Child diet and mother-child interactions mediate intervention effects on child growth and development

Abstract

This study examined whether child diet and mother-child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0-24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother-child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother-child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother-child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms.

Keywords: Pakistan; child; child development; developing countries; diet; mediation analysis; mother-child interactions.

Figure 1

Conceptual framework showing the Pakistan Early Child Development Scale‐up Trial (PEDS) intervention effects on child growth and development through child diet and mother–child interactions. The numbers describe the direct effects comprising the indirect effects of interest we assessed: (1) direct intervention effects on mediators at 12 months of age, (2) prospective associations between the mediators at 12 months of age and child outcomes at 24 months of age