Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments.

OBJECTIVES: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN: Ecological time-series study. METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Association between persistent organic pollutants in human milk and the infant growth and development throughout the first year postpartum in a cohort from Rio de Janeiro, Brazil.

Persistent organic pollutants (POPs) are compounds that are recalcitrant and ubiquitous that bioaccumulate in human milk (HM) and can impact infant growth and development. We explore the association between POP concentration in HM at 2-50 days postpartum and infant growth and development trajectory throughout the first year of life. A cohort of 68 healthy adult Brazilian women and their infants were followed from 28 to 35 gestational weeks to 12 months postpartum. HM samples were collected between 2 and 50 days postpartum, and POP concentrations were analyzed using gas chromatography with mass spectrometry. Concentrations of POPs >limit of quantification (LOQ) were defined as presence, and concentrations ≤LOQ as an absence. Growth z-scores were analyzed according to WHO growth charts and infant development scores according to Age & Stages Questionnaires at 1 (n = 66), 6 (n = 50), and 12 months (n = 45). Linear mixed effects (LME) models were used to investigate the association of POPs in HM with infant growth and development. Benjamini-Hochberg (BH) correction for multiple testing was performed to reduce the false discovery ratio. P < 0.1 was considered for models with the interaction between POPs and time/sex. After BH correction, adjusted LME models with time interaction showed (1) a positive association between the presence of ß hexachlorocyclohexane and an increase in head circumference-for-age z-score (ß = 0.003, P = 0.095); (2) negative associations between total POPs (ß = -0.000002, P = 0.10), total organochlorine pesticides (ß = -0.000002, P = 0.10), and dichlorodiphenyldichloroethylene concentrations in HM (ß = -0.000002, P = 0.10) and fine motor scores. No statistical difference between the sexes was observed. Postnatal exposure to organochlorine pesticides in HM shows a positive association with the trajectory of head circumference-for-age z-score and a negative association with the trajectories of fine motor skills scores. Future studies on POP variation in HM at different postpartum times and their effect on infant growth and development should be encouraged.

Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico.

BACKGROUND: Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities. METHODS: Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth. RESULTS: Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (ß: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (ß: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (ß: -0.15, 95% CI: -0.36, 0.06). CONCLUSIONS: Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.

A Thousand Days-A programme for vulnerable early childhood in Argentina: Targeting, dropout risk factors and correlates of time to graduation.

BACKGROUND: Mil Días (A Thousand Days) is a programme for the first thousand days of life, from gestation to 2 years of age, targeted at highly vulnerable children and/or mothers and pregnant women. The programme was implemented in August 2015 in the municipality of San Miguel, in Argentina. Mil Días is designed in a holistic and intersectoral way. The main form of intervention is through home visits, but other benefits are available depending on the 51 vulnerability criteria by which participants are admitted to the programme, most of which are related to health issues. Exits of the programme occur when the mother and/or child have reversed the deprivation/s of the entrance-criteria. METHODS: This paper provides an analysis of the programme's primary data between August 2015 and May 2019, with a total of 1,111 programme participants. First, we perform a statistical analysis of the targeted population of the programme. Second, using a logistic regression, we study factors associated to the withdrawal from the programme. Third, using survival analysis, we study the correlates of time to graduation from the programme. RESULTS: We find that the programme is well-targeted, as participants exhibit higher deprivation levels than those exhibited by beneficiaries of social programmes in general in the same municipality. We also find that programme participants in situations of most extreme vulnerability are more likely to abandon the programme and that successful exits from the programme take longer for more complex cases. CONCLUSIONS: Mil Días-San Miguel is a programme for early childhood development in Argentina, which was pioneer when it was first introduced. It is well targeted and exhibits encouraging results despite complex cases taking longer to sucessfully exit the programme. In addition, the poorest poor participants are more likely to abandon the programme and so additional actions could be taken to retain them, as intended by the 'Leave No One Behind' 2030 commitment.

Maternal History of Adversity and Subsequent Mother-Child Interactions at Early Ages: A Systematic Review.

