Measuring Contextual Influences on Early Child Development Patricia Kariger April 17, 2014 Investing in Young Child Children Globally
Wednesday, April 16, 2014
Measuring Contextual Influences on Early Child Development
Patricia KarigerApril 17, 2014
Investing in Young Child Children Globally
Contextual Influences on Early DevelopmentContextual Influences on Early Development
KARIGER: Talking points for presentation: Measuring Contextual Influences on Early Child Development
Slide 1: Graphic of environmental influences on ECD. Child development results from interactions between the child, and the child’s environments, over time. Environments refer to those which are immediate and proximal to the child (such as family and community environments, including schools, health providers, religious or spiritual centers, etc.) as well as those which are more distal, such as state and national policies and governance; regional unions (EU, African Union), and global doctrines agreed to by the country (such as UN Convention on the Rights of the Child).
Contextual Influences on Early Development
FamilyCommunity
State
Nation/Region
World
Slide 2: Graphic of environmental influences on ECD by sector, across environments. Various evidence-based policies, programs and services are implemented across these levels of the environment to support early child development, although few, if any, are implemented at a global level. None are implemented consistently across countries, but some common sectors that include provisions to benefit early child development include: economic investments in strengthening household capacities to support families, especially in times of need; legal policies to ensure rights of the child and ensure protection to families and children; promotion of health and nutrition services for pregnant women, families and young children; education and ECD programs; other social welfare services to support women and families with young children.
Contextual Influences on Early Development
Family Community State Nation/Region World
Econo
mic Sup
ports
/
Protec
tions
Social and Child Protection
Health and Nutrition ServicesEducation and Care Services
Judicial Protectio
n
Social Welfare Services
Slides 3-5: Brief summary graphic (table?) of ECD indicators widely used by agency, that map on to sectors presented in previous slides. Many existing indicators of early child development are collected at various levels, across countries, but not consistently. That is: not all are collected across countries, and not all use the same definition (for example, poverty is not well-defined). This can be used to point out gaps.
Slides 6-12: Gaps in measurement of ECD factors that may benefit promoting/investing in child development-related policies (recognizing these may vary across countries):
6. How to measure responsive parenting (including responsive feeding) in 0-8 years
Adapted from Bronfenbrenner, 1986
International Declarations
Policies, Investments
Capacities, Implementation
Local Institutions
Relationships, Resources
Wednesday, April 16, 2014
Contextual Influences on Early DevelopmentContextual Influences on Early Development
Family Community State Nation/Region World
Econo
mic Sup
ports
/
Protec
tions
Social and Child Protection
Health and Nutrition ServicesEducation and Care Services
Judicial Protectio
n
Social Welfare Services
Wednesday, April 16, 2014
Engle et al, 2007 The Lancet
•Development is influenced by both biological and environmental risk factors. Environmental risks include:• Socio-cultural factors: gender inequity, low levels of maternal education• Psychosocial risks: parenting factors, maternal health, household
environment (from Walker et al 2007; 2011, The Lancet)
Early child development Promote child development
Prevent risks Ameliorate negative e!ects of risks
Poverty
Biological risk factors
Psychosocial risk factors
Child development
School performance
Economic performance
Intergenerational transmission
CNS development and function
Sensori-motor
Cognition-language
Social-emotional
Figure !: Conceptual model of how interventions can a!ect early child development
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.
Early child development programmes Improving food intake and reducing stunting Both e!cacy 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 showed benefi cial e"ects on schooling, reading, and intelligence tests during adulthood (25–42 years).17
Conditional cash transfers provide funds dependant on behaviour, such as participation in nutrition monitoring and supplementation programmes.18 Evidence from a conditional cash transfer programme in Mexico for more than 20 million people showed that transfers to women plus direct nutritional supplements for young children and nutrition education19 were associated with children’s improved growth and motor development.18,20 Conversely, analysis of such a transfer programme in Brazil noted that recipient children grew slower than non-recipients, perhaps because families feared that benefits would be discontinued if their child grew well.21
Reducing iodine and iron defi ciencies Assessments of e!cacy trials and programmes of iodine interventions provide conclusive evidence of a signifi cant e"ect on cognition and behaviour.2 Salt iodisation remains the most cost-e" ective way of delivering iodine and of substantially improving cognition. At least 30
developing countries have reached the 2005 goal of sustainable elimination of iodine defi ciency through universal salt iodisation:10 69% of households consume iodised salt, with rates of 86% in Latin America, 85% in east Asia, but only 47% in central Europe and central Asia.10
Iron deficiency anaemia impedes child development.2
Detrimental e"ects in infants and toddlers might not be readily reversed by iron therapy, suggesting the need for a preventive approach.22 Iron supplementation to prevent anaemia in young children has positive e" ects on motor, social-emotional, and language development.2 Inno-vations for iron supplementation include: micro encap-sulated ferrous fumarate plus ascorbic acid supplied as sprinkles added to complementary foods;23 growing plant varieties with higher iron content;24 removing phytates from plants that inhibit iron absorption; soaking maize flour in excess water with phytase and decanting the water before cooking the fl our;25 and new iron fortifi cation methods that eliminate aftertaste, reduce risk of excess intake, and maintain bioavailability.26,27 These approaches are promising for the reduction of iron defi ciency and anaemia in young children.26,27 A 6-month trial in South Africa assessed the e"ect of iron and other micronutrient-fortified maize porridge on infant development and reported better motor development in the fortifi ed porridge group than the non-fortifi ed group.28
Concerns have been raised about giving iron supple-ments to iron replete infants, eg, decreased linear growth29,30 or increased hospitalisations and death in a malarial region.31 These issues should be studied further and need to be considered in public health programming.
