Investigation of a new sequential multiple hit model to examine risk and resilience in a prospective longitudinal cohort of children in Ghana

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Project Summary An estimated 250 million children under five years of age in low- and middle-income countries (LMICs) are at risk of failing to reach their potential in cognitive and social-emotional development because of poverty- related risk factors. The long-term goal of this proposal is to inform evidence-based programs and policies to support children in low-income communities to grow and develop to their full potential. While many studies of risk and resilience in developmental science have focused on singular or a small number of risk and protective factors and time points, development is a dynamic system, and children often contend with constellations of risks that can change over time and interact with each other, rather than isolated instances of adverse circumstances. Challenges for studying these questions about the timing and interactions of risk and protective factors predicting developmental outcomes are the large sample size required and the high cost and human resource investment necessary to collect longitudinal data. This proposal is to conduct secondary analysis of existing data collected during pregnancy, infancy, and childhood from the sample enrolled in the International Lipid-Based Nutrient Supplements Project in Ghana 2009-2012 at ≤ 20 weeks of gestation (n=1320). The dataset contains more than 30 indicators of biological risks (such as low birth weight, premature delivery, growth stunting, and anemia) and psychosocial risks (such as maternal depression and lack of learning opportunities in the home environment), and multilevel protective factors (including child, home and school) during pregnancy, at birth, in infancy (18 months; n=1173), and at kindergarten age (4-6 years; n=966). An additional follow-up assessment is currently being conducted in 2020-2021 at age 8-10 years. This rich, longitudinal dataset will be leveraged to investigate a new sequential multiple hit model of risk and resilience, which expands on multi-hit models used in clinical research to explain the etiology of diseases such as cancer and Alzheimer’s disease. According to a multi-hit model, an early hit-free experience protects children from adverse outcomes associated with later hits, while conversely an early hit causes children to be more susceptible to later hits. Applying this model to risk and resilience, we conceptualize a hit as high exposure to biological or psychosocial risks at a given time point. This leads to the hypothesis that early low risk experience will protect children from adverse outcomes associated with later risk exposures. That is, among children with early exposure to a greater magnitude of risks, versus those with low early risk exposure, stronger associations will be found between later risk exposure and outcomes. Further understanding of the dynamics of the timing and interaction of such exposures is an essential first step to design interventions targeting risk prevention, as well as promotion of protective factors, at the time points when they will most likely show positive impacts on child outcomes.