Adverse childhood experiences (ACEs) can negatively impact physical, emotional, cognitive, and social development, consequently affecting the next generation. The aim of the present study was to systematically review evidence from empirical studies on the association between maternal history of adversity in childhood (maltreatment and household dysfunction) and subsequent mother-child interactions at an early age. A search was performed in the PubMed, Web of Science, PsycINFO, EMBASE, Scopus, LILACS, and SciELO databases to identify studies, including measures of maternal childhood adversities and mother-child interaction, published between 2016 and 2022. Twenty-nine studies met the inclusion criteria. The results showed that in 90% of the studies, maternal childhood adversities negatively impacted subsequent mother-child interactions in early childhood, reducing maternal displays of affection, emotional availability, sensitivity, mother-child communication, and bonding. Biological factors (e.g., genetic and hormonal) and maternal emotional recognition moderated these associations. In addition, biological factors (i.e., neurobiological and hormonal) and psychosocial factors (e.g., depression, executive functioning, and violence) acted as mediators. Preventive interventions should be implemented to break out of the intergenerational cycle of violence that impacts mother-child interactions.

Validation of the Dominican system for measuring early childhood development.

Background: The purpose of the study was to determine the psychometric properties of the Dominican System for Measuring Early Childhood Development (SIMEDID, for its Spanish acronym), to adjust the sequence of item presentation, and to provide age-standardized norms for each item, to enable policy and program managers to make decisions based on specific and structured data. Methods: After approval from an ethics committee, a total of 948 children from 0 to 60 months participated in this study. Participants were evaluated on four early childhood development domains (gross motor, fine motor, language development, and socio-emotional development). The data were collected from November 2021 to February 2022, either at early childhood care centers or at home, using mobile devices that guided the evaluators through the screener. Data were later synced to a global database. Psychometric properties were calculated using Cronbach's alpha and split-half parallel reliability. For reorganizing item presentation and to obtain age-standardized norms, we conducted a logistic regression analysis for each item on dependent variable item success, and independent variable age. Results: The instrument showed excellent reliability and additional evidence of validity. The item presentation order was rearranged according to the probability of item success progression. In addition, the study characterized the expected evolution of item success probability across participants' age. Conclusions: SIMEDID is a valid and reliable instrument for depicting childhood development in national evaluations. Its integration with electronic platforms for national monitoring represents a cost-effective, time-efficient screening tool adapted to the Dominican sociocultural context. This represents a promising tool to strengthen strategies that support early childhood development.

Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy.

INTRODUCTION: Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development. METHODS: We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge. RESULTS: The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs. CONCLUSION: Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.

Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children.

Background. Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods. We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results. Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion. Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

Assessing the effect of an educational intervention on early childhood development among Mexican preschool children in the state of Oaxaca: a study protocol of a cluster randomized stepped-wedge trial.

BACKGROUND: Early childhood development (ECD) is essential in human capacity building and a critical element in the intergenerational process of human development. In some countries, social programs targeted at improving ECD have proven to be successful. Oaxaca is one of the States with the greatest social inequities in Mexico. Therefore, children in Oaxaca are at a high risk of suboptimal ECD. In 2014, the non-governmental organization (NGO) Un Kilo de Ayuda started to implement the Neurological and Psycho-affective Early Childhood Development Program in eighty marginalized communities of Oaxaca. In this article, we present the impact evaluation design to estimate the effect of this program on ECD. METHODS: We will use a cluster randomized stepped-wedge design with an allocation ratio of 1:1. Communities will be randomly assigned to each study group: four groups of twenty communities each. We expect that children from intervened communities will show better ECD outcomes. DISCUSSION: This study is one of the few rigorous assessments of the effect of an ECD program on the neurodevelopment of Mexican children recruited in their first 3 years of life from communities of high social vulnerability. Our study design is recommended when the way in which outcomes are measured and assessed depends on age, self-selection is present, and assignment is performed at an aggregate level. Implementation research will be conducted prior to study launch and quality control measures will be in place to maximize the fidelity of study design implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT04210362.

Adaptation of the INTERGROWTH-21st neurodevelopment assessment (INTER-NDA) to the context of the English-speaking Caribbean.

BACKGROUND: Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings. METHODS: We report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies. RESULTS: Eight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains. CONCLUSIONS: The current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings.

A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial.

