Databases searched were MEDLINE (PubMed), Embase, Psych Info, the Cochrane Review, the Educational Resources Information Center (ERIC), the World Health Organization, the World Bank and the International Bureau of Education for UNESCO (United Nations Educational, Scientific and Cultural Organization), SIGLE (grey literature from Europe), LILACS (Latin American and Caribbean Health Services), and UNICEF. The UNICEF and World Bank databases were searched and queries were sent to
SeriesStrategies to avoid the loss of developmental potential in more than 200 million children in the developing world
Introduction
This is the third paper in a series that addresses the lost developmental, educational, and economic potential of more than 200 million children under the age of 5 years in developing countries.1 The second paper identified risks with the strongest evidence base and highest prevalence as stunting, iodine and iron deficiencies, and inadequate cognitive and social-emotional stimulation.2 Less well-documented, but with consistent epidemiological evidence, are risks related to social conditions (maternal depression and violence), environmental factors (lead and arsenic), and some infectious diseases (malaria and HIV). Risk factors often co-occur and interfere with children's development, thereby contributing to a trajectory that includes poor health, lack of readiness for school, poor academic performance, inadequate preparation for economic opportunities, and perpetuation of the intergenerational cycle of poverty.
This paper examines the effectiveness of intervention programmes in developing countries. Based on the recommendations from earlier papers in this series,1, 2 we assess programmes that promote child development through preventing or ameliorating the effects of stunting, iodine deficiency, iron deficiency anaemia, and inadequate stimulation. We also identify examples of interventions to reduce the effects of social, environmental, and infectious risks. We include only evaluations that report cognitive or social-emotional outcomes.
Child development refers to the ordered emergence of interdependent skills of sensori-motor, cognitive-language, and social-emotional functioning (figure 1). Early child development programmes3 are designed to improve the survival, growth, and development of young children, prevent the occurrence of risks, and ameliorate the negative effects of risks. Most are directed toward disadvantaged children. Some programmes work directly with children through improved services such as growth monitoring, early child-care centres, or improved hygiene or health services; others work with parents to improve their parenting skills and resources, through home visits, group sessions, or communication for behaviour change.
Awareness of child development is increasing in developing countries. The health sector has advocated for early child development programmes for children with low birthweight,4 developmental delays,5 and from low-income disadvantaged environments.6, 7, 8 Child development information is often incorporated into growth monitoring charts. Government-supported preschool programmes for children are increasing; in the past 15 years, at least 13 developing countries have instituted compulsory preschool or pre-primary programmes.9 By 2005, the World Bank had financed loans to 52 developing countries for child development programmes, for a total of US$1680 million, at least 30 developing countries had policies on early child development,10 and UNICEF was assisting governments in supporting parenting programmes in 60 countries.10 Despite this interest, there have been few systematic evaluations of early child development programmes in developing countries.
Section snippets
Improving food intake and reducing stunting
Both efficacy trials and programme evaluations have shown that improving the diets of pregnant women, infants, and toddlers can prevent stunting11, 12 and result in better motor and mental development.2, 13, 14 Food supplementation during the first 2–3 years of life improves cognition at 3 years of age and beyond.13, 15 One trial showed an improvement in motor development with exclusive breastfeeding.16 The longest follow-up duration is from Guatemala, where supplementation before age 3 years
Social risks
There have been few evaluations of social protection interventions designed to mitigate the effects of social risks (eg, maternal depression, exposure to domestic and community violence, and stigma and loss due to HIV/AIDS) on children from developing countries. Women in developing countries have high rates of stress and depressive symptoms,86, 87 often associated with poverty, lack of support, and negative life events. Children of depressed mothers are at risk for poor development, in part
Future directions and crucial issues
In the final section we discuss priorities for improving the development of the 200 million children younger than 5 years at risk for cognitive and social-emotional deficits.
Conclusion
Effective interventions are available to reduce the developmental loss currently estimated to affect more than 200 million children under 5 years of age in developing countries, by promoting child development and preventing or ameliorating developmental loss. The most effective interventions are comprehensive programmes for younger and disadvantaged children and families that are of adequate duration, intensity, quality, and are integrated with health and nutrition services. Providing services
Search strategy
References (130)
- et al.
