1) Over 200 million children under age 5 in developing countries fail to reach their developmental potential due to risks like poverty, malnutrition, poor health, and unstimulating home environments.
2) Two indicators of poor development, childhood stunting and absolute poverty, are closely associated with poor cognitive performance and educational outcomes.
3) Early cognitive development strongly predicts later school performance. Interventions in early childhood can provide sustained benefits to cognition and academic achievement.
Wekerle CIHR Team - Anne Niec - Understanding Child MaltreatmentChristine Wekerle
This document discusses child maltreatment and its impacts. It defines the different types of child abuse and neglect, and summarizes data from a Canadian study that found around 85,000 substantiated child maltreatment cases in 2008. The study found that neglect was the primary concern in most cases, and that many involved multiple incidents of abuse. Child maltreatment can have lasting developmental impacts by interfering with children's physical, cognitive, emotional, and social development. It is associated with issues like attachment problems, mental health disorders, poorer academic performance, and health problems later in life. Preventative programs that support at-risk families can help reduce rates of child abuse and its long-term consequences.
Child mortality rates have declined globally over the past few decades due to improvements in child health programs and social conditions. However, progress has been uneven, and mortality has stalled or increased in some countries and regions. Two main types of child health programs have contributed to declines: short-term disease-specific initiatives and more general primary health care programs. Both program approaches need to evolve to complete the goal of improving child health worldwide, with a greater emphasis on household behaviors and interventions across the life cycle.
S13c6 chapter 6- facts and figures on healthShivu P
Health does not mean the 'hospital and the doctors', health is the reflection of nutrition/food, water, environment, air, pollution, society, infrastructure and the leaders intelligence. In this chapter some of the facts and figures related to family and health, various causes for death in various age groups in different locations, food insecurity - hunger - under nutrition, why orphanages are increasing, environment - water supply - sanitation -its impact on health care, doctor - population ratio, money spent on health, measures taken by the government still not able to achieve the satisfactory results, why millennium development goals are not achieved and how these can be handled well with model village and model nation are mentioned.
This document discusses how economic shifts and natural disasters affect vulnerable populations in low and middle-income countries. While the proportion of people living in extreme poverty has declined globally, nearly 1 billion people still live in poverty. Extreme poverty is concentrated in sub-Saharan Africa and Southern Asia and is worsened by slow employment growth, volatile commodity prices, and natural disasters. Research studies in India, Indonesia, the Philippines, and Bangladesh found that economic downturns and natural disasters increase food insecurity, malnutrition, and lower educational attainment, especially for vulnerable groups. However, certain health, nutrition, and cash transfer programs were shown to help mitigate the effects of poverty and protect vulnerable populations.
Franklin D. Roosevelt contracted polio in 1921 and was left paralyzed, but went on to become a transformative US president. The polio vaccine, developed in the 1950s, nearly eradicated the disease but outbreaks are increasing again due to falling vaccination rates. Some parents are opting out of vaccinating their children due to unfounded fears that vaccines cause autism or other harms, despite clear scientific evidence that vaccines are safe. When vaccination rates fall below 95%, "herd immunity" is lost, putting many lives at risk, including those who cannot be vaccinated such as newborns or the immunocompromised. Recent outbreaks of diseases like measles and whooping cough highlight the dangers
The document discusses several determinants of health including heredity, environment, culture, media, and technology. It provides definitions and discusses the level of control for each determinant. Some key points made include that heredity has about 5 out of 10 control and can be influenced by treatments. The environment has less control but can be influenced by one's friends and activities. Culture has a rating of 5 out of 10 for control as home culture is harder to influence than choices outside the home. Media is rated as having 8 out of 10 control as people can control what they post but not where it spreads. The effects of each determinant on health are also discussed briefly.
The document discusses malnutrition in children. It notes that malnutrition is the most severe form that requires urgent medical attention and can cause delays in development and increased risk of death if not treated. Over 24 million children worldwide are underweight each year due to lack of basic nutrients, especially in developing countries. Malnutrition is caused by immediate factors like insufficient feeding and disease, as well as underlying issues like lack of access to food, water, sanitation, and health care. Proper nutrition is essential for economic growth and development. UNICEF and other organizations work to address malnutrition through supporting child health, nutrition programs, and advocating for children's rights.
15.8 million American children lived in food-insecure households in 2012, with 20% or more of children in 37 states and DC facing food insecurity. Food insecurity threatens children's nutrition, health, academic achievement and economic prospects. Additionally, 3.9 million American households with children face limited or uncertain access to adequate nutrition. Globally, malnutrition contributes to nearly half of all childhood deaths, and 66 million primary school-aged children in developing nations attend class hungry. Various organizations work to address child hunger through food assistance, nutrition programs, and economic interventions.
Wekerle CIHR Team - Anne Niec - Understanding Child MaltreatmentChristine Wekerle
This document discusses child maltreatment and its impacts. It defines the different types of child abuse and neglect, and summarizes data from a Canadian study that found around 85,000 substantiated child maltreatment cases in 2008. The study found that neglect was the primary concern in most cases, and that many involved multiple incidents of abuse. Child maltreatment can have lasting developmental impacts by interfering with children's physical, cognitive, emotional, and social development. It is associated with issues like attachment problems, mental health disorders, poorer academic performance, and health problems later in life. Preventative programs that support at-risk families can help reduce rates of child abuse and its long-term consequences.
Child mortality rates have declined globally over the past few decades due to improvements in child health programs and social conditions. However, progress has been uneven, and mortality has stalled or increased in some countries and regions. Two main types of child health programs have contributed to declines: short-term disease-specific initiatives and more general primary health care programs. Both program approaches need to evolve to complete the goal of improving child health worldwide, with a greater emphasis on household behaviors and interventions across the life cycle.
S13c6 chapter 6- facts and figures on healthShivu P
Health does not mean the 'hospital and the doctors', health is the reflection of nutrition/food, water, environment, air, pollution, society, infrastructure and the leaders intelligence. In this chapter some of the facts and figures related to family and health, various causes for death in various age groups in different locations, food insecurity - hunger - under nutrition, why orphanages are increasing, environment - water supply - sanitation -its impact on health care, doctor - population ratio, money spent on health, measures taken by the government still not able to achieve the satisfactory results, why millennium development goals are not achieved and how these can be handled well with model village and model nation are mentioned.
This document discusses how economic shifts and natural disasters affect vulnerable populations in low and middle-income countries. While the proportion of people living in extreme poverty has declined globally, nearly 1 billion people still live in poverty. Extreme poverty is concentrated in sub-Saharan Africa and Southern Asia and is worsened by slow employment growth, volatile commodity prices, and natural disasters. Research studies in India, Indonesia, the Philippines, and Bangladesh found that economic downturns and natural disasters increase food insecurity, malnutrition, and lower educational attainment, especially for vulnerable groups. However, certain health, nutrition, and cash transfer programs were shown to help mitigate the effects of poverty and protect vulnerable populations.
Franklin D. Roosevelt contracted polio in 1921 and was left paralyzed, but went on to become a transformative US president. The polio vaccine, developed in the 1950s, nearly eradicated the disease but outbreaks are increasing again due to falling vaccination rates. Some parents are opting out of vaccinating their children due to unfounded fears that vaccines cause autism or other harms, despite clear scientific evidence that vaccines are safe. When vaccination rates fall below 95%, "herd immunity" is lost, putting many lives at risk, including those who cannot be vaccinated such as newborns or the immunocompromised. Recent outbreaks of diseases like measles and whooping cough highlight the dangers
The document discusses several determinants of health including heredity, environment, culture, media, and technology. It provides definitions and discusses the level of control for each determinant. Some key points made include that heredity has about 5 out of 10 control and can be influenced by treatments. The environment has less control but can be influenced by one's friends and activities. Culture has a rating of 5 out of 10 for control as home culture is harder to influence than choices outside the home. Media is rated as having 8 out of 10 control as people can control what they post but not where it spreads. The effects of each determinant on health are also discussed briefly.
The document discusses malnutrition in children. It notes that malnutrition is the most severe form that requires urgent medical attention and can cause delays in development and increased risk of death if not treated. Over 24 million children worldwide are underweight each year due to lack of basic nutrients, especially in developing countries. Malnutrition is caused by immediate factors like insufficient feeding and disease, as well as underlying issues like lack of access to food, water, sanitation, and health care. Proper nutrition is essential for economic growth and development. UNICEF and other organizations work to address malnutrition through supporting child health, nutrition programs, and advocating for children's rights.
15.8 million American children lived in food-insecure households in 2012, with 20% or more of children in 37 states and DC facing food insecurity. Food insecurity threatens children's nutrition, health, academic achievement and economic prospects. Additionally, 3.9 million American households with children face limited or uncertain access to adequate nutrition. Globally, malnutrition contributes to nearly half of all childhood deaths, and 66 million primary school-aged children in developing nations attend class hungry. Various organizations work to address child hunger through food assistance, nutrition programs, and economic interventions.
The document discusses several obstacles that children face, including hunger, food insecurity, and malnutrition. Some key points made include:
- 15.8 million American children lived in food-insecure households in 2012.
- Food insecurity threatens children's physical and mental development.
- Malnutrition is linked to nearly half of all childhood deaths globally.
- Charitable organizations like UNICEF and Feeding America are working to address these issues and improve nutrition assistance for children worldwide.
This document provides an overview of over 100 population, poverty, and reproductive health research projects funded by various organizations. It lists each project's title, lead investigator, funding organization, and whether the project examines topics at the macro level, micro/household level, involves policy/program evaluation, focuses on HIV/AIDS, uses experimental design, concerns female empowerment, measures impacts on GDP, poverty reduction, or labor force participation/savings, or evaluates the effects of reproductive health investments and programs. The projects cover a wide range of countries, especially in sub-Saharan Africa, and methods.
This document discusses various factors that can influence intelligence, including heredity, environment, sex, culture, socioeconomic status, race, and geographic location. It also defines different levels of mental retardation (moron, imbecile, idiot) based on IQ and maturity levels. The causes of mental retardation are discussed as being primary/endogenous (familial, genetic disorders) or secondary/exogenous (prenatal issues like Down syndrome, postnatal issues like disease or injury). Treatment methods include medical, psychological, and training/educational approaches. Giftedness is defined as those with IQs above 130 or those who perform remarkably in valuable skills, and identification methods include teacher/peer ratings, tests, grades.
Assessment of Mothers Education and their Knowledge about Home-Accident among...Mohammed Talib Abed
This study assessed mothers' education levels and knowledge about home accidents among children aged 5 and under. A questionnaire was administered to 200 mothers selected from health centers. Most mothers were 25-35 years old with primary education and unemployed. Over a quarter of the sample had moderate knowledge about home accidents. The study found that some mothers had poor knowledge about accident prevention for young children and there was no correlation between mothers' knowledge and their age or education levels. The study recommends implementing health education programs at various levels to teach mothers about home accident explanations, first aid, and avoidance techniques.
Cultural competence in international adoptionbirmanta
Over 200,000 children from dozens of countries have been adopted internationally by American families in recent decades. While adoption rates have declined, thousands still occur annually. These adoptions often involve transracial placements that can be challenging as children must adjust to new cultures and identities. Current support services lack programs providing adoptive parents with attitudes, skills, and knowledge needed to promote positive ethnic identity development in their children. More is needed to address this issue and improve outcomes for international adoptees.
This document discusses childhood obesity in New Jersey. It begins by defining childhood obesity and outlining national statistics on prevalence, causes, and effects. It then provides statistics specific to New Jersey, showing higher rates of obesity in low-income areas. The document discusses national initiatives like Let's Move and the Healthy Hunger-Free Kids Act, as well as New Jersey's Partnership for Healthy Kids program. It provides examples of initiatives in New Jersey cities like Camden that aim to increase access to healthy foods and physical activity opportunities to help reduce childhood obesity rates.
Educational achievement is a significant indicator of children’s wellbeing and future life opportunities. It can predict growth potential and economic viability of a country. While this is an ideal situation for all children, the case may be different for orphans and vulnerable children (OVC) due to the psychosocial challenges they go through on a daily basis. It is even worse for children attending public primary schools in Kenya. This paper aims to advance a debate on the relationship between psychosocial support and educational support provided for OVC through a critical engagement on the challenges experienced and the intervention measures to be taken in Kenyan public primary schools context. The study is based on the critical review of related literature materials. Findings suggest that, although the Kenyan government has put mechanisms in place to support OVC attain basic education, numerous challenges are found to be hindering some OVC from attaining quality education. Based on the findings, the paper recommends that there is need for various interventions to address psychosocial needs of orphans and children attending primary schools.