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

El ensayo controlado aleatorizado analizó la eficacia de un un programa personalizado de parentalidad a distancia mediante feedback por vídeo dirigido a mejorar la parentalidad y el comportamiento de los niños. Se distribuyó aleatoriamente a 92 madres de niños de entre 2 y 6 años de edad en el grupo de intervención (n = 50) y un grupo control de lista de espera (n = 42). Para mejorar la parentalidad positiva se utilizó el programa preventivo Strengthening Bonds, en el que las madres participaron en una sesión de grupo presencial. Durante seis semanas recibieron por teléfono móvil feedback en vídeo personalizado sobre su interacción madre-hijo durante el juego. El resultado primario fue la conducta parental, y el resultado secundario la conducta del niño. Se llevaron a cabo mediciones preintervención y posintervención. El análisis de ecuaciones de estimación general no tuvo resultados significativos en los análisis por intención de tratar (AIT). En los análisis por protocolo (APP) hubo efectos significativos, reduciendo las prácticas parentales coercitivas de las madres y los problemas de conducta de los niños. El análisis de modelos de ecuaciones estructurales reveló que la disminución de los problemas de conducta de los niños producida por la intervención era mediada por la mejora en las prácticas coercitivas. La intervención tenía un efecto directo en la mejora del sentimiento de competencia parental. A pesar de la falta de resultados del AIT, el APP dio resultados prometedores en cuanto a la mejora de las conductas y creencias parentales positivas y en la reducción de los problemas de conducta de los niños.

Qualitative evaluation of a scalable early childhood parenting programme in rural Colombia.

BACKGROUND: Integrating early childhood parenting programmes into existing government services is a key strategy for reducing the loss of children's developmental potential in low- and middle-income countries. There is limited evidence of participants' perceptions of these programmes, especially when implemented at scale. We integrated an intervention into an existing government programme targeting pregnant women and mothers of children up to 2 years of age and their families in rural Colombia. METHODS: As part of a cluster randomized trial, 171 government workers (facilitators) implemented the intervention. The intervention included four components: (1) structured curricula, (2) play materials, (3) nutrition and (4) training and supervision. In this qualitative evaluation of the programme, we conducted semi-structured interviews with beneficiary mothers (n = 62), facilitators (n = 40) and supervisors (n = 8). Topic guides were developed to collect information on participants' perspectives of the acceptability, feasibility and effectiveness of the intervention and the enablers and barriers to implementation. All interviews were audiotaped and transcribed, and data were analysed using the framework approach. RESULTS: Participants' responses indicated that the intervention was acceptable, feasible and effective. Key enablers to implementation were (1) the use of evidence-based behaviour change techniques leading to interactive, fun and participatory sessions; (2) structured curricula with easy to use, simple activities and materials; (3) the focus on positive, supportive relationships; and (4) the perceived benefits of the programme to the beneficiary mothers, children and families, facilitators and programme supervisors. The main barriers were (1) facilitators took time to become comfortable and competent in using the new participatory methodology and (2) the logistics related to making and distributing the play materials. CONCLUSION: Providing structured curricula and play materials with training and ongoing supervision to enhance an existing programme targeting mothers, families and children was reported as acceptable, feasible and effective by beneficiary mothers and programme staff.

Determinants of the Early Childhood Development Index among children aged < 5 years in Bangladesh, Costa Rica and Ghana: a comparative study.

BACKGROUND: Early child development is a crucial factor for children that controls health and well-being in later life. AIMS: To determine the influence of sociodemographic factors on the Early Child Development Index (ECDI) among children aged < 5 years. METHODS: The analysis was performed using cross-sectional survey data from 2019, 2017-2018 and 2018 Multiple Indicator Cluster Surveys from Bangladesh, Ghana and Costa Rica, respectively. We used the χ2 test for bivariate analysis and binary logistic regression model for multivariate analysis for all 3 countries. All the statistical analyses were performed with IBM SPSS version 25 and R version 4.0.0. RESULTS: Child age and sex, followed by maternal education level, economic status, child nutritional status, reading children's books, and maternal functional difficulties had the greatest effect on ECDI. Children aged 36-47 months had lower odds of development than those aged 48-59 months, and boys had lower odds of development than girls in Bangladesh, Costa Rica and Ghana. Urban children had lower odds of development than rural children in Costa Rica but higher odds in Ghana. CONCLUSION: We recommend that governments should take the necessary steps to enhance children's early development and well-being in all 3 countries by raising education, improving economic conditions and providing balanced nutrition.

