RESUMEN
BACKGROUND: The early childhood years provide an important window of opportunity to build strong foundations for future development. One impediment to global progress is a lack of population-based measurement tools to provide reliable estimates of developmental status. We aimed to field test and validate a newly created tool for this purpose. METHODS: We assessed attainment of 121 Infant and Young Child Development (IYCD) items in 269 children aged 0-3 from Pakistan, Malawi and Brazil alongside socioeconomic status (SES), maternal educational, Family Care Indicators and anthropometry. Children born premature, malnourished or with neurodevelopmental problems were excluded. We assessed inter-rater and test-retest reliability as well as understandability of items. Each item was analyzed using logistic regression taking SES, anthropometry, gender and FCI as covariates. Consensus choice of final items depended on developmental trajectory, age of attainment, invariance, reliability and acceptability between countries. RESULTS: The IYCD has 100 developmental items (40 gross/fine motor, 30 expressive/receptive language/cognitive, 20 socio-emotional and 10 behavior). Items were acceptable, performed well in cognitive testing, had good developmental trajectories and high reliability across countries. Development for Age (DAZ) scores showed very good known-groups validity. CONCLUSIONS: The IYCD is a simple-to-use caregiver report tool enabling population level assessment of child development for children aged 0-3 years which performs well across three countries on three continents to provide reliable estimates of young children's developmental status.
Asunto(s)
Desarrollo Infantil , Brasil , Niño , Preescolar , Humanos , Lactante , Malaui , Pakistán , Reproducibilidad de los ResultadosRESUMEN
Design and evaluation of early child development (ECD) programs are poorly documented in low- or middle-income countries. The study aimed to identify family and child characteristics associated with developmental health outcomes among children aged from 4 to 6 years who participated in the "Primeira Infância Melhor" - PIM (Better Early Childhood), a home visiting program in Rio Grande do Sul State, Brazil. We also evaluated the impact of PIM on developmental vulnerability at school entry using a comparison group. Multistage sampling was first used to select cities, then families, in different regions of the state, resulting in a sample of eight cities and 571 children (364 PIM; 207 comparison). We used a sociodemographic questionnaire, completed by parents, and the Early Development Instrument (EDI), completed by teachers. Among PIM children, lower family income, time of exit from the program, city, and younger age were associated with higher risk of developmental vulnerability and/or with lower mean scores in EDI domains. Multivariate analysis controlling for covariates found no differences between the study groups in EDI outcomes even though the gaps in equity of the outcomes were smaller in the PIM group. These results are discussed in the context of challenges faced by home visiting programs in addressing complex social conditions of high-risk families and difficulties in finding an adequate comparison group in communities where an ECD program is universally accessible. We also note the importance of setting structured and longitudinal monitoring systems together with the implementation of ECD policies.
Asunto(s)
Desarrollo Infantil , Servicios de Salud del Niño/estadística & datos numéricos , Composición Familiar , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Factores de Edad , Brasil , Niño , Preescolar , Femenino , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Factores Sexuales , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Design and evaluation of early child development (ECD) programs are poorly documented in low- or middle-income countries. The study aimed to identify family and child characteristics associated with developmental health outcomes among children aged from 4 to 6 years who participated in the "Primeira Infância Melhor" - PIM (Better Early Childhood), a home visiting program in Rio Grande do Sul State, Brazil. We also evaluated the impact of PIM on developmental vulnerability at school entry using a comparison group. Multistage sampling was first used to select cities, then families, in different regions of the state, resulting in a sample of eight cities and 571 children (364 PIM; 207 comparison). We used a sociodemographic questionnaire, completed by parents, and the Early Development Instrument (EDI), completed by teachers. Among PIM children, lower family income, time of exit from the program, city, and younger age were associated with higher risk of developmental vulnerability and/or with lower mean scores in EDI domains. Multivariate analysis controlling for covariates found no differences between the study groups in EDI outcomes even though the gaps in equity of the outcomes were smaller in the PIM group. These results are discussed in the context of challenges faced by home visiting programs in addressing complex social conditions of high-risk families and difficulties in finding an adequate comparison group in communities where an ECD program is universally accessible. We also note the importance of setting structured and longitudinal monitoring systems together with the implementation of ECD policies.
