Importance: Recent studies have associated the COVID-19 pandemic with negative developmental outcomes in children. However, research focused on young children remains limited, with few studies including multiple years of pre- and postpandemic onset data.
Objective: To examine the impact of the COVID-19 pandemic on US kindergarteners' developmental health.
Design, setting, and participants: This repeated cross-sectional panel study examined developmental health trends, as measured by the Early Development Instrument (EDI), among a convenience sample US kindergarteners from 2010 to 2023. EDI data were obtained from 390 school districts across 19 states. Data were analyzed from June December 2024.
Exposure: Kindergarteners' developmental health was compared between prepandemic (2018 to 2020) and postpandemic (2021 to 2023) onset cohorts.
Main outcomes and measures: Outcomes were EDI scores across time in 5 domains: (1) physical health and well-being, (2) social competence, (3) emotional maturity, (4) language and cognitive development, and (5) communication and general knowledge. The mean (95% CI) EDI scores were assessed.
Results: In this sample of of 475 740 US kindergarten students, 242 869 were male (51.1%), there were 53 841 African American or Black students (11.4%), 263 037 Hispanic or Latino/a students (55.5%), and 95 258 White students (20.1%), and the mean (SD) age was 6 (0.4) years (range, 4.0-8.0 years). Compared with the immediate prepandemic onset period, the rate of change in EDI scores was significantly lower following the pandemic onset in language and cognitive development (mean change, -0.45; 95% CI, -0.48 to -0.43), social competence (mean change, -0.03; 95% CI, -0.06 to -0.01), and communication and general knowledge (mean change, -0.18; 95% CI, -0.22 to -0.15). EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03 to 0.07), and no significant changes were observed in the physical health and well-being domain (mean change, 0; 95% CI, -0.01 to 0.02).
Conclusions and relevance: The COVID-19 pandemic was associated with varying developmental health outcomes in kindergarteners. Negative developmental trends existed immediately before the pandemic, with most persisting or slowing postpandemic onset. These results highlight troubling trends in kindergarteners' development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time.
Importance: Despite a global decline in the mortality rate of children younger than 5 years (the under-5 mortality rate), neonatal deaths continue to present a substantial challenge. The etiology behind deaths varies between the early and late neonatal periods as well as at later ages.
Objective: To decompose the under-5 mortality rate in 47 low- and middle-income countries into 8 age intervals, providing a comprehensive understanding of varying vulnerability across age groups.
Design, setting, and participants: This cross-sectional study used nationally representative data from 47 Demographic and Health Surveys conducted between 2014 and 2023 in low- and middle-income countries, including 1.4 million live births.
Exposure: Age in days, weeks, months, or years.
Main outcomes and measures: The under-5 mortality rate was decomposed by age based on a life table approach, using true cohort probabilities for the early and late neonatal periods and synthetic cohort probabilities for other age intervals, to obtain deaths per 1000 live births (ie, the cohort entering the life table) for each age interval.
Results: In the pooled sample of 1 448 001 live births, there were 14 576 deaths in the early neonatal period (age 0 to 6 days); 3400 in the late neonatal period (age 7-27 days); 6760 in the early postneonatal period (age 28 days to 5 months); 4912 in the late postneonatal period (age 6-11 months); and 5145, 3990, 2674, and 1640 at ages 1, 2, 3, and 4 years, respectively. The early neonatal mortality rate accounted for 21.3 (95% CI, 20.5-22.1) deaths per 1000 births from a total under-5 mortality rate of 57.7 (95% CI, 56.2-59.3) deaths per 1000 births. The early neonatal mortality rate was significantly higher than mortality at subsequent ages (eg, median [IQR] mortality rates: early neonatal period, 18.8 [14.3-23.2] deaths per 1000 births; late neonatal period, 4.7 [3.1-5.9] deaths per 1000 births) and much higher when considering the average daily mortality rate. The early neonatal mortality rate accounted for the greatest share of under-5 mortality rate in all but 2 countries. In most countries the lowest mortality rates were observed at age 3 or 4 years. The share of deaths occurring in the late postneonatal period and later was greater in countries with greater under-5 mortality rates.
Conclusions and relevance: The concentration of mortality in the first week after birth underscores a critical need for enhanced maternal and neonatal health care. Furthermore, early neonatal mortality rates should be routinely reported and included in health targets. In this study, the age of 6 months emerged as an important turning point: high-mortality countries were characterized by a greater concentration of deaths after age 6 months than countries with lower under-5 mortality rate.
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