Impact of adversity on early childhood growth & development in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS)

Abstract

Introduction: Early childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & development.

Methods: This was a substudy of the SPRING cluster randomised controlled trial covering the whole population of 120 villages of rural India. We assessed all children born from 18 June 2015 for adversities in the first year of life and summed these to make a total cumulative adversity score, and four subscale scores. We assessed the association of each of these with weight-for-age z-score, length-for-age z-score, and the motor, cognitive and language developmental scales of the Bayley Scales of Infant Development III assessed at 18 months.

Results: We enrolled 1726 children soon after birth and assessed 1273 of these at both 12 and 18 months of age. There were consistent and strongly negative relationships between all measures of childhood adversity and all five child growth & development outcome measures at 18 months of age. For the Bayley motor scale, each additional adversity was associated with a 1.1 point decrease (95%CI -1.3, -0.9); for the cognitive scales this was 0.8 points (95%CI -1.0, -0.6); and for language this was 1.4 points (95%CI -1.9, -1.1). Similarly for growth, each additional adversity was associated with a -0.09 change in weight-for-age z-score (-0.11, -0.06) and -0.12 change in height-for-age z-score (-0.14, -0.09).

Discussion: Our results are the first from a large population-based study in a low/middle-income country to show that each increase in adversity in multiple domains increases risk to child growth and development at a very early age. There is an urgent need to act to improve these outcomes for young children in LMICs and these findings suggest that Early Childhood programmes should prioritise early childhood adversity because of its impact on developmental inequities from the very start.

Fig 1. Conceptual framework linking domains of childhood adversity to suboptimal growth and development.

Fig 2. SPRING-ELS sub-study–flowchart of final assessment sub-sample *inclusion in this paper’s analysis sample requires both a 12 and 18 month assessment to be done.

Fig 3. Proportion of children in the SPRING-ELS sub-study with each total adversity score.

Fig 4

Histograms showing adversity scale scores for children in SPRING-ELS study for each of A) Socioeconomic B) Maternal Stress C) Relationship D) Child.

Fig 5

Regression model associations between adversity and growth & development at 18 months of age in children enrolled in SPRING-ELS as follows: A) Cumulative adversity & Development B) Cumulative adversity & Growth C) Adversity Quintile & Development D) Adversity Quintile & Growth.

Fig 6

Regression model associations between adversity scales and growth & development at 18 months of age in children enrolled in SPRING-ELS as follows: A) Socioeconomic Score B) Maternal Stress C) Relationship D) Child. Note: weight-for-age described in text but not shown to aid clarity of figure.