O planejamento e avaliação de programas de desenvolvimento na primeira infância (DPI) são pouco documentados em países de renda baixa e média. O objetivo deste estudo foi identificar características familiares e infantis associadas a desfechos do saúde desenvolvimental em crianças com idade de 4 a 6 anos que participaram do Primeira Infância Melhor (PIM), um programa de visitas domiciliares do Estado do Rio Grande do Sul, Brasil. Também avaliamos o impacto do PIM na vulnerabilidade no desenvolvimento no início da escolarização usando um grupo de comparação. Uma amostragem multi-etapas foi usada inicialmente para selecionar cidades, depois famílias, em diferentes regiões do estado, resultando numa amostra de oito cidades e 571 crianças (364 PIM; 207 comparação). Usamos um questionário sociodemográfico, respondido pelos pais, e o Instrumento de Desenvolvimento na Primeira Infância (EDI, em inglês), respondido pelos professores. Dentre as crianças do PIM, renda familiar mais baixa, tempo de saída do programa, cidade e menor idade estava associados a um risco maior de vulnerabilidade no desenvolvimento e/ou escores médios mais baixos nos domínios do EDI. A análise multivariada controlada por covariáveis não encontrou diferenças entre os grupos do estudo em termos dos desfechos do EDI, a despeito de as lacunas na equidade dos desfechos serem menores no grupo PIM. Esses resultados são discutidos no contexto dos desafios que programas de visitas domiciliares enfrentam para fazer frente às condições sociais complexas de famílias de alto risco e as dificuldades para encontrar um grupo de comparação adequado em comunidades onde um programa de DPI é universalmente acessível. Também apontamos a importância de estabelecer sistemas de monitoramento estruturados e longitudinais em conjunto com a implementação de políticas de DPI.
El diseño y evaluación de los programas para la infancia temprana (PIT) se han documentado escasamente en países de ingresos medios o bajos. El estudio tuvo como objetivo identificar familias y características de niños, asociándolas con resultados en cuanto a la salud del desarrollo, con edades comprendidas entre 4 y 6 años de edad, que participaron en el programa "Primeira Infância Melhor" -PIM (Primera Infancia Mejor). Un programa de visitas a domicilio en el estado de Río Grande do Sul, Brasil. También se evaluó el impacto del PIM, en cuanto a la vulnerabilidad de su desarrollo tras entrar en la escuela, usando un grupo de comparación. En primer lugar, se utilizó un muestreo por etapas múltiples para seleccionar ciudades, luego familias en diferentes regiones del estado, dando como resultado una muestra de ocho ciudades y 571 niños (364 PIM; 207 en el grupo de comparación). Se usó un cuestionario sociodemográfico, cumplimentado por los padres, y el Instrumento de Desarrollo Temprano (EDI, en inglés), completado por los profesores. Niños en el PIM, en familias con ingresos bajos, tiempo desde su salida del programa, ciudad, y contar con menor edad, estuvieron asociados con un riesgo más alto respecto a la vulnerabilidad del desarrollo y/o con puntuaciones promedio más bajas en el ámbito del EDI. El análisis multivariado al realizar controles de las covariables no encontró diferencias entre los grupos de estudio en los resultados EDI, incluso a pesar de las brechas, respecto a la equidad de los resultados, que fueron más pequeñas en el grupo PIM. Estos resultados se discutieron en el contexto de los desafíos a los que se enfrentan los programas de visitas a hogares, dirigidos a familias en condiciones sociales complejas de alto riesgo y con dificultades para encontrar un grupo de comparación, adecuado en comunidades, donde un programa PIT fuera accesible universalmente. También resaltamos la importancia de establecer sistemas estructurados y longitudinales de supervisión junto a la implementación de políticas PIT.