165 miljoen kinderen zijn wereldwijd chronisch ondervoed. Dit zorgt niet alleen voor kind dat sterft als gevolg van ondervoeding, elke 15 seconden, het heeft ook als gevolg dat kinderen daar de rest van hun leven onder lijden. Het is een groot probleem maar er zijn ook grote kansen om dit probleem aan te pakken
US Government Action Plan for Children in Adversity_Neil Boothby_4.26.13CORE Group
The document discusses the U.S. Government Action Plan on Children in Adversity, which aims to promote evidence-based integration, strengthen systems, put family care first, protect children from violence and build strong beginnings. It provides context on the challenges children face globally related to adversity, poverty and lack of family care. Key strategies discussed include integrating health, nutrition and family support; supporting and enabling family care; and preventing and protecting children from violence, exploitation, abuse and neglect. Metrics proposed to measure success include reduced cognitive delays and increased percentage of children living with family.
Wereldwijd hebben kinderen het beter dan ooit. Vergeleken met een paar decennia geleden overlijden er per dag minder jonge kinderen, leven er minder kinderen in armoede en gaan meer kinderen goed gevoed naar school.
Dit bemoedigende nieuws blijkt uit een nieuw rapport van UNICEF en Save the Children - voorbereid in samenwerking met het Overseas Development Institute. Nog beter nieuws is dat we weten hoe we nog meer vooruitgang moeten boeken; met meer nadruk op de meest kwetsbare kinderen. Daar waar kinderen het grootste gebrek hebben aan basale voorzieningen, kan op een kosteneffectieve en efficiënte manier snel vooruitgang worden geboekt.
Casestudies in het rapport laten zien dat verschillende factoren bijdragen aan de vooruitgang voor kinderen: sterkere en expliciete nationale wil om te investeren in kinderen, ondersteunende programma's en meer ontwikkelingssamenwerking gericht op kinderen.
Het volledige rapport verschijnt binnenkort.
Parents' attitudes significantly impact how they fulfill their parental roles and children's development in Uganda. Traditionally, fathers are viewed as the head of the household and decision-makers, while mothers are responsible for childrearing and domestic duties. This attitude favors sons and discourages the development of daughters. Changing social norms are challenging this view, but it remains entrenched in many communities. For children to thrive, both parents must be equally involved in caring for their physical, emotional, and intellectual needs, through open communication, quality time, and serving as positive role models.
Tracking Progress On Child And Maternal Nutrition E N 11030900shelly
This document provides an overview and analysis of child and maternal nutrition around the world. It discusses the large burden of undernutrition, with an estimated 195 million children under 5 suffering from stunting. The period from a woman's pregnancy through a child's second year is identified as being critically important for nutrition. Effective interventions to address undernutrition are also outlined, including breastfeeding, vitamin and mineral supplementation, and treatment of severe acute malnutrition. The report calls for urgent action to address undernutrition given its negative impacts on health, development, and poverty reduction goals.
This document discusses childhood obesity, its causes, and potential solutions. It notes that childhood obesity can lead to long-term health issues. While genes may play a small role, the main causes are environmental factors like parenting, food marketing, and lack of physical activity. The document recommends intervention programs, limiting junk food and screen time at home, and increasing exercise as ways to help address the problem.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
10 coast and jungle peruvian malnutritionJuan R Farro
This document discusses malnutrition in Peru. It begins by introducing a human medical school class and its members. It then defines malnutrition and describes its prevalence and causes in Peru. Chronic malnutrition affects over 20% of Peruvian children under 5, with the highest rates in the Sierra and jungle regions. Causes of malnutrition in Peru include maternal malnutrition, lack of healthcare and nutrition information, economic hardship, and water/sanitation issues. The document outlines consequences of childhood malnutrition like increased disease risk, lower educational and economic attainment. It concludes by proposing policies to address malnutrition in Peru like nutrition education programs, kitchens, health campaigns, and food security projects.
Nearly 200,000 infants and toddlers come into contact with the child welfare system each year during their most rapid period of brain development. Maltreatment can cause permanent damage to the developing brain. The child welfare system has not adequately addressed the unique developmental needs of infants and toddlers, and in some cases may do more harm. The author calls for a new policy agenda that makes vulnerable infants and toddlers a priority and establishes a developmental approach to their care, with increased involvement from policymakers and practitioners.
This document discusses sudden infant death syndrome (SIDS) and modifiable risk factors. It notes that SIDS remains the leading cause of infant death beyond the neonatal period despite decreases from recommendations that infants sleep on their backs. Prone sleeping, soft sleep surfaces, loose bedding, overheating, maternal smoking, and bed sharing have been identified as independent risk factors. National campaigns emphasizing back sleeping have significantly reduced SIDS rates. Further reduction may require increased focus on additional modifiable factors like sleep surface and position.
The document discusses how lack of access to contraception and family planning options exacerbates the cycle of poverty for women. Unintended early pregnancies often force women to abandon their education and career goals, limiting their employment opportunities and potential earnings. This perpetuates an intergenerational cycle of poverty, as teenage mothers and their children have lower educational attainment and income levels. The document argues that increasing access to contraception could help more women choose when to start families and pursue education or jobs first, empowering them to break out of poverty.
Declaration of Mental Health Emergency among Children in 2021Wayne Macfadden
Formerly based in North Dakota, Wayne Macfadden, MD, is a Psychiatrist who brings more than three decades of experience to his position as the President of International Psychiatric Services. Wayne Macfadden, MD, has been a principal investigator and co-investigator in various pharmacological clinical trials during his career. One of these trials included a safety study of drugs for adolescents and children with mental health disorders.
In a joint statement released on October 20, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children's Hospital Association declared an emergency of worsening “child and adolescent mental health” that is intrinsically linked to the tension caused by COVID-19, as well as the continuous fight for racial justice. As a result of COVID-19, about 140,000 children in the United States have lost a primary or secondary caregiver. The impact on BIPOC children is disproportionately large. As suicide rates among children and adolescents increased, doctors report caring for young people with “soaring rates” of despair, anxiety, trauma, loneliness, and suicidality.
Dr. Wayne Macfadden notes this emergency declaration emphasizes the need to watch out for early warning signs of mental health problems in children. The organizations are calling on legislators to come up with solutions that would strengthen early intervention efforts and increase funding for mental health resources.
A validation of the adverse childhood experiences scale inAlexander Decker
This document discusses the validation of the Adverse Childhood Experiences Scale in Nigeria. It describes a study that examined the concurrent validity of the Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Childhood Trauma Questionnaire (CTQ) using responses from 253 prison inmates in Nigeria. The study found significant correlations between the total scores on the ACE-IQ and CTQ, as well as between their subscales, indicating the two scales have concurrent validity in measuring adverse childhood experiences. It also found that male, young, low education, and divorced inmates reported more adverse childhood experiences.
The document outlines the basic laws and principles of government in Saudi Arabia. It establishes that Saudi Arabia is an Islamic state governed by Sharia law, with the Quran and teachings of Muhammad as its constitution. The system of government is a monarchy that is hereditary within the sons and grandsons of the first king. Some of the principles established include protecting Islam, upholding human rights according to Sharia, providing education to combat illiteracy, and establishing armed forces to defend Islam and society. The government has separate judicial, executive, and regulatory authorities that cooperate under the king.
1) Kazakhstan is a country located in Central Asia, with a capital of Astana. The currency is the Kazakhstani Tenge.
2) Kazakhstan was formerly a member of the USSR and supplied raw materials and food during World War 2. It gained independence in 1991 after the collapse of the Soviet Union.
3) Today, Kazakhstan is a republic with an authoritarian presidential system. It is a member of several international organizations and focuses on exporting grains, cotton, wool, livestock, and oil.
The document discusses several obstacles that children face, including hunger, food insecurity, and malnutrition. Some key points made include:
- 15.8 million American children lived in food-insecure households in 2012.
- Food insecurity threatens children's physical and mental development.
- Malnutrition is linked to nearly half of all childhood deaths globally.
- Charitable organizations like UNICEF and Feeding America are working to address these issues and improve nutrition assistance for children worldwide.
This document provides an overview of over 100 population, poverty, and reproductive health research projects funded by various organizations. It lists each project's title, lead investigator, funding organization, and whether the project examines topics at the macro level, micro/household level, involves policy/program evaluation, focuses on HIV/AIDS, uses experimental design, concerns female empowerment, measures impacts on GDP, poverty reduction, or labor force participation/savings, or evaluates the effects of reproductive health investments and programs. The projects cover a wide range of countries, especially in sub-Saharan Africa, and methods.
This document discusses various factors that can influence intelligence, including heredity, environment, sex, culture, socioeconomic status, race, and geographic location. It also defines different levels of mental retardation (moron, imbecile, idiot) based on IQ and maturity levels. The causes of mental retardation are discussed as being primary/endogenous (familial, genetic disorders) or secondary/exogenous (prenatal issues like Down syndrome, postnatal issues like disease or injury). Treatment methods include medical, psychological, and training/educational approaches. Giftedness is defined as those with IQs above 130 or those who perform remarkably in valuable skills, and identification methods include teacher/peer ratings, tests, grades.
Assessment of Mothers Education and their Knowledge about Home-Accident among...Mohammed Talib Abed
This study assessed mothers' education levels and knowledge about home accidents among children aged 5 and under. A questionnaire was administered to 200 mothers selected from health centers. Most mothers were 25-35 years old with primary education and unemployed. Over a quarter of the sample had moderate knowledge about home accidents. The study found that some mothers had poor knowledge about accident prevention for young children and there was no correlation between mothers' knowledge and their age or education levels. The study recommends implementing health education programs at various levels to teach mothers about home accident explanations, first aid, and avoidance techniques.
Cultural competence in international adoptionbirmanta
Over 200,000 children from dozens of countries have been adopted internationally by American families in recent decades. While adoption rates have declined, thousands still occur annually. These adoptions often involve transracial placements that can be challenging as children must adjust to new cultures and identities. Current support services lack programs providing adoptive parents with attitudes, skills, and knowledge needed to promote positive ethnic identity development in their children. More is needed to address this issue and improve outcomes for international adoptees.
This document discusses childhood obesity in New Jersey. It begins by defining childhood obesity and outlining national statistics on prevalence, causes, and effects. It then provides statistics specific to New Jersey, showing higher rates of obesity in low-income areas. The document discusses national initiatives like Let's Move and the Healthy Hunger-Free Kids Act, as well as New Jersey's Partnership for Healthy Kids program. It provides examples of initiatives in New Jersey cities like Camden that aim to increase access to healthy foods and physical activity opportunities to help reduce childhood obesity rates.
Educational achievement is a significant indicator of children’s wellbeing and future life opportunities. It can predict growth potential and economic viability of a country. While this is an ideal situation for all children, the case may be different for orphans and vulnerable children (OVC) due to the psychosocial challenges they go through on a daily basis. It is even worse for children attending public primary schools in Kenya. This paper aims to advance a debate on the relationship between psychosocial support and educational support provided for OVC through a critical engagement on the challenges experienced and the intervention measures to be taken in Kenyan public primary schools context. The study is based on the critical review of related literature materials. Findings suggest that, although the Kenyan government has put mechanisms in place to support OVC attain basic education, numerous challenges are found to be hindering some OVC from attaining quality education. Based on the findings, the paper recommends that there is need for various interventions to address psychosocial needs of orphans and children attending primary schools.
165 miljoen kinderen zijn wereldwijd chronisch ondervoed. Dit zorgt niet alleen voor kind dat sterft als gevolg van ondervoeding, elke 15 seconden, het heeft ook als gevolg dat kinderen daar de rest van hun leven onder lijden. Het is een groot probleem maar er zijn ook grote kansen om dit probleem aan te pakken
US Government Action Plan for Children in Adversity_Neil Boothby_4.26.13CORE Group
The document discusses the U.S. Government Action Plan on Children in Adversity, which aims to promote evidence-based integration, strengthen systems, put family care first, protect children from violence and build strong beginnings. It provides context on the challenges children face globally related to adversity, poverty and lack of family care. Key strategies discussed include integrating health, nutrition and family support; supporting and enabling family care; and preventing and protecting children from violence, exploitation, abuse and neglect. Metrics proposed to measure success include reduced cognitive delays and increased percentage of children living with family.
