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

BMC Pediatrics

Waldemar A Carlo⁶  Elizabeth McClure¹  Linda L Wright⁷  Hrishikesh Chakraborty^1,10  Dennis Wallace¹  Shivaprasad Goudar⁴  Omrana Pasha⁹  Elwyn Chomba⁵  Desiree M de Jong³  Sangappa M Dhaded⁴  Vanessa Thorsten¹  Fred J Biasini⁸  Jan L Wallander² 

[1]Department of Statistics and Epidemiology, RTI International, Durham, NC, USA

[2]Psychological Sciences and Health Sciences Research Institute, University of California, Merced, CA, USA

[3]University of Massachusetts Amherst, Amherst, MA, USA

[4]KLE Jawaharlal Nehru Medical College, Belgaum, India

[5]University of Zambia, Lusaka, Zambia

[6]Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

[7]the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA

[8]Sparks Clinics and Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA

[9]Aga Kahn University Medical College, Karachi, Pakistan

[10]University of South Carolina, Columbia, SC, USA

关键词: Developing countries;    Birth asphyxia;    Neurodevelopmental disability;    Early developmental intervention;    Treatment dose;   

Others  :  1118901
DOI  :  10.1186/1471-2431-14-281

 received in 2014-10-07, accepted in 2014-10-16,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Wallander et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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