Estimates of a multidimensional index of nurturing care in the next 1000 days of life for children in low-income and middle-income countries: a modelling study
Estimates of a multidimensional index of nurturing care in the next 1000 days of life for children in low-income and middle-income countries: a modelling study
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DOI：
10.1016/s2352-4642(22)00076-1
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发表时间：
2022-05-01
影响因子：
36.4
通讯作者：
Waldman, Marcus
中科院分区：
文献类型：
--
作者：
McCoy, Dana Charles;Seiden, Jonathan;Waldman, Marcus
背景在学前教育阶段或生命的未来1000天，养育护理对儿童的持续发展至关重要。我们产生了具有全国代表性的患病率估计获得10个基本指标的养育照顾3-4岁的儿童在低收入和中等收入国家（LMICs）。方法我们采用多重插补和预测模型的数据，生活在LMICs的儿童。10项指标的个人数据来自儿童基金会的多指标类集调查和人口健康调查方案，我们纳入了36至59个月的所有儿童的数据，调查询问了他们关于养育子女和儿童发展的相关问题。我们将最低限度的适当护理定义为在养育护理的五个维度中的每一个维度中至少获得两个指标中的一个：响应式养育，早期学习，安全和保障，营养和健康。我们使用了两步多水平多重插补程序来解决个体、指标和国家之间的缺失数据。使用插补数据集，我们生成了一组预期的后验估计值，用于估计每个国家、国家收入分组和地区以及所有中低收入国家接受每项养育护理指标的儿童的百分比和总数，以及整体最低限度的适当护理。对于54个国家的所有指标的个人层面的数据，我们还产生了亚组估计的基础上，家庭财富，儿童性别，和urbanicity.Findings养育护理我们包括2005年和2019年之间收集的426349名3-4岁的儿童在104个低收入国家的个人层面的数据。在我们的建模中考虑的137个LMIC中，我们估计有6200万（90%可信区间[CrI] 51.6-71.7）3-4岁儿童，相当于25.4%（90% CrI 21.2- 29.4），在评估时接受最低限度的适当养育，使1.819亿人（1.722 - 1.923亿人）得不到适当的照顾。获得保健的最高是营养（86.2% [84.2- 88.2]，或2.103亿[205.4-215.1]，体重健康），早期学习最低（29.3% [21.5-39.6]，即7 150万人[52.5-96.6]，在幼儿保育和教育方面），（29.7% [25.6-34.9]，或7240万[62.4-85.0]，经历了来自非产妇照顾者的充分刺激），以及安全和保障（32.3% [28.3-36.7]，或78. 700万人[68.9-89.5]，生活在没有体罚的情况下）。估计数中的差距很明显，中上收入国家50.8%（38.3- 60.7）的儿童获得最低限度的适当护理，而低收入国家为5.6%（4.8-6.4）。在拥有完整儿童层面数据的54个国家中，财富最低的五分之一家庭中有10.7%（10.4-10.9）的儿童获得了最低限度的适当照料，而财富最高的五分之一家庭中这一比例为41.2%（40.7- 41.7）。城市化程度的不平等也很大（农村为17.7% [17.5-18.0]，城市为32.2% [31.8-32.6]），但按性别分列的比例较小（23.9% [ 23.6-24.2]女孩对22.1% [21.9-22.4]男孩）。日期间。需要进一步投资于学龄前儿童的指标衡量和资源，特别是低收入人口，以及在响应性教育、早期学习以及安全和安保领域。版权所有（C）2022由Elsevier Ltd.发布。保留所有权利。
Background Nurturing care is crucial for children's ongoing development during the pre-primary education period, or the next 1000 days of life. We generated nationally representative prevalence estimates of access to ten basic indicators of nurturing care among children aged 3-4 years in low-income and middle-income countries (LMICs).Methods We applied multiple imputation and predictive modelling to data on children living in LMICs. Individuallevel data on ten indicators were from UNICEF's Multiple Indicator Cluster Surveys and the Demographic Health Surveys Program, and we included data on all children aged 36 to 59 months for whom the surveys asked relevant questions on parenting and child development. We defined minimally adequate care as receiving at least one of two indicators in each of five dimensions of nurturing care: responsive caregiving, early learning, safety and security, nutrition, and health. We used a two-step multi-level multiple imputation procedure to address missing data across individuals, indicators, and countries. Using imputed datasets, we generated a set of expected-a-posteriori estimates of the percentage and overall number of children receiving each indicator of nurturing care, as well as overall minimally adequate care, for each country, country income grouping, and region, and across all LMICs. For the 54 countries with individual-level data on all indicators, we also produced subgroup estimates of nurturing care on the basis of household wealth, child sex, and urbanicity.Findings We included individual-level data collected between 2005 and 2019 on 426 349 children aged 3-4 years in 104 LMICs. Across the 137 LMICs considered in our modelling, we estimated that 62.0 million (90% credible interval [CrI] 51.6-71.7) children aged 3-4 years, equivalent to 25.4% (90% CrI 21.2-29 .4) of that age group in LMICs, were receiving minimally adequate nurturing care at the time of assessment, leaving 181.9 million (172.2-192 .3) without adequate care. Access to care was highest for nutrition (86.2% [84.2-88 .2], or 210.3 million [205.4-215.1], with healthy weight), and lowest for early learning ( 29.3% [21.5-39.6], or 71.5 million [52.5-96.6], in early childhood care and education), responsive caregiving (29.7% [25.6-34.9], or 72.4 million [62.4-85.0], experiencing adequate stimulation from non-maternal caregivers), and safety and security (32.3% [28.3-36.7], or 78. 7 million [68.9-89.5], living without physical punishment). Gaps were evident in the estimates, with 50.8% (38.3- 60.7) of children from upper middle-income countries receiving minimally adequate care compared with 5.6% (4.8-6.4) in low-income countries. Within 54 countries with complete child-level data, 10.7% (10.4-10.9) of children from households in the lowest wealth quintile had access to minimally adequate care compared with 41.2% (40.7- 41.7) in the highest quintile. Inequalities were also large by urbanicity (17.7% [17.5-18.0] rural vs 32.2% [31.8-32.6] urban) but smaller by child sex (23.9% [ 23.6-24.2] girls vs 22.1% [21.9-22.4] boys).Interpretation Most children in LMICs are not receiving minimally adequate nurturing care during the next 1000-day period. Further investments in indicator measurement and resources for preschool-age children are needed, particularly for low-income populations and in the domains of responsive caregiving, early learning, and safety and security. Copyright (C) 2022 Published by Elsevier Ltd. All rights reserved.