Wereldwijd hebben kinderen het beter dan ooit. Vergeleken met een paar decennia geleden overlijden er per dag minder jonge kinderen, leven er minder kinderen in armoede en gaan meer kinderen goed gevoed naar school.
Dit bemoedigende nieuws blijkt uit een nieuw rapport van UNICEF en Save the Children - voorbereid in samenwerking met het Overseas Development Institute. Nog beter nieuws is dat we weten hoe we nog meer vooruitgang moeten boeken; met meer nadruk op de meest kwetsbare kinderen. Daar waar kinderen het grootste gebrek hebben aan basale voorzieningen, kan op een kosteneffectieve en efficiënte manier snel vooruitgang worden geboekt.
Casestudies in het rapport laten zien dat verschillende factoren bijdragen aan de vooruitgang voor kinderen: sterkere en expliciete nationale wil om te investeren in kinderen, ondersteunende programma's en meer ontwikkelingssamenwerking gericht op kinderen.
Het volledige rapport verschijnt binnenkort.
Parents' attitudes significantly impact how they fulfill their parental roles and children's development in Uganda. Traditionally, fathers are viewed as the head of the household and decision-makers, while mothers are responsible for childrearing and domestic duties. This attitude favors sons and discourages the development of daughters. Changing social norms are challenging this view, but it remains entrenched in many communities. For children to thrive, both parents must be equally involved in caring for their physical, emotional, and intellectual needs, through open communication, quality time, and serving as positive role models.
Tracking Progress On Child And Maternal Nutrition E N 11030900shelly
This document provides an overview and analysis of child and maternal nutrition around the world. It discusses the large burden of undernutrition, with an estimated 195 million children under 5 suffering from stunting. The period from a woman's pregnancy through a child's second year is identified as being critically important for nutrition. Effective interventions to address undernutrition are also outlined, including breastfeeding, vitamin and mineral supplementation, and treatment of severe acute malnutrition. The report calls for urgent action to address undernutrition given its negative impacts on health, development, and poverty reduction goals.
This document discusses childhood obesity, its causes, and potential solutions. It notes that childhood obesity can lead to long-term health issues. While genes may play a small role, the main causes are environmental factors like parenting, food marketing, and lack of physical activity. The document recommends intervention programs, limiting junk food and screen time at home, and increasing exercise as ways to help address the problem.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
10 coast and jungle peruvian malnutritionJuan R Farro
This document discusses malnutrition in Peru. It begins by introducing a human medical school class and its members. It then defines malnutrition and describes its prevalence and causes in Peru. Chronic malnutrition affects over 20% of Peruvian children under 5, with the highest rates in the Sierra and jungle regions. Causes of malnutrition in Peru include maternal malnutrition, lack of healthcare and nutrition information, economic hardship, and water/sanitation issues. The document outlines consequences of childhood malnutrition like increased disease risk, lower educational and economic attainment. It concludes by proposing policies to address malnutrition in Peru like nutrition education programs, kitchens, health campaigns, and food security projects.
Nearly 200,000 infants and toddlers come into contact with the child welfare system each year during their most rapid period of brain development. Maltreatment can cause permanent damage to the developing brain. The child welfare system has not adequately addressed the unique developmental needs of infants and toddlers, and in some cases may do more harm. The author calls for a new policy agenda that makes vulnerable infants and toddlers a priority and establishes a developmental approach to their care, with increased involvement from policymakers and practitioners.
This document discusses sudden infant death syndrome (SIDS) and modifiable risk factors. It notes that SIDS remains the leading cause of infant death beyond the neonatal period despite decreases from recommendations that infants sleep on their backs. Prone sleeping, soft sleep surfaces, loose bedding, overheating, maternal smoking, and bed sharing have been identified as independent risk factors. National campaigns emphasizing back sleeping have significantly reduced SIDS rates. Further reduction may require increased focus on additional modifiable factors like sleep surface and position.
The document discusses how lack of access to contraception and family planning options exacerbates the cycle of poverty for women. Unintended early pregnancies often force women to abandon their education and career goals, limiting their employment opportunities and potential earnings. This perpetuates an intergenerational cycle of poverty, as teenage mothers and their children have lower educational attainment and income levels. The document argues that increasing access to contraception could help more women choose when to start families and pursue education or jobs first, empowering them to break out of poverty.
Declaration of Mental Health Emergency among Children in 2021Wayne Macfadden
Formerly based in North Dakota, Wayne Macfadden, MD, is a Psychiatrist who brings more than three decades of experience to his position as the President of International Psychiatric Services. Wayne Macfadden, MD, has been a principal investigator and co-investigator in various pharmacological clinical trials during his career. One of these trials included a safety study of drugs for adolescents and children with mental health disorders.
In a joint statement released on October 20, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children's Hospital Association declared an emergency of worsening “child and adolescent mental health” that is intrinsically linked to the tension caused by COVID-19, as well as the continuous fight for racial justice. As a result of COVID-19, about 140,000 children in the United States have lost a primary or secondary caregiver. The impact on BIPOC children is disproportionately large. As suicide rates among children and adolescents increased, doctors report caring for young people with “soaring rates” of despair, anxiety, trauma, loneliness, and suicidality.
Dr. Wayne Macfadden notes this emergency declaration emphasizes the need to watch out for early warning signs of mental health problems in children. The organizations are calling on legislators to come up with solutions that would strengthen early intervention efforts and increase funding for mental health resources.
A validation of the adverse childhood experiences scale inAlexander Decker
This document discusses the validation of the Adverse Childhood Experiences Scale in Nigeria. It describes a study that examined the concurrent validity of the Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Childhood Trauma Questionnaire (CTQ) using responses from 253 prison inmates in Nigeria. The study found significant correlations between the total scores on the ACE-IQ and CTQ, as well as between their subscales, indicating the two scales have concurrent validity in measuring adverse childhood experiences. It also found that male, young, low education, and divorced inmates reported more adverse childhood experiences.
The document outlines the basic laws and principles of government in Saudi Arabia. It establishes that Saudi Arabia is an Islamic state governed by Sharia law, with the Quran and teachings of Muhammad as its constitution. The system of government is a monarchy that is hereditary within the sons and grandsons of the first king. Some of the principles established include protecting Islam, upholding human rights according to Sharia, providing education to combat illiteracy, and establishing armed forces to defend Islam and society. The government has separate judicial, executive, and regulatory authorities that cooperate under the king.
1) Kazakhstan is a country located in Central Asia, with a capital of Astana. The currency is the Kazakhstani Tenge.
2) Kazakhstan was formerly a member of the USSR and supplied raw materials and food during World War 2. It gained independence in 1991 after the collapse of the Soviet Union.
3) Today, Kazakhstan is a republic with an authoritarian presidential system. It is a member of several international organizations and focuses on exporting grains, cotton, wool, livestock, and oil.
Styles of learning and thinking matter in instruction and assessmentJamaica Mirador
This document discusses two styles of learning and thinking - ability-based styles and personality-based styles. It defines styles as individual differences in approaches to tasks that can impact how a person learns or thinks. Ability-based styles are assessed through maximum-performance tests, while personality-based styles are assessed through typical-performance tests. The document argues that both styles are important for instruction and assessment in schools. It describes the theory of successful intelligence, an ability-based theory, and the theory of mental self-government, a personality-based theory. It presents data showing teaching students analytically, creatively, and practically through these theories leads to better learning outcomes compared to conventional teaching methods.
The document outlines the basic laws and principles of government in Saudi Arabia. It establishes that Saudi Arabia is an Islamic state with Islam as the official religion and the Quran and teachings of Muhammad as the constitution. The system of government is a monarchy that is hereditary within the sons and grandsons of the first king. The king chooses the heir to the throne and is succeeded by the heir upon death. The government is based on principles of justice, consultation and equality according to Islamic law.
Non traditional measures in assessment 090712 (1)Jonathan Martin
The document discusses assessing student skills beyond standardized tests, including creativity, practical skills, and wisdom. It describes 5 projects that assessed these additional skills through measures like storytelling, situational judgment, and factor analysis. The results showed that while standardized tests capture some skills well, other important skills are not measured, such as creativity, practical application, and ethical decision making. Assessing a broader range of skills can provide a more comprehensive view of students' abilities.
This document summarizes trends in European politics from 1815-1848, including the Congress of Vienna which sought to restore traditional monarchies, Metternich's suppression of liberalism and nationalism, and the revolutions of 1830 and 1848 which protested economic hardship and called for greater political and social reforms. Key events discussed include the Spanish rebellion of 1820, Greek independence from the Ottoman Empire, the July Revolution of 1830 in France, and the revolutions of 1848 which began in France and spread to the German and Italian states as nationalist sentiments grew.
1. The document discusses school culture and school climate and how they impact student learning and performance. School culture refers to shared beliefs and values of a school organization, while school climate characterizes the environment at the school building level.
2. A positive school climate with a caring environment, high expectations, and emphasis on learning is associated with higher academic achievement and student well-being. Components of a positive climate include physical, social, affective, and academic environments that make students feel safe, supported, and engaged.
3. Improving school climate and culture requires leadership from administrators and teachers. Approaches include promoting safety, facilitating relationships, and fostering a positive social environment through smaller class sizes and extracurricular
The document discusses the impacts of the COVID-19 pandemic on child development during middle childhood (ages 5-9). Using the framework of developmental psychopathology, it analyzes effects in multiple domains: increased anxiety/depression due to isolation; decreased inhibitory control from excessive technology use; and higher obesity risk from sedentary lifestyles. It argues teachers and parents must help children offset negative impacts through limiting screen time, encouraging physical activity, and facilitating mental health discussions. Individual temperament also influences children's risk levels for issues like anxiety.
1. Physical growth is rapid in the first two years as body size increases dramatically and brain development occurs at an astounding pace, though children vary in their physical maturity.
2. Motor skills, perception, cognition, language, emotion, temperament, attachment, and self-awareness all develop remarkably during this time through complex interactions between genetic and environmental factors.
3. Caregiving practices and early stimulation are crucial for promoting healthy physical, cognitive, and socio-emotional development in infancy and toddlerhood.
The Covid-19 pandemic has significantly impacted children's development in physical, social, and cognitive domains. Physically, children have become less active and more obese due to lack of physical activity and increased unhealthy eating. Socially, lack of interaction with peers has negatively affected children's ability to learn social skills and emotional understanding. Cognitive development is also at risk, as the pandemic may disrupt important processes like synaptic pruning in the brain and increase risk of developmental disorders. Parents can help support children's development during this time by promoting physical activity, healthy eating, and social-emotional learning at home.
The document discusses research that proves poverty and lack of social support can negatively impact childhood development and outcomes. Multiple studies show that poverty is linked to worse performance in school, lower IQs, more aggressive behaviors, and a higher risk of abuse and neglect. However, strengthening social programs like early education funding and better living conditions can help break this cycle by improving outcomes for disadvantaged children. The document argues this research proves the importance of maintaining a robust social safety net.
Current Events and Child Development Research Paperimankeen
This research paper allowed me to learn the effects of COVID-19 on developing children. I gained knowledge on developmental changes such as executive functioning, emotional regulation, and physical health. I learned how brain development is negatively affected just by a slight change of a physical and social environment. As a nurse, knowledge on COVID-19 is very useful and beneficial. Knowing how a prevalent contagious disease affects individuals allows for better and more related quality of care.
Presentation by Dr Jan Macvarish, entitled The Uses and Abuses of Biology: Neuroscience, Parenting and British Family Policy, given to the conference of the same name on Friday 28 March 2014, Birkbeck, London University. The conference was organised by the Centre for Parenting Culture Studies, the University of Kent.
4080 Current Events and Child Development Paper.docxAliBullock1
The coronavirus pandemic has impacted the development of children ages 5-9 in several key ways:
1) Daily life changed dramatically with school closures, lack of socialization, and mandated social distancing and masks. This disrupted their physical, social, and learning environments.
2) Brain development may have been hindered by the loss of in-person learning support and increased stress at home. Emotional development also suffered without peer socialization opportunities.
