Early childhood experiences, caregiver behaviour, and developmental outcomes in low- and middle-income countries

Background: Child survival has improved substantially over the past 30 years, with the mortality rate for children under the age of 5 years dropping by 59% due to improved socioeconomic conditions, health systems, and access to health services. Despite the improvements in mortality, more than one-third of children in low- and middle-income countries (LMICs) under the age of 5 years may currently not achieve their full developmental potential. Failure to achieve these important foundational skills will likely have negative consequences for countries' long-term developmental and economic potential. For this reason, early childhood development (ECD) is increasingly recognized as a key public health policy concern in many LMICs. Goal and objectives: This Ph.D. dissertation aims to show how maternal behavioural can improve the development of young children and how early acquisition of these developmental skills contribute to the long term outcomes of the children. In addition, the dissertation expands the available evidence base on the impacts of early life behaviours and experiences on the developmental trajectories of young children. Specifically, this Ph.D. focuses on how early childhood experiences and caregiver (including fathers) behaviour shape the developmental outcomes for children across different ages in LMICs. The evidence generated in this dissertation is intended to provide a basis to support future policy formulation and implementation of ECD programmes, as well as interventions to successfully support the growth and development of children in low-resource settings. Procedures: We analyzed data from four related studies conducted in Kenya, Zambia, and Brazil. The first paper used data analyzed as part of the São Paulo Western region cohort and assessed the association between kangaroo mother care (KMC) and child development for children born preterm. The second paper used data analyzed as part of a cluster-randomized control trial (cRCT) conducted in western Kenya to assess the association between exclusive breastfeeding (EBF) and child development. The third paper employed data analyzed as part of the longitudinal assessment of a community-led parenting empowerment intervention in Kenya and Zambia, focusing on the association between maternal stimulation activities and child development. The final paper looked at slightly older children to assess which domains of early childhood development is particularly relevant for later schooling outcomes, readily analyzing data drawn from a larger Zambia Early Childhood Development Project (ZECDP). Principal findings: The first three studies strongly and consistently highlight the critical role caregiver behaviour plays for the healthy development of children; KMC for children born preterm, EBF for at least 6 months, and maternal stimulation were all highly predictive of positive child outcomes. The level of caregiver involvement often determined developmental gains or gaps. In the last paper, we showed how important these early life developmental milestones are for later schooling outcomes. Together, the studies highlight not only the critical role of early childhood development but also the extent to which child outcomes can be improved by rather basic behaviours and activities that are feasible and easily implementable in low-resource settings. Conclusions/significance: The results presented suggest that positive early childhood experiences and caregivers’ practices have a positive impact on children’s development. Taken together, this dissertation highlights the strong association between maternal activities/behaviours and the developmental outcomes of children as well as how early experiences determine developmental trajectories. Across chapters three, four, and five, the results provide evidence that the practice of KMC, EBF, and maternal stimulation improves the development of cognitive skills. In chapter six, the results indicate that cognitive skills are vital in positive schooling outcomes, especially as it relates to being in the expected grade in the adolescent period. The results of this dissertation contribute to the body of literature on how early childhood experiences and caregivers' behavioural practices shape the developmental outcomes of children living in low-resource settings