儿童认知发展的轨迹和社会决定因素：孟加拉国达卡从婴儿期到儿童中期的前瞻性队列研究

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet regional health. Southeast Asia Pub Date : 2024-11-23 DOI:10.1016/j.lansea.2024.100511

Viviane Valdes , Eileen F. Sullivan , Fahmida Tofail , Lisa M. Thompson , Shahria H. Kakon , Talat Shama , Rashidul Haque , Charles A. Nelson

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引用次数: 0

摘要

背景全球有超过三分之一的儿童没有实现其发展潜力，而生活在中低收入国家（LMICs）的儿童最为脆弱。了解影响中低收入国家儿童认知发展的环境因素对于提供信息和制定干预措施至关重要。我们试图描述孟加拉国儿童的认知发展轨迹，并确定突出的社会决定因素。在基线访问时，我们采用口头访谈和家庭评估相结合的方法对社会决定因素（母亲和父亲的教育程度、住房风险、家庭资产和食品安全）进行了评估。认知发展在 6 个月、2、3、4、5 和 7 岁时进行评估。所有参与者共完成了 1397 次认知评估。研究结果在贫困线以上的儿童中，从 6 个月到 2 岁，认知分数与预期分数的偏差越来越大（-12.85, p <0.001），2 到 7 岁的分数趋于稳定。对于那些生活在贫困线以下的儿童，从 6 个月到 4 岁，他们的认知分数与预期分数的差距越来越大（-24.58，p < 0.001），而 4 到 7 岁的分数保持稳定。较高的母亲教育水平（t = 2.22，p = 0.03）和较高的食品安全水平（t = 4.48，p <0.001）对认知具有纵向保护作用。认知发展轨迹显示，在出生后的头两年，与预期的差异越来越大，对贫困线以下儿童的影响更明显、更持久，一直持续到 4 岁。在全部样本中，母亲教育和食品安全对认知发展的纵向得分具有促进/保护作用。与生活在贫困线以上的儿童相比，母亲教育和食品安全对生活在贫困线以下的儿童的认知发展有更强的影响。

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Trajectories and social determinants of child cognitive development: a prospective cohort study from infancy through middle childhood in Dhaka, Bangladesh

Background

Over a third of children globally do not meet their developmental potential, and children living in low and middle-income countries (LMICs) are most vulnerable. Understanding the contextual factors that influence cognitive development for children in LMICs is crucial to inform and develop interventions. We sought to characterize developmental trajectories of cognition in Bangladeshi children and identify salient social determinants.

Methods

We used a longitudinal design and included 542 children living in Dhaka, Bangladesh. Social determinants (maternal and paternal education, housing risks, household assets, and food security) were assessed at baseline visits using a combination of oral interviews and home assessments. Cognitive development was assessed at 6 months, 2, 3, 4, 5, and 7 years. A total of 1397 cognitive assessments were completed across all participants. Growth curve models and mixed effect models were used.

Findings

In children living above the poverty line, there was increasing deviation from expected cognitive scores from 6 months to 2 years (−12.85, p < 0.001) with stable scores from 2 to 7 years. For those below the poverty line, there were widening disparities from expectations in scores from 6 months to 4 years (−24.58, p < 0.001) with stable scores from 4 to 7 years. Higher levels of maternal education (t = 2.22, p = 0.03) and more food security (t = 4.48, p < 0.001) were protective for cognition longitudinally. Interaction effects between poverty level and maternal education and food security respectively were observed.

Interpretation

Cognitive development trajectories showed increasing disparities from expectations in the first two years of life, with more pronounced and lasting effects through 4 years for children below the poverty line. Maternal education and food security had promotive/protective effects on longitudinal cognitive development scores for the full sample. Maternal education and food security had stronger effects on cognitive development for children living below the poverty line compared to those living above the poverty line.