3) Physical health declined for some as access to nutritious meals decreased and sedentary behaviors increased while stuck at home.
The document summarizes 8 key things to remember about child development:
1) Even infants and young children are negatively affected by significant family stresses and adversity. Adverse early experiences can disrupt brain development and increase health risks.
2) Development is highly interactive - both genes and the environment shape development, and early experiences can alter gene expression.
3) While parents are primary, relationships with other caregivers can also benefit young children's social-emotional development if care is consistent and high-quality.
4) Brain architecture is largely shaped in the first 3 years, but development continues into adulthood, so opportunities exist beyond age 3 to mitigate early impacts.
Factors Affecting Individual Growth and Development: Health, Inborn, AcquiredSyafiqah Kadar
The document discusses cognitive and language development in children. It describes key stages in cognitive development according to Piaget's theory, including the sensory motor stage occurring in infancy. It also outlines stages in language development, from babbling and crying as infants to using complex grammatical rules by age two. Nutrition, stimulation, and brain development in the first years of life are essential for children's learning and development.
Effect of Mothers Working and Non Working Status on the Nutritional Status of...YogeshIJTSRD
Health and nutritional status are two crucial and interlinked aspects of human development, which in to interact with demographic variables Malnutrition a condition that occurs due to intake of inadequate amount of nutrients leading to insufficient nourishment continues to be a problem of considerable magnitude in most of the developing countries in the world. Preschool children are one of the most nutritionally vulnerable segments of the population. Nutrition during the first 5 years has not only an impact on growth and morbidity during childhood, but also acts as a determinant of nutritional status in adolescent and adult life. Global comparative data indicate that contrary to common perception, prevalence of under nutrition is highest in South Asian children. India has the highest occurrence of childhood malnutrition in the world. Malnutrition is responsible for 55 percent of all deaths of children younger than 5 years of age globally. Malnutrition makes a child susceptible to infections and delayed recovery, thus increasing mortality and morbidity. It is therefore logical to direct attention to the quality of life of the survivors Bose and Das, 2010 . Joyeeta Bhattacharyya "Effect of Mothers Working and Non-Working Status on the Nutritional Status of Pre School Children" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41167.pdf Paper URL: https://www.ijtsrd.comhome-science/food-and-nutrition/41167/effect-of-mothers-working-and-nonworking-status-on-the-nutritional-status-of-pre-school-children/joyeeta-bhattacharyya
What did you find most interesting regarding the health issue ea.docxberthacarradice
What did you find most interesting regarding the health issue each learner selected? one paragraph each post
Desiree post
Skeletal growth along with brain development, grow rapidly during early childhood. Although it can vary from culture to culture, the fact remains that there will be undeniably a growth spurt in physical and mental development. Skeletal growth is what is the most obvious during development. We notice the physical changes of children getting taller, thinner, baby teeth falling out and even facial maturity. Brain development is noticeable over a period of time. Memory, language, attention, and coordination can all be indicators of mental development.
Asthma is said to be the most chronic disease in child development. It is defined as “a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath” (Clinic, 2016). Factors that have a major influence on asthma are pre and post birth smoking environments. Another factor that grossly effects asthma is air pollution. “Air pollutions exposure before 2-3 years of age appear most important for asthma development” (Nina Clark, 2010). Although there is no cure for asthma, nebulizers and inhalers are used to keep it under control. This health issue is so important to me because my husband suffers from severe asthma, and I worry that it will be passed down to our young daughters.
LaRoya post
During the preschool age, children learn how to regulator their physical development and movement patterns through physical activities & play. Gross motor skills are essential for running jumping and throwing throwing. Gross motor skills develop faster than fine motor development skills, which progress at a slower pace during this age range. Physical activities that develop and nurture preschoolers' coordination, fine motor skills and gross motor skills will benefit them to progress physically and it may also increase their interactions and performance times with one another. Educating children about having a healthy lifestyle and encouraging a positive body image is critically imperative at this age. The most vital way for parents to assist children in developing a lifestyle of healthy attitudes and behaviors towards food and exercise is to train, to demonstrate, and to encourage correct eating and activity patterns. It is also imperative to continue to deliver children with love and nurturing that builds string, positive self - images based on attributes other than appearance is important as well.
It is extremely important for child's health development to be assessed and observed. This is the period in which young children reach their developmental milestones emotional, cognitive and motor skills. During this time young children are at risk of many health conditions, one that is extremely known is obesity. Childhood obesity raise the risk for cardiovascular disease and can ...
The document explores the relationship between a child's socioeconomic status and their health as an adult. It discusses how children from disadvantaged backgrounds face greater physical and psychosocial stressors that can disrupt self-regulation and increase risk of health issues later in life. Specifically, it examines research on the environmental factors like family turmoil, the physiological outcomes like elevated blood pressure, and psychological outcomes like problems with self-control associated with low socioeconomic status in childhood. The document concludes that social inequalities profoundly impact children's physical and mental health, and that a child's socioeconomic status is strongly linked to their socioeconomic status and health as an adult.
Healthcare issues for children include violence, infectious diseases, poverty, hunger, environment, education, and access to care. Violence has caused many children to lose their lives or be disabled. Infectious diseases such as tuberculosis, HIV/AIDS, diarrhea and malaria have killed many children worldwide. Poverty deprives children of their rights and weakens their environment. Hunger continues to affect over 1 billion children globally through inadequate access to essential resources. Environmental factors also impact children's physical and mental development. Lack of education and access to affordable healthcare further exacerbate health challenges for children.
Early Childhood Development: Emerging Concepts II - The Place of the World Ba...jehill3
The document discusses the World Bank's role in supporting early childhood development (ECD). It notes that 219 million children in developing countries are not reaching their developmental potential due to poverty and lack of stimulation. Investing in ECD programs that integrate health, nutrition, care and stimulation is productive for children and society. The World Bank leads donor support for ECD, with a portfolio of $1.7 billion for ECD programs worldwide. It will continue to build investment in and promote innovative ECD initiatives.
1) Tracking student progress over time through a shared tracking system and regularly reviewing information can help identify students experiencing academic or behavioral problems or who are at risk of adverse childhood experiences (ACEs).
2) Providing volunteers and staff with brief training on common ACEs faced by the community and strategies to support students can help strengthen relationships between students and mentors.
3) Integrating ACE prevention, early detection, and community support are recommended to interrupt the intergenerational cycle of ACEs and promote resilience among students attending the Out-of-School Time program.
Mental health%20 problems_early%20childhoodRenata Costa
Mental health problems can emerge early in childhood and impair learning and behavior if left unaddressed. Significant adversity like abuse, neglect, poverty or family mental illness can damage the developing brain and increase risks for later mental health issues. While all children facing prolonged adversity are vulnerable, genetics also play a role - some children are more susceptible to stress. Early intervention can help address emerging problems and improve outcomes, but young children often express mental health issues differently than older children and adults due to differences in brain development, self-awareness and relationships. Untreated difficulties that start early may worsen over time into more serious disorders.
1. The document discusses growth and development in children from 0-12 years. It defines key terms like growth, maturation, and development and outlines factors that influence a child's growth such as heredity, nutrition, environment, and illnesses.
2. The predictable patterns of development are discussed, including progression from head to toe and central axis outward. Development occurs through maturation and learning at different rates for each child.
3. The document covers all aspects of physical growth including height, weight, body proportions, and development of body systems like the brain, heart, and digestive system from birth through age 12.
Early Learning Experiences - ebookschoice.comnoblex1
Documented efforts to enhance the development of children, especially to remediate the consequences of deprivation, have taken place since the early nineteenth century, when researchers learned that certain types of early experience were essential for the emergence of high intellectual functioning. More recently, studies of children in orphanages in the 1950s and 1960s initiated the investigation of what young children need to ensure healthy growth and development.
Source: https://ebookschoice.com/early-learning-experiences/
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. Grantham-McGregor et al. Page 2
Introduction
A previous Lancet series focused attention on the more than 6 million preventable child deaths
every year in developing countries. Unfortunately, death is the tip of the iceberg. We have
made a conservative estimate that more than 200 million children under 5 years fail to reach
their potential in cognitive development because of poverty, poor health and nutrition, and
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deficient care. Children's development consists of several interdependent domains, including
sensory-motor, cognitive, and social-emotional, all of which are likely to be affected. However,
we focus on cognitive development because of the paucity of data from developing countries
on other domains of young children's development. The discrepancy between their current
developmental levels and what they would have achieved in a more nurturing environment
with adequate stimulation and nutrition indicates the degree of loss of potential. In later
childhood these children will subsequently have poor levels of cognition and education, both
of which are linked to later earnings. Furthermore, improved parental education, particularly
of mothers, is related to reduced fertility, and improved child survival, health, nutrition,
cognition, and education. Thus the failure of children to fulfil their developmental potential
and achieve satisfactory educational levels plays an important part in the intergenerational
transmission of poverty. In countries with a large proportion of such children, national
development is likely to be affected.
The first UN Millennium Development Goal is to eradicate extreme poverty and hunger, and
the second is to ensure that all children complete primary schooling. Improving early child
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development is clearly an important step to reaching these goals. Although policymakers
recognise that poverty and malnutrition are related to poor health and increased mortality, there
is less recognition of their effect on children's development or of the value of early intervention.
This paper is the first of a three part series reviewing the problem of loss of developmental
potential in young children in developing countries. The first paper describes the size of the
issue, the second paper discusses the proximal causes of the loss, and the final paper reviews
existing interventions. Here, we first examine why early child development is important and
then develop a method to estimate the numbers of children who fail to fulfil their developmental
potential. We then estimate the loss of income attributed to poor child development.
Why early child development is important
Children's development is affected by psychosocial and biological factors and by genetic
inheritance. Poverty and its attendant problems are major risk factors. The first few years of
life are particularly important because vital development occurs in all domains. The brain
develops rapidly through neurogenesis, axonal and dendritic growth, synaptogenesis, cell
death, synaptic pruning, myelination, and gliogenesis. These ontogenetic events happen at
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different times (figure 1) and build on each other, such that small perturbations in these
processes can have long-term effects on the brain's structural and functional capacity.
Brain development is modified by the quality of the environment. Animal research shows that
early undernutrition, iron-deficiency, environmental toxins, stress, and poor stimulation and
social interaction can affect brain structure and function, and have lasting cognitive and
emotional effects.
In humans and animals, variations in the quality of maternal care can produce lasting changes
in stress reactivity, anxiety, and memory function in the offspring,
Despite the vulnerability of the brain to early insults, remarkable recovery is often possible
with interventions, and generally the earlier the interventions the greater the benefit.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
3. Grantham-McGregor et al. Page 3
Early cognitive development predicts schooling
Early cognitive and social-emotional development are strong determinants of school progress
in developed countries. A search of databases for longitudinal studies in developing countries
that linked early child development and later educational progress identified two studies. In
Guatemala, preschool cognitive ability predicted children's enrolment in secondary school and
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achievement scores in adolescence. In South Africa, cognitive ability and achievement at the
end of grade one predicted later school progress. Three further studies had appropriate data
that we analysed (from the Philippines and Jamaica) or requested the investigators to analyse
(from Brazil). In each case, multiple regression of educational outcome (or logistic regression
for dichotomous variables), controlling for a wealth index, maternal education, and child's sex
and age, showed that early cognitive development predicted later school outcomes. Table 1
shows that each SD increase in early intelligence or developmental quotient was associated
with substantially improved school outcomes. Further evidence of the importance of early
childhood is that interventions at this age can have sustained cognitive and school achievement
benefits (table 1).
Problem of poor development
National statistics on young children's cognitive or social-emotional development are not
available for most developing countries, and this gap contributes to the invisibility of the
problem of poor development. Failure to complete primary education (Millennium
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Development Goal 2) gives some indication of the extent of the issue, although school and
family characteristics also play a part. In developing countries, an estimated 99 million children
of primary-school age are not enrolled, and of those enrolled, only 78% complete primary
school. Most children who fail to complete are from sub-Saharan Africa and south Asia. Only
around half of the children enrol in secondary schools. Furthermore, children in some
developing countries have much lower achievement levels than children in developed countries
in the same grade. In 12 African countries, surveys of grade 6 (end of primary school) children
showed that on average 57% had not achieved minimum reading levels (webtable).
