Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov;58(11):1264-1275.
doi: 10.1111/jcpp.12751. Epub 2017 May 23.

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

Elizabeth L Prado  1 , Souheila Abbeddou  1 , Seth Adu-Afarwuah  2 , Mary Arimond  1 , Per Ashorn  3   4 , Ulla Ashorn  3 , Jaden Bendabenda  3   5 , Kenneth H Brown  1   6 , Sonja Y Hess  1 , Emma Kortekangas  3 , Anna Lartey  2 , Kenneth Maleta  5 , Brietta M Oaks  1 , Eugenia Ocansey  1   2 , Harriet Okronipa  1   2 , Jean Bosco Ouédraogo  7 , Anna Pulakka  3   8 , Jérôme W Somé  1   7 , Christine P Stewart  1 , Robert C Stewart  9 , Stephen A Vosti  10 , Elizabeth Yakes Jimenez  11 , Kathryn G Dewey  1
Affiliations

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso

Elizabeth L Prado et al. J Child Psychol Psychiatry. 2017 Nov.

Abstract

Background: Previous reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.

Methods: We conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.

Results: Out of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.

Conclusions: Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.

Keywords: Language development; growth; iLiNS Project; lipid-based nutrient supplements; low- and middle-income countries; motor development; nutrition; risk factors; stimulation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Conceptual model
Figure 2
Figure 2
Data collection timeline in each cohort. Abbreviations: CDI: communicative development inventory, IYCF‐FPQ: infant and young child feeding—feeding practices questionnaire, DMC: developmental milestones checklist, FCI: family care indicators, Hb: hemoglobin, HOME, home observation for the measurement of the environment inventory, KDI: Kilifi developmental inventory, LNS: lipid‐based nutrient supplements, PSS: perceived stress scale
Figure 3
Figure 3
Path diagram of language development in four iLiNS cohorts
Figure 4
Figure 4
Path diagram of motor development in four iLiNS cohorts
Figure 5
Figure 5
Coefficients of direct and indirect effects on language and motor development in the final models. Note. Coefficient size represents the change in SD of the language or motor score with 1 SD change in the independent variable, adjusted for all other variables in the model
See this image and copyright information in PMC

References

    1. Aboud, F.E. , & Yousafzai, A.K. (2015). Global health and development in early childhood. Annual Review of Psychology, 66, 433–457. - PubMed
    1. Abubakar, A. , Holding, P. , van Baar, A. , Newton, C.R. , & van de Vijver, F.J. (2008). Monitoring psychomotor development in a resource‐limited setting: An evaluation of the Kilifi Developmental Inventory. Annals of Tropical Paediatrics, 28, 217–226. - PMC - PubMed
    1. Adu‐Afarwuah, S. , Lartey, A. , Okronipa, H. , Ashorn, P. , Zeilani, M. , Peerson, J.M. , … & Dewey, K.G. (2015). Lipid‐based nutrient supplement increases the birth size of infants of primiparous women in Ghana. American Journal of Clinical Nutrition, 101, 835–846. - PubMed
    1. Arimond, M. , Abbeddou, S. , Kumwenda, C. , Okronipa, H. , Hemsworth, J. , Jimenez, E.Y. , … & Dewey, K.G. (2016). Impact of small quantity lipid‐based nutrient supplements on infant and young child feeding practices at 18 months of age: Results from four randomized controlled trials in Africa. Maternal & Child Nutrition. Advanced online publication. https://doi.org/10.1111/mcn.12377. - DOI - PMC - PubMed
    1. Ashorn, P. , Alho, L. , Ashorn, U. , Cheung, Y.B. , Dewey, K.G. , Gondwe, A. , … & Maleta, K. (2015). Supplementation of maternal diets during pregnancy and for 6 months postpartum and infant diets thereafter with small‐quantity lipid‐based nutrient supplements does not promote child growth by 18 months of age in rural Malawi: A randomized controlled trial. Journal of Nutrition, 145, 1345–1353. - PubMed