Nutritional, Socioeconomic, and Delivery Characteristics Are Associated with Neurodevelopment in Tanzanian Children - 17/12/18

Doi : 10.1016/j.jpeds.2018.10.066

Mia M. Blakstad, MSc ¹, Emily R. Smith, ScD, MPH ^1,², Analee Etheredge, PhD ², Lindsey M. Locks, ScD, MPH ³, Christine M. McDonald, ScD ⁴, Roland Kupka, ScD ⁵, Rodrick Kisenge, MBBS ⁶, Said Aboud, MD, PhD ⁷, David Bellinger, PhD, MSc ⁸, Christopher R. Sudfeld, ScD ¹, Wafaie W. Fawzi, MBBS, MPH, MS, DrPH ^1,^3,⁹, Karim Manji, MBBS, MMED, MPH ^6,^{*
Contributed equally.}, Christopher P. Duggan, MD, MPH ^1,^2,^3,^*^{*
Contributed equally.}
¹ Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
² Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
³ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
⁴ UCSF Benioff Children's Hospital Oakland Children's Hospital Oakland Research Institute, Oakland, CA
⁵ UNICEF Headquarters, New York, NY
⁶ Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
⁷ Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
⁸ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
⁹ Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA

^*Reprint requests: Christopher P. Duggan, MD, MPH, 333 Longwood Ave, LO-418, Boston, MA 02115.333 Longwood AveLO-418BostonMA02115

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 December 2018

Abstract

Objectives

To evaluate the hypothesis that various maternal, socioeconomic, delivery, and infant nutritional characteristics are associated with early childhood development in young Tanzanian children.

Study design

We performed a prospective cohort study among 206 HIV-exposed, uninfected and 247 HIV-unexposed Tanzanian infants who had been enrolled in 2 separate micronutrient trials (NCT00197730 and NCT00421668). Trained nurses administered culturally modified Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III), to evaluate cognitive, motor, and language development at 15 months of age. This analysis explored predictors of BSID-III z-scores using multivariable linear regression.

Results

Among maternal determinants, we found that low maternal height predicted all BSID-III domains in HIV-unexposed children; low maternal education predicted lower cognitive (standardized mean difference, -0.41; 95% CI, -0.74 to -0.08) and lower gross motor scores (standardized mean difference, -0.32; 95% CI, -0.61 to -0.04) in HIV-exposed children. Among delivery characteristics, facility delivery predicted higher cognitive scores (standardized mean difference, 1.36; 95% CI, 0.26-2.46); and oxytocin administration predicted lower fine motor scores (standardized mean difference, -0.48; 95% CI, -0.87 to -0.09) in HIV-exposed children. Higher length-for-age z-scores at 6 weeks of age predicted better cognitive (standardized mean difference, 0.15; 95% CI, 0.01-0.29) and expressive language scores (standardized mean difference, 0.16; 95% CI, 0.02-0.29) at 15 months in HIV-exposed infants.

Conclusions

This hypothesis-generating study found significant associations between nutritional status and health of the mother and child, and maternal educational attainment, with direct measures of early childhood development at 15 months of age. In addition, several aspects of delivery (facility birth and oxytocin administration) were associated with early childhood development. Future intervention trials should focus on modifiable maternal, infant, and obstetric factors to strengthen the evidence base concerning early childhood development.

Trial registration

ClinicalTrials.gov: NCT00197730 and NCT00421668.

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Keywords : early childhood development, prospective cohort, Bayley Scales of Infant and Toddler Development, 3rd edition, BSID-III

Abbreviations : BSID-III, LAZ, WAZ, WLZ

Plan

Methods

Results

Discussion

Supported by the National Institutes of Health (NICHD R01 HD048969-01, NICHD R01 HD043688-01, K24DK104676, and 2P30 DK040561) and the Aker Scholarship. C. D. serves on the Editorial Board of The Journal of Pediatrics. The study sponsors had no role in study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication. No financial incentive was given for producing this manuscript. Roland Kupka is a UNICEF staff member. The opinions and statements in this article are those of the author and may not reflect official UNICEF policies. The authors declare no conflicts of interest.