Indicators of poor development
In the following section we estimate the numbers of children who fail to reach their
developmental potential. We first identify early childhood growth retardation (length-for-age
less than −2 SD according to the National Center for Health Statistics growth reference
[moderate or severe stunting]) and absolute poverty as possible indicators for poor
development. We then show that they are good predictors of poor school achievement and
cognition. Finally, we use these indicators to estimate the number of children involved. We
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identified stunting and poverty for indicators because they represent multiple biological and
psychosocial risks, respectively, stunting and to a lesser extent poverty are consistently defined
across countries, both are relevant to most developing countries, and worldwide data are
available. We omit other risk factors that could affect children's development because they fail
to fit all the above criteria and there is marked overlap between them and with stunting and
poverty. However, by using only two risk factors we recognise that our estimate is conservative.
Assessment of stunting, poverty, and child development
Growth potential in preschool children is similar across countries, and stunting in early
childhood is caused by poor nutrition and infection rather than by genetic differences. Patterns
of growth retardation are also similar across countries. Faltering begins in utero or soon after
birth, is pronounced in the first 12–18 months, and could continue to around 40 months, after
which it levels off. Some catch-up might take place, but most stunted children remain stunted
through to adulthood.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
4. Grantham-McGregor et al. Page 4
There are multiple approaches to measuring poverty. One assessment used measures of
deprivation of basic needs, availability of services, and infrastructure, and surveys in 45
developing countries reported that 37 % of children lived in absolute poverty, more so in rural
areas. We use the percentage of people having an income of less than US$1 per day, adjusted
for purchasing power parity by country because this information is available for the largest
number of countries. This indicator is considered the best available despite excluding important
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components of poverty, and is more conservative than measures based on deprivation since it
identifies only the very poorest families.
Poverty is associated with inadequate food, and poor sanitation and hygiene that lead to
increased infections and stunting in children. Poverty is also associated with poor maternal
education, increased maternal stress and depression, and inadequate stimulation in the home.
All these factors detrimentally affect child development (figure 2). Poor development on
enrolment leads to poor school achievement, which is further exacerbated by inadequate
schools and poor family support (due to economic stress, and little knowledge and appreciation
of the benefits of education).
Risk factors related to poverty frequently occur together, and the developmental deficit
increases with the number of risk factors. Deficits in development are often seen in infancy
and increase with age. For example, a cross sectional study in Ecuador reported that the
language deficit in poor children increased from 36 to 72 months of age compared with
wealthier children (figure 3).
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As a first step to examining the use of poverty and stunting as indicators, we did regression
analyses of the relation between the percentage of children completing primary school and
poverty and stunting, with data from developing countries (defined as the non-industrialised
countries in UNICEF classification). Stunting prevalence was based on the WHO Global
Database on Child Growth and Malnutrition, and absolute poverty prevalence came from
UNICEF. In 79 countries with information on stunting and education, the average prevalence
of stunting was 26·0%. For every 10% increase in stunting (less than −2 SD), the proportion
of children reaching the final grade of primary school dropped by 7·9% (b=−0·79, 95% CI
−1·03 to −0·55, R2=36·2%, p<0·0001). In 64 countries with information on absolute poverty,
the average prevalence was 20%; for every 10% increase in the prevalence of poverty there
was a decrease of 6·4% (b=−0·64, 95% CI=−0·81 to −0·46, R2=46·3%, p<0·0001) of children
entering the final grade of primary school.
To establish whether stunting and absolute poverty were useful predictors of poor child
development in individual studies, we searched the published papers and identified all
observational studies that related stunting and poverty in early childhood to concurrent or later
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child development or educational outcomes. We also identified all studies that related stunting
at school age to cognition or education, based on the assumption that stunting developed in
early childhood. We selectively reviewed studies of older children that linked economic status
to school achievement or cognition, choosing examples with international or nationally
representative samples. We assessed whether measurements of the risk factors and
developmental outcome were clearly reported, and the relation between them (adjusted or
unadjusted) was examined. We did not assess causality.
Stunting and poor development
Cross-sectional studies
Many cross-sectional studies of high-risk children have noted associations between concurrent
stunting and poor school progress or cognitive ability. Stunted children, compared with non-
stunted children, were less likely to be enrolled in school (Tanzania), more likely to enrol late
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
5. Grantham-McGregor et al. Page 5
(eg, Nepal, and Ghana and Tanzania), to attain lower achievement levels or grades for their
age (Nepal, China, Jamaica, India, Philippines, Malaysia, Vietnam, Brazil, Turkey, Guatemala
[only in boys]), and have poorer cognitive ability or achievement scores (Kenya, Guatemala,
Indonesia, Ethiopia, Peru, India, and Vietnam, and Chile). Only three studies reported no
significant relation between stunting and poor school progress. In the Philippines, associations
were recorded with weight-for-height, and in Ghana stunted children enrolled in school late
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but taller children left school early to earn money or help with family farming.
There are fewer studies with younger children. In Guatemala, Jamaica, Chile, and Kenya,
associations between height and child development measures were reported. Age of walking
was related to height-for-age in Zanzibarian and Nepalese children, but height was not related
to motor development in Kenyans at 6 months of age. Weight-for-age, which indicates a
combination of weight-for-height and height-for-age, has often been used instead of stunting
to measure nutrition in young children. Weight-for-age was associated with child development
in India, Ethiopia, and Bangladesh.
Longitudinal studies
In Pakistan and Guatemala, growth retardation in infancy predicted age of walking. Excluding
studies of children hospitalised for severe malnutrition, four published longitudinal studies
showed that early stunting predicted later cognition, school progress, or both. Stunting at 24
months was related to cognition at 9 years in Peru and, in the Philippines to intelligent quotient
(IQ) at 8 and 11 years, age at enrolment in school, grade repetition, and dropout from
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school. In Jamaica, stunting before 24 months was related to cognition and school achievement
at 17–18 years and dropout from school. In Guatemala, height at 36 months was related to
cognition, literacy, numeracy, and general knowledge in late adolescence, and stunting at 72
months was related to cognition between 25–42 years. In Indonesia, weight-for-age at 1 year
of age did not predict scores on a cognitive test at 7 years, whereas growth in weight between
1 and 7 years did.
To assess the size of the deficit in later function associated with a loss of 1 SD in height in
early childhood, we reanalysed the data from Philippines, Jamaica, Peru, and Indonesia
(Guatemala had too few well-nourished children to be included). We added two other
longitudinal studies, from Brazil and South Africa, that had not previously analysed the effect
of stunting (table 2). In these studies, stunting between 12 and 36 months was related to later
measures of cognition or grade attainment. Being moderately or severely stunted compared
with not stunted (height-for-age greater than −1 SD) was associated with scores for cognition
in every study, and the effect size varied from 0·4 to 1·05 SD. Stunting was also associated
with attained grades. The consistent relation between early childhood stunting and poor child
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development, with moderate to large effects, justifies its use as an indicator of poor
development.
Poverty and poor development
Cross-sectional studies
Nationally representative studies from many countries have seen relations between household
wealth and school enrolment, early dropout, grades attained, and achievement. Gaps in mean
attained grades between the richest and poorest children were particularly large in western and
central Africa and south Asia, reaching as high as ten grades in India. In Zambia, poor children
were four times more likely to start school late than the richest children, and in Uganda the
difference was ten times. Representative surveys in 16 Latin American countries also reported
that family income predicted the probability of completing secondary schooling. Rural children
were worse off in most studies.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
6. Grantham-McGregor et al. Page 6
There are fewer studies on wealth and development in preschool children. In 3668 Indian
children under 6 years, paternal occupation was associated with developmental milestones. In
Ecuador, wealth was related to vocabulary scores of children from 3 to 6 years of age. In
Jamaica, 71·4% of 3887 children from more affluent families entering fee-paying preparatory
schools had mastery of all four school-readiness subjects tested, compared with 42·7% of 22
241 children entering free government primary schools. An association between poverty and
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child development was recorded at as early as 6 months of age in Egypt, 12 months in
Brazil, 10 months in India, and 18 months in Bangladesh. In another Brazilian study, preschool
children's language scores were associated with maternal working but not income.
Longitudinal studies
Several longitudinal studies have assessed the association between wealth at birth and later
educational and cognitive attainment. Socioeconomic status in infancy was associated with
children's cognition at 5 years of age in Kenya. In Brazil, parental income at birth was associated
with poor performance on a developmental screening test at 12 months in 1400 infants, and
with school grades attained at 18 years in 2222 men on army enlistment. In Guatemala,
socioeconomic status at birth was associated with school attainment and cognition in 1469
adults. We analysed data from three other longitudinal studies (table 3). Wealth quintiles at
birth were related to IQ at 8 years in the Philippines, and to cognitive scores at 7 years in South
Africa and 9 years in Indonesia. The effect size in all these studies was substantial, ranging
from 0·70 to 1·24 SD scores between the top and bottom quintiles in children from varied
socioeconomic backgrounds, and from 0·45 to 0·53 SD scores in Guatemala where all study
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children were poor. We had to use wealth quintiles rather than the cutoff of US$1 per day
because of limitations in the data. Poor children consistently had considerable developmental
deficits compared with more affluent children. Thus poverty can be used as an indicator of
poor development.
Estimate of number of children who are stunted or living in poverty
We estimated the prevalence of children under 5 years who are stunted or living in absolute
poverty in developing countries. Data for the number of children in 2004 and percent living in
poverty were obtained from UNICEF and data for stunting obtained from WHO. Of the 156
countries analysed, 126 have a known stunting prevalence and 88 have a known proportion
living in absolute poverty (table 4). We replaced missing country values of stunting and poverty
with the average prevalence of the region for the purpose of estimating the proportion and
number of disadvantaged children. Sensitivity analysis based on imputing stunting by poverty
and imputing poverty by stunting through regression analysis gave similar results to using the
regional average (webappendix). The most recent poverty data we obtained was up to year
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2003, with median 2000 and inter-quartile range of 4 years. The most recent stunting data were
up to year 2004, with median 2000 and inter-quartile range of 3 years. We extrapolated all the
stunting and poverty data to the year 2004 (table 4).
There are 559 million children under 5 years in developing countries, 156 million of whom are
stunted and 126 million are living in absolute poverty (table 4). To avoid the double-counting
of children who are both stunted and living in poverty, we estimated the prevalence of stunting
among children in poverty in countries with both indicators available, and calculated the
numbers of stunted children plus the number of non-stunted children living in poverty. We
refer to these children as disadvantaged.
The relation between prevalence of stunting and poverty at the country level is non-linear and
can be captured by a regression line of percentage stunted=7·8+4·2×√%poverty (using the 82
countries with available data; R=40·9%). Extrapolation of this regression line gives an estimate
of the prevalence of stunting in people living in poverty to be 50%. Hence, the number of
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
7. Grantham-McGregor et al. Page 7
children stunted or living in poverty is the sum of the total number of stunted children (156
million) plus 50% of children living in poverty (63 million) making a total of 219 million
disadvantaged children, or 39% of all children under 5 in developing countries.
An alternative estimate of the prevalence of stunting in children in poverty was obtained by
analysis of micro-level data from 13 Multiple Indicator Cluster Surveys in developing countries
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with data for both stunting and a wealth index. A meta-analysis of the datasets showed that
43% of children below the poverty line were stunted. Based on this estimate, the total number
of disadvantaged children is 227 million. Although the estimate of 219 million is inevitably
crude, it is more conservative than the alternative estimate of 227 million; we use the lower
estimate in the rest of the paper.
Figure 4 shows the numbers of disadvantaged children in millions by region. Most
disadvantaged children (89 million) are in south Asia. The top ten countries with the largest
number of disadvantaged children (in millions) are: India 65, Nigeria 16, China 15, Bangladesh
10, Ethiopia 8, Indonesia 8, Pakistan 8, Democratic Republic of the Congo 6, Uganda 5, and
Tanzania 4. These ten countries account for 145 (66%) of the 219 million disadvantaged
children in the developing world.
Figure 5 shows the prevalence by country. Sub-Saharan Africa has the highest prevalence of
disadvantaged children under 5 years, 61% (table 4), followed by south Asia with 52%.