Stimulation combined with nutrition and health programmes Stimulation occurs through responsive and increasingly complex developmentally appropriate interactions (matched to the child’s emerging abilities) between caregivers and children that enhance child develop-ment.32,33 Both cognitive and social-emotional skills provide the basis for later academic and employment success1,34,35
Inadequate stimulation and interactions can a" ect child development through disrupting basic neural circuitry. Neural disruptions are measured through stress hormones,36 brain images,37 and event-related potentials.38
Early stimulation may enhance neurocognitive processing and brain functioning, particularly for premature infants.39
The e"ects of early stimulation are also evident in the dramatic improvements in child development in undernourished, institution-raised children adopted into middle-class homes. A study of Korean girls adopted into middle-class families illustrates the synergistic e" ects of malnutrition and environmental deprivation on children’s intelligence.40,41 IQ scores of children adopted after 2 years of age and with a history of malnutrition scored worse than equally malnourished children adopted at less than age 2 years (figure 2), but both were close to average.
Socio-culturalfactors
Conceptual Model: Risk and Development
Cumulative Environmental Risk and Cognitive Development at Age 4
Sameroff et al 1993
WPPSI125
Raw Scores ~Q- Adjust for Covariate
FIG. 5.-risk groups.
0 1 2 3 4 5 6 7-8Multiple Risk Score
-Mean 4-year TQ scores, and means adjusted for covariation of mother TQ, within multiple
125
120
115
110
105
100
95
90
85
80
75
FIG. 6.risk groups.
WISC-R
-.iji • ^
\ \ h -
""̂ K~ Raw Scores ~D" Adjust for Covariate
\ . s z'
1 \ 1 1—6 7-90 1 2 3 4 5
Multiple Risk Score-Mean T3-year TQ scores, and means adjusted for covariation of mother TQ, within multiple
91
Engle et al, 2007 The Lancet
Early child development Promote child development
Prevent risks Ameliorate negative e!ects of risks
Poverty
Biological risk factors
Psychosocial risk factors
Child development
School performance
Economic performance
Intergenerational transmission
CNS development and function
Sensori-motor
Cognition-language
Social-emotional
Figure !: Conceptual model of how interventions can a!ect early child development
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.
Early child development programmes Improving food intake and reducing stunting Both e!cacy 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 showed benefi cial e"ects on schooling, reading, and intelligence tests during adulthood (25–42 years).17
Conditional cash transfers provide funds dependant on behaviour, such as participation in nutrition monitoring and supplementation programmes.18 Evidence from a conditional cash transfer programme in Mexico for more than 20 million people showed that transfers to women plus direct nutritional supplements for young children and nutrition education19 were associated with children’s improved growth and motor development.18,20 Conversely, analysis of such a transfer programme in Brazil noted that recipient children grew slower than non-recipients, perhaps because families feared that benefits would be discontinued if their child grew well.21
Reducing iodine and iron defi ciencies Assessments of e!cacy trials and programmes of iodine interventions provide conclusive evidence of a signifi cant e"ect on cognition and behaviour.2 Salt iodisation remains the most cost-e" ective way of delivering iodine and of substantially improving cognition. At least 30
developing countries have reached the 2005 goal of sustainable elimination of iodine defi ciency through universal salt iodisation:10 69% of households consume iodised salt, with rates of 86% in Latin America, 85% in east Asia, but only 47% in central Europe and central Asia.10
Iron deficiency anaemia impedes child development.2
Detrimental e"ects in infants and toddlers might not be readily reversed by iron therapy, suggesting the need for a preventive approach.22 Iron supplementation to prevent anaemia in young children has positive e" ects on motor, social-emotional, and language development.2 Inno-vations for iron supplementation include: micro encap-sulated ferrous fumarate plus ascorbic acid supplied as sprinkles added to complementary foods;23 growing plant varieties with higher iron content;24 removing phytates from plants that inhibit iron absorption; soaking maize flour in excess water with phytase and decanting the water before cooking the fl our;25 and new iron fortifi cation methods that eliminate aftertaste, reduce risk of excess intake, and maintain bioavailability.26,27 These approaches are promising for the reduction of iron defi ciency and anaemia in young children.26,27 A 6-month trial in South Africa assessed the e"ect of iron and other micronutrient-fortified maize porridge on infant development and reported better motor development in the fortifi ed porridge group than the non-fortifi ed group.28
Concerns have been raised about giving iron supple-ments to iron replete infants, eg, decreased linear growth29,30 or increased hospitalisations and death in a malarial region.31 These issues should be studied further and need to be considered in public health programming.
