Risk and protective factors for child development: An observational South African birth cohort
Risk and protective factors for child development: An observational South African birth cohort
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DOI：
10.1371/journal.pmed.1002920
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发表时间：
2019-09-01
期刊：
影响因子：
15.8
通讯作者：
Stein, Dan J.
中科院分区：
文献类型：
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作者：
Donald, Kirsten Ann;Wedderburn, Catherine J.;Stein, Dan J.
作者摘要 为什么要做这项研究？儿童早期的发展为终身学习奠定了基础。众所周知，儿童发展的风险和保护因素包括低收入和中等收入国家儿童成长所面临的许多问题。研究表明，男孩和女孩在影响发展的因素的影响方面存在差异，但尚未在撒哈拉以南非洲地区进行评估。研究人员做了什么并发现了什么？我们在南非西开普省 Drakenstein 儿童健康研究中对 734 名儿童的 2 岁儿童发育情况进行了评估。我们评估了从先前文献中确定的影响儿童发育的潜在风险和保护因素。我们发现了许多导致该队列儿童发育不良的重要风险因素。这些发现意味着什么？在高风险环境中，男孩似乎更有可能出现发育不良的风险。关键的保护因素包括母亲至少受过一定程度的中学教育、较好的家庭环境和健康的出生体重，关键的危险因素包括孕产妇妊娠期贫血、孕产妇健康状况不佳（如艾滋病毒）和孕产妇心理健康问题。儿童性别与关键保护因素和风险因素以及发育结果之间的关联相互作用。了解本研究中报告的因素的相关和相互作用的作用可以为综合干预政策的设计和实施提供信息，以支持高风险环境中的发展。背景低收入和中等收入国家 (LMIC) 中约有 2.5 亿 (43%) 5 岁以下儿童未能发挥其发展潜力。人们认识到风险因素会导致人类潜力的丧失。扩大对导致不良结果的风险以及哪些保护性因素有助于儿童复原力的了解可能对于改善差异至关重要。方法和结果 Drakenstein 儿童健康研究是在南非西开普省进行的一项基于人口的出生队列研究。 2012年至2015年期间，两个社区诊所招募了妊娠20至28周的孕妇；产前收集社会人口统计学和社会心理数据。母亲和孩子从出生到两岁都受到跟踪。发育评估由训练有素、不了解背景的评估员使用贝利 III 婴幼儿发育量表 (BSID-III) 进行，该量表经验证可在南非使用，适用于 24 个月大的婴儿。该研究评估了所有 24 个月大的儿童；然而，一些儿童由于无法跟进或没有照料者或适龄儿童而无法参加。在 1,143 名活产婴儿中，有 1,002 名在 24 个月时进行了随访，共有 734 名儿童（73%）接受了发育评估，其中 354 名（48.2%）是女孩。该样本的特点是家庭就业率低 (n = 183; 24.9%) 和家庭收入低 (n = 287; 39.1% 收入 1 个领域受到影响，75 人 (10.2%) 在所有领域都有延迟。双变量和多变量分析揭示了与发育结果相关的几个因素。其中包括保护性因素（母亲教育、较高的出生体重和社会经济地位）和危险因素（母亲妊娠期贫血、 抑郁症或终生亲密伴侣暴力以及孕产妇艾滋病毒感染）。男孩的表现始终比女孩差（认知 [beta = -0.74；95% CI -1.46 至 -0.03，p = 0.042]、接受性语言 [beta = -1.10；95% CI -1.70 至 -0.49，p < 0.001]、表达性语言 [beta = -1.65；95% CI -1.70 至 -0.49，p < 0.001]。 95% CI -2.46 至 -0.84，p < 0.001]，精细运动 [beta = -0.70； 95% CI -1.20 至 -0.20，p = 0.006] 尺度）。有证据表明，儿童性行为与风险和保护因素相互作用，包括出生体重、孕期母亲贫血和社会经济因素。该研究的重要局限性包括从出生到评估年龄的样本流失以及某些数据的缺失 评估的暴露区域。结论 这项研究提供了来自撒哈拉以南非洲地区的母子二人组样本的可靠发育数据。我们的研究结果不仅强调了母亲教育、出生体重和社会经济地位对发育结果的重要保护作用，而且还强调了发育结果的性别差异以及每个群体的关键风险和保护因素。
Author summaryWhy was this study done? Child development in early childhood lays a foundation for lifelong learning. Risk and protective factors for child development are known to include many issues faced by children growing up in low- and middle-income countries. Studies indicate a difference between boys and girls in terms of impact of factors influencing development, but these have not been evaluated in a sub-Saharan African context. What did the researchers do and find? We assessed child development at 2 years of 734 children in the Drakenstein Child Health Study, Western Cape, South Africa. We assessed potential risk and protective factors identified from prior literature to impact child development. We found a number of important risk factors that contributed to poor developmental outcomes in children in this cohort. What do these findings mean? Boys appear to be at higher risk of poor developmental performance in a high-risk environment. Key protective factors include mothers having at least some secondary school education, better home circumstances, and healthy birth weight, and key risk factors include maternal anaemia in pregnancy, poor maternal health (such as HIV), and maternal mental health problems. Child sex interacts with the associations between key protective and risk factors and developmental outcomes. Understanding the related and interacting roles of factors reported in this study may inform integrated intervention policy design and implementation for supporting development in high-risk environments.Background Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. Methods and findings The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning 1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [beta = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [beta = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [beta = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [beta = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. Conclusions This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads.Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.