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Limitations of the estimate of numbers of disadvantaged children
More than 200 million disadvantaged children is an exceedingly large amount. However,
limitations in the data suggest that the estimate is conservative. We assumed that the percentage
of people in absolute poverty was equal to the percentage of children in absolute poverty. This
assumption probably underestimates the number of children because poverty is associated with
higher fertility levels and larger household size. Furthermore, less than US$1 per day is an
extreme measure of poverty, and children in slightly better off households are probably also
at risk. Also, we did not take into account many other risk factors for poor development, such
as maternal illiteracy, unstimulating homes, and micronutrient deficiencies.
WHO recently produced new growth standards, and the −2 SD curves for length and height-
for-age are slightly higher than the −2SD curves of the previous standards in certain age ranges
under 60 months. Therefore, if we used the new growth standards our estimate of prevalence
of stunting and disadvantaged children would be slightly higher.
The precision of the estimate of disadvantaged children would be improved with internationally
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comparable data for maternal education and stimulation in the home. We also need data to
establish which cutoff for income and poverty is best for identifying children at high risk.
Internationally comparable and feasible measures of child development would produce the best
estimate of disadvantaged children, and there is an urgent need to develop such measures both
to more accurately assess the problem and to assess interventions.
Some of the disadvantaged children would have IQs of less than −2 SD, the level used to
diagnose mild mental retardation (IQ 50–69). However, a deficit in adaptive behaviour is
usually needed to make the diagnosis and these data are not available, although most would
have learning problems in school and restricted employment opportunities. We are concerned
in this series about the loss of potential across the whole range of cognitive ability.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
8. Grantham-McGregor et al. Page 8
Economic implications of poor child development
Disadvantaged children in developing countries who do not reach their developmental potential
are less likely to be productive adults. Two pathways reduce their productivity: fewer years of
schooling, and less learning per year in school. What is the economic cost of one less year of
schooling? Studies from 51 countries show that, on average, each year of schooling increases
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wages by 9·7%. Although some of the studies had methodological weaknesses, this average
matches another more rigorous study, which reported that each year of schooling in Indonesia
increased wages by 7–11%.
Both stunting and poverty are associated with reduced years of schooling. Table 5 presents
data for school grades attained in 18-year-old Brazilian men, by income quintile at birth and
stunting status in the first 2 years. We estimate from these data that the deficit attributed to
being stunted (height-for-age less than −2 z scores compared with non-stunted greater than −1
z scores), stratified for income quintiles was 0·91 grades, and the deficit from living in poverty
(first vs third quintile of income) stratified for stunting status was 0·71 grades. Furthermore,
the deficit from being both stunted and in poverty (first income quintile) compared with being
non-stunted and in the third income quintile was 2·15 grades.
Stunted children also learn less per year in school. Data from the Philippines has shown that,
controlling for years of schooling and income, the combined reading and math test score of
stunted children was 0·72 SD below that of non-stunted children. This reduction was equivalent
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to 2·0 fewer years of schooling. Regression analysis with Jamaican data corroborate this
finding; controlling for wealth and grade level, stunted children's combined math and reading
test score was 0·78 SD below those of non-stunted children. Controlling for stunting, poor
children almost certainly learn less per year in school, but we know of no studies that
convincingly estimate the deficit.
Assuming that every year of schooling increases adult yearly income by 9%, we estimate that
the loss in adult income from being stunted but not in poverty is 22·2%, the loss from living
in poverty but not being stunted is 5·9% and from being both stunted and in poverty is 30·1%
(table 6). Taking into account the number of children who are stunted, living in poverty, or
both (table 6), we calculate the average deficit in adult yearly income for all 219 million
disadvantaged children to be 19·8%. This estimate is limited by the scarcity of data for the loss
of learning ability of children in poverty, and almost certainly underestimates the true loss.
Clearly, disadvantaged children are destined not only to be less educated and have poorer
cognitive function than their peers but also to be less productive. In consideration of the total
cost to society of poor early child development, we need to take into account that the next
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generation will be affected, sustaining existing inequities in society with their attendant
problems. Where large numbers of children are affected, national development will also be
substantially affected. These costs have to be weighed against those of interventions.
Conclusion
Many children in developing countries are exposed to multiple risks for poor development
including poverty and poor health and nutrition. There are few national data for children's
development but our conservative estimate is that more than 200 million children under 5 years
of age in developing countries are not developing to their full potential. Sub-Saharan African
countries have the highest percentage of disadvantaged children but the largest number live in
south Asia. The children will subsequently do poorly in school and are likely to transfer poverty
to the next generation. We estimate that this loss of human potential is associated with more
than a 20% deficit in adult income and will have implications for national development. The
proximal causes of poor child development are analysed in the second paper in this series.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
9. Grantham-McGregor et al. Page 9
The problem of poor child development will remain unless a substantial effort is made to mount
appropriate integrated programmes. There is increasing evidence that early interventions can
help prevent the loss of potential in affected children and improvements can happen rapidly
(see third paper in this series). In view of the high cost of poor child development, both
economically and in terms of equity and individual well-being, and the availability of effective
interventions, we can no longer justify inactivity.
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Search strategy and selection criteria
The following databases were searched for studies in developing countries reported in
English from 1985, to February, 2006: BIOSIS via ISI web of science, PubMed, ERIC,
PsychInfo, LILACS, EMBASE, SIGLE, and Cochrane Review, along with published
documents from the World Bank, UNICEF, and UNESCO's International Bureau of
Education. References in retrieved papers were examined and further information sought
from experts in the field. Keywords used for search 1 were: “developing countries” or
“developing nations” or “third world” and “child development” or “cognitive development”
or “language development” or “cognition” or “education” or “school enrolment”, “school
dropout”, “grade retention”, “grade attained”, “educational achievement”. For search 2 we
also used stunting or malnutrition or undernutrition, and for search 3 we used search 1
keywords and poverty or income or economic status.
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Conflict of interest statement
We declare that we have no conflict of interest.
Web Extra Material
Supplementary Material1. Webtable.
Supplementary Material2. Webappendix.
Acknowledgments
Acknowledgments
UNICEF provided funding for a working group meeting for all of the authors with assistance from the Bernard van
Leer Foundation. The UNICEF Innocenti Centre in Florence, Italy, hosted the meeting. Deanna Olney provided
research assistance. Cesar Victora, Fernando Barros, Magda Damiani, Rosangela Lima, Denise Gigante, and Bernardo
Horta assisted with the Brazilian data, Andres Lescano analysed Peruvian data, Shane Norris assisted with the South
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African data, and Tanya Abramsky analysed the Young Lives data. The sponsor of the study had no role in study
design, data collection, data analysis, data interpretation, or writing of the report.
International Child Development Steering Group—Sally Grantham-McGregor, Patrice Engle, Maureen Black, Julie
Meeks Gardner, Betsy Lozoff, Theodore D Wachs, Susan Walker.
References
1. Jones G, Steeketee RW, Black RE, Bhutta ZA, Morris S, the Bellagio Child Survival Study Group.
How many deaths can we prevent this year? Lancet 2003;362:65–71. [PubMed: 12853204]
2. Maitra P. Effect of socioeconomic characteristics on age at marriage and total fertility in Nepal. J
Health Pop Nutr 2004;22:84–96. [PubMed: 15190816]
3. Lam D, Duryea S. Effects of schooling on fertility, labor supply, and investments in children, with
evidence from Brazil. J Hum Res 1999;34:160–192.
4. Frankenberg E, Mason W. Maternal education and health-related behaviors: a preliminary analysis of
the 1993 Indonesian Family Life Survey. J Pop 1995;1:21–44.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
10. Grantham-McGregor et al. Page 10
5. Hatt LE, Waters HR. Determinants of child morbidity in Latin America: a pooled analysis of
interactions between parental education and economic status. Soc Sci Med 2006;62:375–386.
[PubMed: 16040175]
6. Psacharopoulos G. The determinants of early age human capital formation: evidence from Brazil. Econ
Dev Cult Change 1989;37:683–708.
7. Rosenzweig MR, Wolpin KI. Are there increasing returns to the intergenerational production of human
Sponsored Document
capital—maternal schooling and child intellectual achievement. J Hum Res 1994;29:670–693.
8. UN. Road map toward the implementation of the United Nations Millennium Declaration. United
Nations; New York: 2002. United Nations General Assembly Document A56/326
9. Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht JP. Applying an equity
lens to child health and mortality: more of the same is not enough. Lancet 2003;362:233–241.
[PubMed: 12885488]
10. Wachs, TD. Necessary but not sufficient: the respective roles of single and multiple influences on
individual development. American Psychological Association; Washington DC: 2000.
11. Brooks-Gunn J, Duncan GJ. The effects of poverty on children. Future Child 1997;7:55–71. [PubMed:
9299837]
12. Bradley R, Corwyn R. Socioeconomic status and child development. Ann Rev Psychol 2002;53:371–
399. [PubMed: 11752490]
13. Mistry RS, Biesanz JC, Taylor LC, Burchinal M, Cox MJ. Family income and its relation to preschool
children's adjustment for families in the NICHD study of early child care. Dev Psychol 2004;40:727–
745. [PubMed: 15355162]
14. NICHD Early Child Care Research Network. Before Head Start: income and ethnicity, family
Sponsored Document
characteristics, child care experiences and child development. Early Educ Dev 2001;12:545–576.
15. Rutter M. Pathways from childhood to adult life. J Child Psychol Psychiatr 1989;30:23–51.
16. Committee on Integrating the Science of Child Development. From neurons to neighborhoods: the
science of child development. National Academy Press; Washington DC: 2000.
17. Thompson RA, Nelson CA. Developmental science and the media: early brain development. Am
Psychol 2001;56:5–15. [PubMed: 11242988]
18. Black, J.; Jones, T.; Nelson, C.; Greenough, W. Neuronal plasticity and the developing brain.
Handbook of child and adolescent psychiatry. Vol. vol 1. Wiley; New York: 1998. p. 31-53.
19. Liu D, Diorio J, Day J, Francis D, Meaney M. Maternal care, hippocampal synaptogenesis and
cognitive development in rats. Nat Neurosci 2000;3:799–806. [PubMed: 10903573]
20. Meaney M. Maternal Care, gene expression, and the transmission of individual differences in stress
reactivity across generations. Ann Rev Neurosci 2001;24:1161–1192. [PubMed: 11520931]
21. Morgan R, Garavan H, Smith E, Driscoll L, Levitsky D, Strupp B. Early lead exposure produces
lasting changes in sustained attention, response initiation, and reactivity to errors. Neurotoxicol
Teratol 2001;23:519–531. [PubMed: 11792522]
22. Rodier P. Environmental causes of central nervous system maldevelopment. Pediatrics
Sponsored Document
2004;113:1076–1083. [PubMed: 15060202]
23. Webb S, Monk C, Nelson C. Mechanisms of postnatal neurobiological development: implications
for human development. Dev Neuropsychol 2001;19:147–171. [PubMed: 11530973]
24. Wilson MA, Johnston MV, Goldstein GW, Blue ME. Neonatal lead exposure impairs development
of rodent barrel field cortex. PNAS 2000;97:5540–5545. [PubMed: 10805810]
25. Gunnar M. Stress, nurture and the young brain. Concepts of care: twenty brief papers that point the
way toward quality care for infants and toddlers. San Francisco: West Ed (in press).
26. Bredy T, Humpartzoomian R, Cain D, Meaney M. Partial reversal of the effect of maternal care on
cognitive function through environmental enrichment. Neurosci 2003;118:571–576.
27. Meaney M, Mitchell J, Aitken D. The effects of neonatal handling on the development of the
adrenocortical response to stress: implications for neuropathology and cognitive deficits in later life.
Psychoneuroendocrinol 1991;16:85–103.
28. Rutter M, O'Connor T, English and Romanian Adoptees (ERA) Study Team. Are there biological
programming effects for psychological development? Findings from a study of Romanian adoptees.
Dev Psychol 2004;40:81–94. [PubMed: 14700466]
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
11. Grantham-McGregor et al. Page 11
29. Currie, J.; Thomas, D. Early test scores, socioeconomic status and future outcomes. National Bureau
of Economic Research; Cambridge: 1999. Working Paper 6943
30. Pianta RC, McCoy SJ. The first day of school: the predictive validity of early school screening. J
Appl Dev Psychol 1997;18:1–22.
31. Feinstein L. Inequality in the early cognitive development of children in the 1970 cohort. Economica
2003;70:73–97.
