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. 2025 Oct 8;25(1):785.
doi: 10.1186/s12887-025-06060-2.

Association of biological, socioeconomic, and environmental factors with child development at two years of age in Bangladesh, Pakistan, and Tanzania: results from the AMANHI-ACT study

Ambreen Nizar  1 , Rasheda Khanam  2 , Jamila Khalfan Ali  3 , Muhammad Imran Nisar  1 , Fahmida Tofail  4 , Bishara Ali Alawi  3 , Nadia Ansari  1 , Salahuddin Ahmed  5 , Usha Dhingra  6 , Fariha Shaheen  1 , Abrarul Haque Asif  5 , Arup Dutta  6   7 , Muhammad Farrukh Qazi  1 , Sayedur Rahman  8 , Mayassa Aly  9 , Usma Mehmood  1 , Nabidul Haque Chowdhury  5 , Fahad Aftab  3 , Shahira Shahid  1 , Mohammod Shahidullah  10 , Fatma M Kabole  11 , Farzana Begum  1 , Pamela J Surkan  2 , Anupama Verma  12 , Alexander Manu  13   14 , Sachiyo Yoshida  15 , Rajiv Bahl  16 , Sunil Sazawal  6   7 , Abdullah H Baqui  2 , Fyezah Jehan  1
Affiliations

Association of biological, socioeconomic, and environmental factors with child development at two years of age in Bangladesh, Pakistan, and Tanzania: results from the AMANHI-ACT study

Ambreen Nizar et al. BMC Pediatr. .

Abstract

Background: The first 1,000 days of life, spanning pregnancy to two years, are critical for development. We investigated the association of maternal, socioeconomic, environmental, nutritional, and childhood characteristics with cognitive, motor, and language development at two years of age.

Methods: The AMANHI-ACT study enrolled pregnant women between 8 and 19 weeks of gestation from Bangladesh, Pakistan, and Tanzania. Data was collected on sociodemographic factors, maternal BMI and co-morbidities during pregnancy, and weight and gestational age at birth. Child characteristics included vaccination history, infections, and physical growth at predefined intervals up to two years. Child development at two years was assessed using the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III). The home environment was assessed using the Home Observation for Measurement of the Environment Infant-Toddler (HOME-IT) tool. We performed linear regression and reported site-adjusted regression coefficients with 95% confidence intervals.

Results: We assessed 3,062 children at two years of age to identify factors associated with their cognitive, language, and motor development scores. Cognitive scores were significantly lower among children whose mothers had no formal education (Adjusted coefficient = -3.8; 95% CI: -5.8, -1.8) and those who had not received any vaccinations (Adjusted coefficient = -6.0; 95% CI: -9.3, -2.6). Language development was similarly affected: children with mothers who had no education (Adjusted coefficient = -4.7; 95% CI: -6.8, -2.5) or only primary-level education (Adjusted coefficient = -4.5; 95% CI: -6.5, -2.5) showed markedly lower scores. Language scores were also reduced in children whose fathers had no education (Adjusted coefficient = -2.4; 95% CI: -4.2, -0.5) or only primary education (Adjusted coefficient = -2.4; 95% CI: -4.1, -0.6). For motor development, children who were stunted (Adjusted coefficient = -2.2; 95% CI: -2.9, -1.4), wasted (Adjusted coefficient = -2.8; 95% CI: -4.3, -1.4), or unvaccinated (Adjusted coefficient = -4.7; 95% CI: -8.0, -1.4) at two years exhibited significantly lower scores.

Conclusion: Preterm births, vaccination history, parental education, and physical growth significantly affected the first 1000 days of child development, thus identifying areas for targeted intervention to optimize long-term health outcomes in LMICs.

Keywords: Bangladesh; Bayley-III; Cognition; Development; Language; Motor; Pakistan; Tanzania.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: The AMANHI study received ethical approval from the local and institutional ethics committees of all three sites. These included Zanzibar Health Research Ethics Committee (formerly ZAMREC) (ZAMREC/0002/OCTOBER/013) for Tanzania, ICDDR, B (PR12073), and Johns Hopkins University (IRB 00004508) for Bangladesh, and Aga Khan University (2790-paeds-ERC-13) for Pakistan. In addition, the protocols for the biorepository study were also approved by the WHO Ethics Committee (RPC 532), and continuing approvals were sought yearly. Informed consent was obtained from pregnant women at the time of enrollment, and later, at childbirth, they consented to their child’s participation in the study. Consent forms were provided in the mothers’ preferred languages to ensure comprehension. In cases where mothers expressed concerns about their child’s development, or where the child showed faltered physical growth or developmental delays, referrals were made to the Outpatient Department (OPD) of the study center. Physicians at the OPD then assessed the child and, if necessary, referred them to nearby hospitals for further evaluation and management. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow of study participants
See this image and copyright information in PMC

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