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Review
. 2019 Oct 3;9(10):e026449.
doi: 10.1136/bmjopen-2018-026449.

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

Ayesha Sania  1 , Christopher R Sudfeld  2 , Goodarz Danaei  3 , Günther Fink  4 , Dana C McCoy  5 , Zhaozhong Zhu  6 , Mary C Smith Fawzi  7 , Mehmet Akman  8 , Shams E Arifeen  9 , Aluisio J D Barros  10 , David Bellinger  11 , Maureen M Black  12 , Alemtsehay Bogale  13 , Joseph M Braun  14 , Nynke van den Broek  15 , Verena Carrara  16 , Paulita Duazo  17 , Christopher Duggan  18 , Lia C H Fernald  19 , Melissa Gladstone  20 , Jena Hamadani  9 , Alexis J Handal  21 , Siobán Harlow  22 , Melissa Hidrobo  23 , Chris Kuzawa  24 , Ingrid Kvestad  25 , Lindsey Locks  26 , Karim Manji  27 , Honorati Masanja  28 , Alicia Matijasevich  29 , Christine McDonald  30 , Rose McGready  31   32 , Arjumand Rizvi  33 , Darci Santos  34 , Leticia Santos  34 , Dilsad Save  35 , Roger Shapiro  36 , Barbara Stoecker  37 , Tor A Strand  38 , Sunita Taneja  39 , Martha-Maria Tellez-Rojo  40 , Fahmida Tofail  41 , Aisha K Yousafzai  2 , Majid Ezzati  42 , Wafaie Fawzi  43
Affiliations
Review

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

Ayesha Sania et al. BMJ Open. .

Abstract

Objective: To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).

Design: Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.

Data sources: We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.

Eligibility criteria for selecting studies: Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.

Analyses: Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.

Results: We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs.

Conclusions: Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

Keywords: SGA; access to clean water; access to sanitation; breast feeding; cognitive development; diarrhoea; early life risk factors; language development; maternal anaemia and anaemia in infancy; maternal education; maternal short stature; motor development; paternal education; preterm.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Pooled estimates of association between maternal factors and development.BMI, body mass index.
Figure 3
Figure 3
Pooled estimates of association between child factors and development.
See this image and copyright information in PMC

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