Sponsored Document
32. Stith AY, Gorman KS, Choudhury N. The effects of psychosocial risk and gender on school attainment
in Guatemala. Appl Psychol 2003;52:614–629.
33. Gorman KS, Pollitt E. Does schooling buffer the effects of early risk? Child Dev 1996;67:314–326.
[PubMed: 8625715]
34. Liddell C, Rae G. Predicting early grade retention: A longitudinal investigation of primary school
progress in a sample of rural South African children. Br J Educ Psychol 2001;71:413–428. [PubMed:
11593948]
35. Daniels MC, Adair LS. Growth in young Filipino children predicts schooling trajectories through
high school. J Nutr 2004;134:1439–1446. [PubMed: 15173409]
36. Mendez MA, Adair LS. Severity and timing of stunting in the first two years of life affect performance
on cognitive tests in late childhood. J Nutr 1999;129:1555–1562. [PubMed: 10419990]
37. Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial
stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican
children: prospective cohort study. Lancet 2005;366:1804–1807. [PubMed: 16298218]
38. Victora CG, Barros FC, Lima RC. The Pelotas birth cohort study, Rio Grande do Sul, Brazil, 1982–
2001. Cad Saude Publica, Rio de Janeiro 2003:1241–1256.
Sponsored Document
39. Victora MD, Victora CG, Barros FC. Cross-cultural differences in developmental rates: a comparison
between British and Brazilian children. Child Care Health Dev 1990;16:151–164. [PubMed:
2350868]
40. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application
to educational enrollments in states of India. Demography 2001;38:115–132. [PubMed: 11227840]
41. Pollitt E, Gorman KS, Engle PL, Martorell R, Rivera J. Early supplementary feeding and cognition.
Mon Soc Child Dev 1993;58
44. UNESCO. EFA Global Monitoring Report 2005. UNESCO; Paris, France: 2005.
45. Gonzalez, P.; Guzman, JC.; Partelow, L. Highlights from the trends in international mathematics and
science study TIMSS 2003. US Department of Education; Washington DC: 2004.
46. Byamugisha, A.; Ssenabulya, F. The SACMEQ II project in Uganda: a study of the conditions of
schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
47. Chimombo, J.; Kunje, D.; Chimuzu, T.; Mchikoma, C. The SACMEQ II project in Malawi: a study
of the conditions of schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
48. Keitheile, M.; Mokubung, M. The SACMEQ II project in Botswana: a study of the conditions of
schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
Sponsored Document
49. Kulpoo, D.; Soonarane, M. The SACMEQ II project in Mauritius: a study of the conditions of
schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
50. Makuwa, D. The SACMEQ II project in Namibia: a study of the conditions of schooling and the
quality of education. SACMEQ; Harare, Zimbabwe: 2005.
51. Moloi, M.; Strauss, J. The SACMEQ II project in South Africa: a study of the conditions of schooling
and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
52. Mothibeli, A.; Maema, M. The SACMEQ II project in Lesotho: a study of the conditions of schooling
and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
53. Mrutu, AS.; Ponera, GE.; Nkumbi, EM. The SACMEQ II project in Tanzania: a study of the conditions
of schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
54. Nassor, SM.; Abdalla, MS.; Salim, MM.; Said, O. The SACMEQ II project in Zanzibar: a study of
the conditions of schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
55. Onsomu, E.; Nzomo, J.; Obiero, C. The SACMEQ II project in Kenya: a study of the conditions of
schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
12. Grantham-McGregor et al. Page 12
56. Passos, A.; Nahara, T.; Magaza, F.; Lauchande, C. The SACMEQ II project in Mozambique: a study
of the conditions of schooling and the quality of education. SACMEQ; Harare, Zimbabwe: 2005.
57. Shabalala, J. The SACMEQ II project in Swaziland: a study of the conditions of schooling and the
quality of education. SACMEQ; Harare, Zimbabwe: 2005.
58. Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF. NCHS growth curves for children birth–
18 years. United States. Vital Health Stat 1977;11:1–74.
Sponsored Document
59. Bhandari N, Bahl R, Taneja S, de Onis M, Bhan MK. Growth performance of affluent Indian children
is similar to that in developed countries. Bull World Health Organ 2002;80:189–195. [PubMed:
11984604]
60. WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among
populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006;450:56–
65. [PubMed: 16817679]
61. Shrimpton R, Victoria CG, de Onis M, Lima RC, Blossner M, Clugston G. Worldwide timing of
growth faltering: implications for nutritional interventions. Pediatrics 2001;107:e75. [PubMed:
11331725]
62. Martorell R, Schroeder DG, Rivera JA, Kaplowitz HJ. Patterns of linear growth in rural Guatemalan
adolescents and children. J Nutr 1995;125:S1060–S1067.
63. Adair LS. Filipino children exhibit catch-up growth from age 2 to 12 years. J Nutr 1999;129:1140–
1148. [PubMed: 10356078]
64. Deaton A. Counting the world's poor: problems and possible solutions. World Bank Res Obs
2001;16:125–147.
65. Gordon, G.; Nandy, S.; Pantazis, C.; Pemberton, S.; Townsend, P. Child poverty in the developing
Sponsored Document
world. The Policy Press; Bristol, UK: 2003.
66. World Bank, World development indicators 2005. World Bank, 2005.
67. Chronic Poverty Research Centre. Chronic poverty report 2004–05. University of Manchester;
Manchester, UK: 2006.
68. Hamadani JD, Grantham-McGregor SM. Report of the family care indicators project: Validating the
family psychosocial indicators in rural Bangladesh. Report to UNICEF Early Child Development
Desk, 2004.
69. Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S. Mothers of undernourished
Jamaican children have poorer psychosocial functioning and this is associated with stimulation
provided in the home. Eur J Clin Nutr 2003;57:786–792. [PubMed: 12792663]
70. Schady, N.; Paxson, C. Cognitive development among young children in Ecuador: the roles of health,
wealth and parenting. World Bank Policy Research Working Paper 3605, May, 2005. World Bank;
Washington DC: 2005.
71. Richter, L.; Griesel, R.; De Wet, T. Growing up and going to school: Birth to Ten, children's cognitive
and social competence at school entry. In: Richter, L., editor. A view of school: preparation for and
adjustment to school under rapidly changing social conditions. The Goethe Institute; Johannesburg:
1998.
Sponsored Document
72. Espy KA, Molfese VJ, DiLalla LF. Effects of environmental measures on intelligence in young
children: growth curve modeling of longitudinal data. Merrill-Palmer Quart 2001;47:42–73.
73. Walker SP, Grantham-McGregor SM. Growth and development of West Indian children. Part 2:
development. West Indian Med J 1990;39:12–19. [PubMed: 1692174]
74. Lozoff B, Teal SJL. Longitudinal analysis of cognitive and motor effects of iron deficiency in infancy.
Pediatr Res 2004;55:23A.
75. UNICEF. State of the world's children 2006. UNICEF; New York: 2005.
76. WHOGlobal database on child growth and malnutrition. World Health Organization. http://
www.who.int/nutgrowthdb/database/en/2006(accessed March 18, 2006)
77. Beasley NMR, Hall A, Tomkins AM. The health of enrolled and non enrolled children of school age
in Tanga, Tanzania. Acta Trop 2000;76:223–229. [PubMed: 10974162]
78. Moock PR, Leslie J. Childhood malnutrition and schooling in the Terai region of Nepal. J Dev Econ
1986;20:33–52.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
13. Grantham-McGregor et al. Page 13
79. Brooker S, Hall A, Bundy DAP. Short stature and the age of enrolment in primary school: studies in
two African countries. Soc Sci Med 1999;48:675–682. [PubMed: 10080367]
80. Jamison DT. Child malnutrition and school performance in China. J Dev Econ 1986;20:299–309.
81. Clarke N, Grantham-McGregor S, Powell C. Health and nutrition predictors of school failure in
Kingston, Jamaica. Ecol Food Nutr 1990;26:1–11.
82. Hutchinson SE, Powell CA, Walker SP, Chang SM, Grantham-McGregor SM. Nutrition, anaemia,
Sponsored Document
geohelminth infection and school achievement in rural Jamaican primary school children. Eur J Clin
Nutr 1997;51:729–735. [PubMed: 9368806]
83. Agarwal DK, Upadhyay SK, Tripathi AM, Agarwal KN. Nutritional status, physical work capacity
and mental function in school children. Nutritional Foundation of India, 1987. Scientific Report No.
6.
84. Florencio, C. Nutrition, health and other determinants of academic achievement and school-related
behavior of grades one to six pupils. University of the Philippines; Quezan City, Philippines: 1988.
85. Steegmann AT, Datar FA, Steegmann RM. Physical size, school performance and visual-motor
maturity in the Philippines. Am J Hum Biol 1992;4:247–252.
86. Glewwe P, Jacoby HG, King EM. Early childhood nutrition and academic achievement: a longitudinal
analysis. J Public Econ 2001;81:345–368.
87. Shariff ZM, Bond JT, Johnson NE. Nutrition and educational achievement of urban primary
schoolchildren in Malaysia. Asia Pacific J Clin Nutr 2000;9:264–273.
88. Partnership for Child Development. An association between chronic undernutrtition and educational
test scores in Vietnamese children. Eur J Clin Nutr 2001;55:801–804. [PubMed: 11528497]
89. Brito GNO, de Onis M. Growth status, behavior and neuropsychological performance. Arquivos
Sponsored Document
Neuro-Psiquiatr 2004;62:949–954.
90. Ozmert EN, Yurdakok K, Soysal S. Relationship between physical, environmental and
sociodemographic factors and school performance in primary schoolchildren. J Trop Pediatr
2005;51:25–32. [PubMed: 15601652]
91. Bogin B, Macvean RB. The relationship of socioeconomic-status and sex to body size, skeletal
maturation, and cognitive status of Guatemala City schoolchildren. Child Dev 1983;54:115–128.
[PubMed: 6831980]
92. Sigman M, Neumann C, Jansen AA, Bwibo N. Cognitive abilities of Kenyan children in relation to
nutrition, family characteristics, and education. Child Dev 1989;60:1463–1474. [PubMed: 2515042]
93. Johnston FE, Low SM, de Baessa Y, Macvean RB. Interaction of nutritional and socioeconomic status
as determinants of cognitive development in disadvantaged urban Guatemalan children. Am J Phys
Anthropol 1987;73:501–506. [PubMed: 3661687]
94. Webb KE, Horton NJ, Katz DL. Parental IQ and cognitive development of malnourished Indonesian
children. Euro J Clin Nutr 2005;59:618–620.
95. Young LivesJustification of the content of the 7·5–8·5 year old questionnaire. Young Lives: an
international study of childhood poverty. http://www.younglives.org.uk/2002(accessed March 18,
2006)
Sponsored Document
96. Ivanovic DM, Perez HT, Olivares MD, Diaz NS, Leyton BD, Ivanovic RM. Scholastic achievement:
a multivariate analysis of nutritional, intellectual, socioeconomic, sociocultural, familial, and
demographic variables in Chilean shool-aged children. Nutrition 2004;20:878–889. [PubMed:
15474876]
97. Cueto S. Height, weight, and education achievement in rural Peru. Food Nutr Bull 2005;26(2 suppl
2):S251–S260. [PubMed: 16075575]
98. Glewwe P, Jacoby H. An economic analysis of delayed primary school enrollment in a low income
country: the role of early childhood nutrition. Rev Econ Stat 1995;77:156–169.
99. Popkin B, Lim Ybanez M. Nutrition and school achievement. Soc Sci Med 1982;16:53–61. [PubMed:
7100957]
100. Lasky RE, Klein RE, Yarbrough C, Engle PL, Lechtig A, Martorell R. The relationship between
physical growth and infant behavioral development in rural Guatemala. Child Dev 1981;52:219–
226. [PubMed: 7238146]
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
14. Grantham-McGregor et al. Page 14
101. Powell CA, Grantham-Mcgregor S. The ecology of nutritional status and development in young
children in Kingston, Jamaica. Am J Clin Nutr 1985;41:1322–1331. [PubMed: 4003336]
102. Monckeberg, F. Malnutrition and mental capacity. In: Organization, PAH., editor. Nutrition, the
nervous system and behaviour, Scientific Publication No 251. PAHO; Washington DC: 1972. p.
