges facing children now are a function of changing times, including increase in urbanization, political violence, changing family forms, and in some areas decreased supplies of adequate food. This review focuses particularly on those changes in which children are the victims and which induce new threats for them, rather than on problems such as child disability or mental illness. The outcome variables of interest in this paper are dimensions of children's psychosocial development, including cognitive development, psychological adjustment and aggression, whereas the companion paper in this issue (Caldwell P., Child survival: vulnerability and resilience in adversity in the European past and the contemporary Third World, Soc. Sci. Med.) [1] focuses on physical aspects of children's development. The risks that are hurdles in the process of development of a young child begin from conception and carry on into later life. To address them all would be impossible; thus, in order to do justice to the issues at hand, we have chosen those risks that, in our view, are important in a child's psychosocial development in developing countries. This paper will thus provide a discussion of the concepts of risk and resilience, then apply these concepts to the analysis of three examples of risk faced by children today: nutritional threats (e.g. malnutrition due to decline in breastfeeding); family dynamics and types of family forms (e.g. child fostering and non-traditional families); and experiences of violence (domestic or political). In each case, the same four questions will be addressed: what are the consequences of the risk factor for children, what are the etiologies and conditions of risk, are there any children who seem to cope with the risk factor successfully and what are some of the protective factors, and what interventions or programs would help support these children?

Early Supplementary Feeding and Cognition: Effects Over Two Decades

Ernesto Pollitt et al. — Thu, 04 Jun 2009 08:51:54 PDT

The study reported in this Monograph of the effects of early supplementary feeding on cognition included two data collection periods: a longitudinal investigation spanning the years 1969-1977 and a cross-sectional follow- up carried out in 1988-1989. The study was conducted in four rural villages in Guatemala and compared the differential effects of exposure in child- hood (0-7 years) to an Atole supplement (11.5 g of protein; 163 kcal) or a Fresco supplement (59 kcal) on performance on a battery of psychoeducational and information-processing tests in adolescence and young adulthood (11-24 years). In this report, particular attention is given to a cohort of subjects who were exposed to the supplement prenatally and during at least the first 2 years of postnatal life. Data on this subsample are contrasted with those on a cohort of subjects who received the supplement only after 24 months of life. The Monograph also reports results from an analysis of the supplementation effects in infancy and early childhood.

Consistent differences between groups on the psychoeducational tests were observed. Adolescents from Atole villages scored significantly higher on tests of knowledge, numeracy, reading, and vocabulary than Fresco subjects. Atole was also associated with a faster reaction time in information- processing tasks. Significant interactions helped identify two groups who benefited more from the Atole treatment: those at the lowest levels of socioeconomic status and those who attained the highest levels of primary schooling. The consistent differences in test performance established in the follow-up assessment contrast sharply with the few and less pronounced between-group differences observed in the infancy and preschool periods.

After close scrutiny of alternative hypotheses, it is concluded that nutritional differences provide the strongest explanation for the test performance differences observed in the follow-up between the subjects exposed to the Atole and those exposed to the Fresco supplement.

The Relationship between Physical Growth and Infant Behavioral Development in Rural Guatemala

Robert E. Lasky et al. — Thu, 04 Jun 2009 08:51:53 PDT

The present study investigated the relationship between a number of anthropometric indices and behavioral development during the first 2 years of life in rural Guatemala. Length and weight were the indices most strongly correlated with behavioral development. If the effect of the infant's length and weight was statistically controlled for, none of the other anthropometric variables explained a significant proportion of the variance in behavioral development. Con- trolling for length (or weight) assessed at the same age as the behavioral assessment, length (or weight) for younger ages was not significantly correlated with behavioral development. Changes in length or weight over time were correlated with changes in behavioral performance. We were unable to explain the association between physical growth and behavioral development by a number of variables including gestational age, nutrient intake, prevalence of disease, and familial characteristics.

Maternal Work and Child-Care Strategies in Peri-Urban Guatemala: Nutritional Effects

Patrice L. Engle — Thu, 04 Jun 2009 08:51:52 PDT

Associations of 293 mothers' works for earnings and child-care arrangements with the anthropometric status of their children were examined in urban Guatemala. It was hypothesized that during the period of life in which growth often falters (8 through 35 months), maternal employment could be beneficial for children. Informal workers tended to be poorer, less educated, and have more undernourished children than formal workers or nonworkers. When poverty and mother's education were controlled for, no effects of maternal employment on children's anthropometric growth patterns were seen. However, the percent of the family income the mother earned was positively associated with all anthropometric indicators, controlling for confounds. Children taken care of by preteen siblings had significantly lower weight for height than those in other situations, even controlling for SES and maternal employment status. These effects were not found in a 36-48-month-old sample.

Effects of Discontinuing Coffee Intake on Iron Deficient Guatemalan Toddlers' Cognitive Development and Sleep

Patrice L. Engle et al. — Thu, 04 Jun 2009 08:51:50 PDT

Coffee is commonly given daily to toddlers in Guatemala. Possible negative effects of coffee ingestion on cognitive development and sleep patterns were assessed in 132 children 12–24 months of age who had received coffee for >2 months and were iron deficient on at least one indicator. Children were stratified by initial hemoglobin (A=anemic, Hgb <10.5 g/dl; NA=‘non-anemic', Hgb ≥10.5 g/dl) and were randomly assigned to an experimental group (S=substitute consisting of sugar and coloring), and a control group (C=continuation of coffee) (42 C-NA; 53 S-NA; 18 C-A; and 19 S-A). Anemic children were provided Fe supplements for 2–3 months. Compliance was assessed every 2 weeks. After 5 months, testers masked to treatment group and anemia evaluated children with the Bayley Scales of Infant Development II in a central location. Scores were the Mental Development Index (MDI), the Psychomotor Development Index (PDI), and scales from the Behavior Rating Scale (BRS). The child's sleep in the previous 24 h was assessed with a set of standardized sleep questions to the care giver on the first visit and every 2 weeks thereafter. No significant effects of treatment on test scores or BRS ratings were found. In the 24 h period reported on at the final visit, children in the Substitute group slept more during the night and overall (night plus naps) than children in the Coffee group, a difference not found at the first visit. No differences were found in sleep difficulty or number of times waking at night. Women's reported coffee intake per day during pregnancy was associated with lower BRS ratings, even after controlling for SES and child age. The effects of postnatal coffee ingestion in Guatemala were seen for sleep duration, but not for cognitive development. Prenatal coffee ingestion was negatively associated with Behavior Rating Scales and should be investigated further.