Developmental potential in the first 5 years for children in developing countries
Lancet
(2007) - et al.
Child development: risk factors for adverse outcomes in developing countries
Lancet
(2007) - et al.
Age differences in the impact of nutritional supplementation on growth
J Nutr
(1995) - et al.
Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras
J Nutr
(2001) - et al.
Conditional cash transfers are associated with a small reduction in the rate of weight gain of preschool children in northeast Brazil
J Nutr
(2004) - et al.
Iron-biofortified rice improves the iron stores of nonanemic Filipino women
J Nutr
(2005) Iron fortification technology development: new approaches
J Nutr
(2006)- et al.
Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants
Am J Clin Nutr
(2005) - et al.
Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras
J Nutr
(2002) - et al.
Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial
Lancet
(2006)
Early malnutrition and “late” adoption: a study of their effects on the development of Korean orphans adopted into American families
Am J Clin Nutr
Evaluation of an early childhood preschool programme in rural Bangladesh
Early Childhood Res Q
Early childhood development interventions and cognitive development of young children in rural Vietnam
J Nutr
Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition
Am J Clin Nutr
Long-term effects of early intervention: Turkish low-income mothers and children
J Appl Dev Psychol
Psychosocial stimulation improves the development of undernourished children in rural Bangladesh
J Nutr
Preschool experience in 10 countries: cognitive and language performance at age 7
Early Child Res Q
Linear growth retardation and cognition
Lancet
Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study
Lancet
Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial
Lancet
Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan
J Psychosom Res
Effectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled trial
Lancet
The role of care in nutrition programmes: current research and a research agenda
Proc Nutr Soc
Low birth-weight infants and the importance of early intervention: enhancing mother-infant interactions. A literature review
Br J Dev Disab
Impact of home-centre based training programme in reducing developmental deficiencies of disadvantaged children
Indian J Disab Rehab
Early childhood development in deprived urban settlements
Indian Pediatr
Early stimulation of infants with risks for development
Psychol Studies
Environmental influences on human brain growth and development
J Prenat Perinat Psychol Health
EFA Global monitoring report 2005 Education for all: the Quality Imperitive
2005 Global thematic report: integrated early child development
What works and what really works? A review of the efficacy and effectiveness of nutrition interventions
Public Health Nutrition
Early supplementary feeding and cognition: effects over two decades
Monogr Soc Res Child Dev
Evaluating preschool programs when length of exposure to the program varies: A nonparametric approach
Rev Econ Stats
Effects of early childhood supplementation on the educational achievement of women
Pediatr
The impact of an experimental nutritional intervention in childhood on education among Guatemalan adults. Food and Nutrition Division Discussion Paper 207, June, 2006, International Food Policy Research Institute, Washington DC
The medium term impact of Oportunidades on child growth and development in rural areas of Mexico
Programme evaluation with unobserved heterogeneity and selective implementation: The Mexican PROGRESA impact on child nutrition
Oxf Bull Econ Stats
The impact of PROGRESA on food consumption
Econ Devel Cult Change
Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy
Pediatr
Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods
Am J Clin Nutr
Community-based dietary phytate reduction and its effect on iron status in Malawian children
Ann Trop Paediatr
Controlling iron deficiency anemia through the use of home-fortified complementary foods
Indian J Pediatr
The effect of iron therapy on the growth of iron-replete and iron-deplete children
J Trop Pediatr
From early child development to human development
Responsive parenting: Establishing early foundations for social, communication, and independent problem-solving skills
Developmental Psychology
Skill formation and the economics of investing in disadvantaged children
Science
The effect of pre-primary education on primary school performance
Salivary cortisol levels in children adopted from Romanian orphanages
Dev Psychopathol
Neuroscience perspectives on disparities in school readiness and cognitive achievement
Future Child
An event-related potential study of the impact of institutional rearing on face recognition
Dev Psychopathol
Cited by (761)
Evaluation of genomic factors and early childhood stimulation on intelligence in children from a Brazilian birth cohort: The primary role of independent factors
2024, Progress in Neuro-Psychopharmacology and Biological PsychiatryA meta-analytic review of the implementation characteristics in parenting interventions to promote early child development
2024, Annals of the New York Academy of Sciences