Dose of early intervention treatment during children’s first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries
Year: 2014
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose. METHODS: Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates. RESULTS: Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose. CONCLUSIONS: Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.
Source: BMC Pediatrics
Institutions: University of California, Merced, University of Alabama at Birmingham, RTI International, Jawaharlal Nehru Medical College, University of Massachusetts Amherst, University of Zambia, Aga Khan University, University of South Carolina, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
Funders: RTI International, University of Alabama at Birmingham, University of South Carolina, University of Alabama, Children's of Alabama, National Institutes of Health, University of Massachusetts Amherst, Fogarty International Center, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: BRAIN Planning Grant for the Developing World, Global Network for Women's & Children's Health Research Data Coordinating Center, G2341531672, Heart Rate Detection during Resuucitation to Reduce Early Neonatal Mortality, AKU Global Network Research Unit, G3068323636, G3449974113, UMKC-JNMC Global Network for Women's and Children's Health Research Unit, G3712565336, G3809068359, Cooperative Multicenter Neonatal Research Network - UAB, Community-based interventions to reduce mortality from neonatal infection, G5358544041, G5843580888, G6277215235, G751055470, G75601068, G8724647457, NICHD Neonatal Research Network Clinical Center UAB, G910932832
OpenAlex ID: W1966707692