Stimulation combined with nutrition and health programmes Stimulation occurs through responsive and increasingly complex developmentally appropriate interactions (matched to the child’s emerging abilities) between caregivers and children that enhance child develop-ment.32,33 Both cognitive and social-emotional skills provide the basis for later academic and employment success1,34,35
Inadequate stimulation and interactions can a" ect child development through disrupting basic neural circuitry. Neural disruptions are measured through stress hormones,36 brain images,37 and event-related potentials.38
Early stimulation may enhance neurocognitive processing and brain functioning, particularly for premature infants.39
The e"ects of early stimulation are also evident in the dramatic improvements in child development in undernourished, institution-raised children adopted into middle-class homes. A study of Korean girls adopted into middle-class families illustrates the synergistic e" ects of malnutrition and environmental deprivation on children’s intelligence.40,41 IQ scores of children adopted after 2 years of age and with a history of malnutrition scored worse than equally malnourished children adopted at less than age 2 years (figure 2), but both were close to average.
Socio-culturalfactors
•Early interventions can help children reach their potential by preventing risks, and by ameliorating the effects of risks
Conceptual Model: Risk and Development
Early interventions: Promote development Prevent risks Ameliorate effects of risks
Global Environmental Risks: What the Evidence Tells Us
• Studies reviewed in Walker et al (2007; 2011), The Lancet
• Key risk factors prioritized were those which:
• Are widely prevalent in the lives of children 0-5 years in low- and middle-income countries
• Affect child developmental outcomes (cognition, language, etc.)
• Are modifiable with interventions
• Environmental, contextual or psychosocial risk factors include:
• Lack of cognitive stimulation/support for learning
• Maternal depression
• Exposure to violence
• Institutionalization
Why Develop Indicators to Assess Children, Family and Environment?
• Population-level measures of children and their environments will:
• Help nations prioritize investment in various sectors
• Help nations evaluate programs and services
• Allow comparisons of families and environments across countries and regions
• Help provide a more complete picture of young children’s lives
• Population-level measures of children and their environments are feasible:
• Indices or items can be added to existing surveys administered to parents, teachers or government officials
Criteria for Indicators
• It’s imperative to use well-defined, evidence-based, reliable and valid indicators that are also:
• Universally meaningful
• Easy to measure and interpret
• Malleable; capable of showing change
• Able to be addressed by programs or services
• Presented in a format easily understood by stakeholders who can effect change
Which Indicators Currently Exist?Overview of Existing Indicators
• What indicators currently exist?
United Nations!"#$%&'()%*+,-$'.)&'/$,%)"
Cultural Organization
Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index
The Review of Care, Education and
Child Development Indicators in Early Childhood
United Nations
Cultural Organization
Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index
The Review of Health and Nutrition Indicators
in Early Childhood
United Nations
Cultural Organization
Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index
The Review of Policy and Planning Indicators
in Early Childhood
United Nations
Cultural Organization
Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index
The Review of Legal Protection Indicators
in Early Childhood
United Nations
Cultural Organization
Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index
The Review of Social Protection Indicators
in Early Childhood
Wednesday, April 16, 2014
http://www.unesco.org/new/en/education/themes/strengthening-education-systems/early-childhood/monitoring-and-evaluation/holistic-ecdindex/
Examples of Indicators Used by Organizations
USAID UNICEF UNESCO WHOPoverty/Wealth Index X X X
Child Protection X X XMaternal DepressionEducation/Early Care X X XEarly Development X X
Institutionalized Children?
Exposure to Violence?Household Support
for Learning X
Child Health/Nutrition X X X X
Measurement Across Indicators by AgeImportant to Measure Comprehensively
Household Support for Learning
Birth Age 8
Proximal
Distal
Health and Nutrition
Age 4
Maternal Caregiving Practices (Health & Nutrition)
Education and Care Services
Language/Cognitive/Social-emotional Development
Social Protection
Poverty Alleviation
Thursday, April 17, 2014
How Can Measurement be Improved?
• More comprehensive measurement of children across 0-8 years
• Measures on responsive parenting spanning age range, including responsive feeding and support for early primary students
• Understanding the quality of care provided by multiple caregivers or home-based care providers
How Can Measurement be Improved?
• Screening for specific disabilities
• Institutionalized children
• Maternal depression
• Monitoring exposure to domestic violence, abuse, community violence and war/unrest
• Efforts to link measures and indicators across sectors
Recent Advancements and Efforts to Improve Measurement of Early Indicators
• UNESCO’s Holistic Early Child Development Index
• USAID’s Center on Children in Adversity
• Guide for Monitoring Child Development. I. Ertem; B. Forsyth. Turkey, India, South Africa, Argentina.
• Malawi Development Assessment Tool. M. Gladstone et al. Malawi, Mali, The Gambia, Burkina Faso.
• Developmental Milestones Checklist. A. Abu-Bakar et al. Kenya, West Africa.
• Global Child Development Group. Exploring creation of 0-3 child development tool.