48-54.
103. Sigman M, Neumann C, Baksh M, Bwibo N, McDonald MA. Relationship between nutrition and
Sponsored Document
development in Kenyan toddlers. J Pediatr 1989;115:357–364. [PubMed: 2769494]
104. Kariger PK, Stoltzfus RJ, Olney D. Iron deficiency and physical growth predict attainment of
walking but not crawling in poorly nourished Zanzibari infants. J Nutr 2005;135:814–819.
[PubMed: 15795440]
105. Siegel EH, Stoltzfus RJ, Kariger PK. Growth indices, anemia, and diet independently predict motor
milestone acquisition of infants in South Central Nepal. J Nutr 2005;135:2840–2844. [PubMed:
16317129]
106. Bhargava A. Modeling the effects of maternal nutritional status and socioeconomic variables on the
anthropometric and psychological indicators of Kenyan infants from age 0–6 months. Am J Phys
Anthropol 2000;111:89–104. [PubMed: 10618590]
107. Vazir S, Naidu AN, Vidyasagar P. Nutritional status, psychosocial development and the home
environment of Indian rural children. Indian Pediatr 1998;35:959–966. [PubMed: 10216718]
108. Drewett R, Wolke D, Asefa M, Kaba M, Tessema F. Malnutrition and mental development: is there
a sensitive period? A nested case-control study. J Child Psychol Psychiatr 2001;42:181–187.
109. Hamadani JD, Fuchs GJ, Osendarp SJ, Khatun F, Huda SN, Grantham-McGregor SM. Randomized
controlled trial of the effect of zinc supplementation on the mental development of Bangladeshi
Sponsored Document
infants. Am J Clin Nutr 2001;74:381–386. [PubMed: 11522564]
110. Hamadani JD, Fuchs GJ, Osendarp SJ, Huda SN, Grantham-McGregor SM. Zinc supplementation
during pregnancy and effects on mental development and behaviour of infants: a follow-up study.
Lancet 2002;360:290–294. [PubMed: 12147372]
111. Cheung YB, Yip PSF, Karlberg JPE. Fetal growth, early postnatal growth and motor development
in Pakistani infants. Int J Epidemiol 2001;30:66–72. [PubMed: 11171859]
112. Kuklina EV, Ramakrishnan U, Stein AD, Barnhart HH, Martorell R. Growth and diet quality are
associated with the attainment of walking in rural Guatemalan infants. J Nutr 2004;134:3296–3300.
[PubMed: 15570028]
113. Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM. Effects of stunting, diarrhoeal
disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study.
Lancet 2002;359:564–571. [PubMed: 11867110]
114. Martorell, R.; Rivera, J.; Kaplowitz, J.; Pollitt, E. Long term consequences of growth retardation
during early childhood. In: Hernandez, M.; Argenta, J., editors. Human growth: basic and clinical
aspects. Elsevier; Amsterdam: 1992. p. 143-149.
115. Behrman JR, Hoddinott J, Maluccio JA, et al. What determines adult cognitive skills? Impacts of
pre-school, schooling and post-school experiences in Guatemala. 2005. Working draft October
Sponsored Document
2005.
116. Cheung YB. Growth and cognitive function of Indonesian children: Zero-inflated proportion models.
Stat Med 2006;25:3011–3022. [PubMed: 16345028]
117. Richter LM, Yach D, Cameron N, Griesel RD, De Wet T. Enrolment into Birth to Ten (BTT):
population and sample characteristics. Paediatr Perinat Epidemiol 1995;9:109–120. [PubMed:
7724410]
118. Wechsler, D. Wechsler adult intelligence scale manual. Psychological Corporation; New York:
1955.
119. Wechsler, D. Wechsler Intelligence Scales for Children-Revised. The Psychological Corporation,
Harcourt Brace Jovanovich Inc; San Antonio: 1974.
120. Raven, J.; Raven, J.; Court, J. Coloured Progressive Matrices. Information Press; Oxford: 1998.
121. Alderman H, Behrman JR, Khan S, Ross DR, Sabot R. The income gap in cognitive skills in rural
Pakistan. Econ Dev Cult Change 1997;46:97–122.
122. Behrman JR, Knowles JC. Household income and child schooling in Vietnam. World Bank Econ
Rev 1999;13:211–256.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
15. Grantham-McGregor et al. Page 15
123. Filmer D, Pritchett L. The effect of household wealth on educational attainment: evidence from 35
countries. Pop Dev Rev 1999;25:85–120.
124. Aldaz-Carroll E, Moran R. Escaping the poverty trap in Latin America: the role of family factors.
Cuadernos Econom 2001;38:155–190.
125. Baker-Henningham, H.; Walker, S.; Chang-Lopez, S. Special education needs study: end of phase
1 report. Department of Educational Studies/Office of the Principal, University of the West Indies;
Sponsored Document
Kingston, Jamaica: 2006.
126. Kirksey A, Wachs TD, Srinath U. Relation of maternal zinc nutrition to pregnancy outcome and
early infant development in an Egyptian village. Am J Clin Nutr 1994;60:782–792. [PubMed:
7942587]
127. Lima MC, Eickmann SH, Lima ACV. Determinants of mental and motor development at 12 months
in a low income population: a cohort study in northeast Brazil. Acta Paediatr 2004;93:969–975.
[PubMed: 15303815]
128. Black MM, Sazawal S, Black RE, Khosla S, Kumar J, Menon V. Cognitive and motor development
among small for gestational age infants: impact of zinc supplementation, birth weight, and
caregiving practices. Pediatr 2004;113:1297–1305.
129. Basilio CS, Puccini RF, da Silva EMK, Pedromônico MRM. Living conditions and receptive
vocabulary of children aged two to five years. Rev Saude Publica 2005;39:725–730. [PubMed:
16254647]
130. Sigman M, McDonald MA, Neumann C, Bwibo N. Prediction of cognitive competence in Kenyan
children from toddler nutrition, family characteristics and abilities. J Child Psychol Psychiat
1991;32:307–320. [PubMed: 1903401]
Sponsored Document
131. Stein AD, Behrman JR, DiGirolamo A. Schooling, educational achievement and cognitive
functioning among young Guatemalan adults. Food Nutr Bull 2005;26:S46–S54. [PubMed:
16060211]
132. Chen, S.; Ravallion, M. How have the world's poorest fared since the early 1980s? World Bank
Policy Research Working Paper (WPS 3341). World Bank; Washington: 2004.
133. de Onis M, Blossner M, Borghi E, Morris R, Frongillo EA. Methodology for estimating regional
and global trends of child malnutrition. Int J Epidemiol 2004;33:1260–1270. [PubMed: 15542535]
134. UNICEFMultiple indicator cluster surveys 2. UNICEF. http://www.childinfo.org/MICS2/
MICSDataSet.htm2006(accessed Feb 24, 2006)
135. de Onis, M.; Onyango, A.; Borghi, E.; Siyam, A.; Pinol, A. WHO child growth standards: length/
height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age:
methods and development. World Health Organization; Geneva: 2006.
136. WHOInternational statistical classification of diseases and related health problems, 10th revision,
version for 2006. World Health Organization. http://www3.who/int/icd/currentversion/fr-
icd.htm2006(accessed July 18, 2006)
137. Psacharopoulos G, Patrinos H. Returns to investment in education: a further update. Educ Econ
2004;12:111–134.
Sponsored Document
138. Duflo E. Schooling and labor market consequences of school construction in Indonesia: evidence
from an unusual policy experiment. Am Econ Rev 2001;91:795–814.
Uncited references
42. Thorndike, RL.; Hagen, E.; Sattler, J. Stanford-Binet Intelligence Scale. 4th edn.. Riverside
Publishing; Itasca: 1986.
43. Griffiths, R. The abilities of young children: a comprehensive system of mental measurement for the
first eight years of life. Child Development Research Centre; London, UK: 1970.
Published as: Lancet. 2007 January 6; 369(9555): 60–70.
16. Grantham-McGregor et al. Page 16
Table 1
Change in later school outcomes per SD increase in intelligence quotient (IQ) or developmental quotient (DQ)
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in early life*
N Independent variable Outcome variable Measure of effect Estimate 95% CI
Jamaica† 165 IQ on the Stanford Dropped out before Odds ratio 0·53‡ 0·32–0·87
Binet test (42) at 7 grade 11
years
Reading and Mean difference 0·65§ 0·53–0·78
arithmetic score at in SD
age 17
Philippines 1134 Cognitive Score at 8 Ever repeat a grade Odds ratio 0·60¶ 0·49–0·75
years by age 14 years
Brazil‖ 152 DQ on Griffiths test Grades attained by Mean difference 0·71** 0·34–1·07
(43) at 4.5 years age 18 years in grades achieved
*
Adjusted for sex, age, mother's education, and wealth quintile.
†
Sample consisted of stunted (<−2 SD) children participating in an intervention trial and a non-stunted (>−1 SD) comparison group. Intervention and
stunting status were also adjusted for.
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‡
p=0·0117; Hosmer-Lemeshow goodness-of-fit test p=0·5704.
§
p<0·0001; R2=54·4%.
¶
p<0·0001; Hosmer-Lemeshow goodness-of-fit test p=0·5375.
‖
Boys only.
**
p=0·0002; R2=51·9%.
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Published as: Lancet. 2007 January 6; 369(9555): 60–70.
17. Grantham-McGregor et al. Page 17
Table 2
Descriptive summary of follow-up studies showing associations between stunting in early childhood and later
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scores on cognitive tests and school outcomes
Philippines South Africa Indonesia Brazil* Peru Jamaica†
Cognitive Ravens Reasoning Attained WISC IQ(9 WAIS IQ‡ Reading and
score (8 Matrices(7 and grades years, (17–18 years, arithmetic‡ (17–
years, years, arithmetic (18 n=72) n=165) 18 years)
n=2489) (9 years, years,
n=603)‡ n=368) n=2041)
Not stunted 56·4 0·17 11·2 8·1 92·3 0·38 0·40
Mildly stunted 53·8 (−0·21) 0·05 (−0·12) 10·3 (−0·26) 7·2 (−0·4) 89·8 (−0·20)
Moderately or 49·6 (−0·54) −0·23 (−0·40) 9·7 (−0·43) 6·5 (−0·7) 79·2 (−1·05) −0·55 (−0·93) −0·60 (−1·00)
severely
stunted
Data are mean (effect size as unadjusted difference from non-stunted children in z scores).
*
Males only.
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†
The sample comprised stunted (<−2 SD) children participating in an intervention trial and a non-stunted (>−1 SD) comparison group.
‡
SD scores. WISC=Wechsler Intelligence Scale for Children. WAIS=Wechsler Adult Intelligence Scale.
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Published as: Lancet. 2007 January 6; 369(9555): 60–70.
18. Grantham-McGregor et al. Page 18
Table 3
Descriptive summary of follow-up studies showing association between wealth quintiles in early childhood, and
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later cognitive and school outcomes
Philippines Indonesia South Africa Brazil Guatemala*
Cognitive Reasoning Ravens Attained Reading and vocabulary (26–
score (8 and progressive grades (18 41 years of age at assessment)
years of age arithmetic matrices†(7 years of age
at (9 years of years of age at
assessment, age at at assessment,
n=2485) assessment, assessment, n=2222)
n=371) n=1143)
Boys (n=683) Girls (n=786)
Fifth quintile (wealthiest) 56·9 12·1 0·47 9·3 50·9 44·8
Fourth quintile 52·5 (−0·35) 11·0 (−0·31) 0·13 (−0·34) 8·2 (−0·48)
Third quintile 51·6 (−0·42) 11·0 (−0·31) −0·16 (−0·63) 7·4 (−0·84) 43·3 (−0·45) 43·6 (−0·01)
Second quintile 49·4 (−0·60) 9·5 (−0·74) −0·20 (−0·67) 6·8 (−1·11)
First quintile (poorest) 46·4 (−0·84) 8·4 (−1·06) −0·23 (−0·70) 6·5 (−1·24) 41·0 (−0·53) 37·6 (−0·45)
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Data are mean (effect size as unadjusted difference from the richest quintile in z scores).
*
Tertiles.
†
SD scores.
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Published as: Lancet. 2007 January 6; 369(9555): 60–70.