Diferenciales en desarrollo infantil temprano por edad de la madre, Encuesta Nacional de Niños, Niñas y Mujeres 2015 / Differentials in early childhood development by mother's age, National Survey of Girls, Boys and Women 2015

Resumen: Objetivo: Determinar el estado de salud, bienestar, desarrollo infantil temprano (DIT) de los niños y niñas menores de cinco años y su asociación con la edad de la madre. Material y métodos: Utilizando la Encuesta Nacional de Niños, Niñas y Mujeres 2015, se compararon características sociodemográficas e indicadores de bienestar, DIT, nutrición, salud y protección infantil por edad de la madre. Se ajustó un modelo de regresión logística para conocer las características asociadas con el DIT adecuado. Resultados: Los hijos/as de madres adolescentes presentan menores posibilidades de DIT adecuado. El apoyo al aprendizaje incrementa casi tres veces las posibilidades de desarrollo adecuado; ser hombre e hijo o hija de madres con sintomatología depresiva reduce estas posibilidades. Conclusiones: Es importante diseñar políticas públicas basadas en condiciones modificables focalizadas en apoyo al aprendizaje, prevención y atención de sintomatología depresiva para disminuir riesgos para el desarrollo e incrementar la atención a los hijos/as de madres en condiciones de desventaja.

Abstract: Objective: To determine under-5 children's state of health, well-being, Early Childhood Development (ECD) and its association with mother age. Materials and methods: Using the National Survey of Girls, Boys and Women (ENIM, in Spanish) 2015, we compared sociodemographic characteristics and indicators of well-being, child development, nutrition, health, and child protection by age of the mother. We adjusted a logistic regression model to know the characteristics associated with an appropriate early child development. Results: The children of adolescent mothers are less likely to have an adequate ECD. Children with support for learning are about three times more likely to develop properly, while being a boy or having a mother with depressive symptomatology reduces this likelihood. Conclusions: It is important to design public policies based on modifiable conditions focused on support for learning, prevention and care of depressive symptoms to reduce development risks and increase care for the children of mothers in disadvantaged conditions.

Differentials in early childhood development by mother's age, National Survey of Girls, Boys and Women 2015 / Diferenciales en desarrollo infantil temprano por edad de la madre, Encuesta Nacional de Niños, Niñas y Mujeres 2015.

Objective: To determine under-5 children's state of health, well-being, Early Childhood Development (ECD), and its association with mother's age. Materials and methods: Using the National Survey of Girls, Boys and Women (ENIM, in Spanish) 2015, we compared sociodemographic characteristics and indicators of well-being, child development, nutrition, health, and child protection by age of the mother. We adjusted a logistic regression model to know the characteristics associated with appropriate early child development. Results: The children of adolescent mothers are less likely to have an adequate ECD. Children with support for learning are about three times more likely to develop properly, while being a boy or having a mother with depressive symptomatology reduces this likelihood. Conclusions: It is important to design public policies based on modifiable conditions focused on support for learning, prevention, and care of depressive symptoms to reduce development risks and increase care for the children of mothers in disadvantaged conditions.

Household food insecurity and early childhood development in Brazil: an analysis of children under 2 years of age.

OBJECTIVE: To determine if household food insecurity (HFI) is associated with the risk of developmental delays. DESIGN: Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement Scale. Multivariable logistic regression was used to test the association between HFI (food secure/insecure) and risk of developmental delays, adjusting for household, maternal and child variables. SETTING: Community Health Centers in the Federal District, Brazil. PARTICIPANTS: 1004 children under 2 years old. RESULTS: Among participants, 15 % were at risk of developmental delays and about 40 % of children lived in food-insecure households. HFI was associated with the risk of developmental delays (adjusted OR 2·61; 95 % CI 1·42, 4·80) compared with food-secure households after adjusting for key confounders. CONCLUSIONS: HFI was strongly associated with the risk of developmental delays in children under 2 years. Investments that prevent or mitigate HFI are likely to be key for improved human and national development.

Reaching Thousands of Children in Low Income Communities With High-Quality ECED Services: A Journey of Perseverance and Creativity.

This paper describes a creative and bold way in which a local NGO addressed increasing access and quality of ECED services in Colombia. This case study on Fundacion Carulla's aeioTU early childhood innovation in Colombia contributes to understanding the possibilities for the private sector to spark innovation, and the importance of an open and collaborative strategy in contributing to the ECED sector at large. The critical role of monitoring and evaluation in the provision of services is highlighted. This guided key decisions on different growth phases. After a decade of work, Fundacion Carulla-aeioTU has shown capacity to effectively support children's development in low-income settings through their participation in quality programming. Furthermore, this case study also describes how the organization, having proven its capacity to provide high-quality services directly to children, decided to innovate and bring about different solutions to reach and support other stakeholders in the early childhood development ecosystem.