Impact of adversity on early childhood growth & development in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS)

Abstract

IntroductionEarly childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & development.MethodsThis was a substudy of the SPRING cluster randomised controlled trial covering the whole population of 120 villages of rural India. We assessed all children born from 18 June 2015 for adversities in the first year of life and summed these to make a total cumulative adversity score, and four subscale scores. We assessed the association of each of these with weight-for-age z-score, length-for-age z-score, and the motor, cognitive and language developmental scales of the Bayley Scales of Infant Development III assessed at 18 months.ResultsWe enrolled 1726 children soon after birth and assessed 1273 of these at both 12 and 18 months of age. There were consistent and strongly negative relationships between all measures of childhood adversity and all five child growth & development outcome measures at 18 months of age. For the Bayley motor scale, each additional adversity was associated with a 1.1 point decrease (95%CI -1.3, -0.9); for the cognitive scales this was 0.8 points (95%CI -1.0, -0.6); and for language this was 1.4 points (95%CI -1.9, -1.1). Similarly for growth, each additional adversity was associated with a -0.09 change in weight-for-age z-score (-0.11, -0.06) and -0.12 change in height-for-age z-score (-0.14, -0.09).DiscussionOur results are the first from a large population-based study in a low/middle-income country to show that each increase in adversity in multiple domains increases risk to child growth and development at a very early age. There is an urgent need to act to improve these outcomes for young children in LMICs and these findings suggest that Early Childhood programmes should prioritise early childhood adversity because of its impact on developmental inequities from the very start.

Comparative Study about Impact of Inadequate Psychomotor Stimulation on Neuro-Development in Pre-School Children in Rural India

“…A randomised controlled trial conducted in 2018 in Haryana, India, with 1,273 rural children, revealed consistent and strongly negative relationships between ECD and childhood adversities, where most children faced one or more adversity and nearly 50% faced four or more, which impeded a child's well-being. 13 stimulation, violence at home, neglect, abuse, and parental ill-health. 18,19 Various studies from across the globe have shown that poor stimulation alone can largely impede development.…”

Observed feeding behaviours and effects on child weight and length at 12 months of age: Findings from the SPRING cluster-randomized controlled trial in rural India

“…SPRING was implemented in 120 villages of three administrative areas of Rewari, a predominantly rural district of Haryana state, in North India, which represents a total population of around 200,000. In Rewari, demographic and health indicators are around average for Haryana state, with a female literacy rate of 67% for an overall literacy of 76%; a sex ratio amongst the lowest in India, with 879 females per 1000 males; and an infant mortality close to the national average (41/1000 births) [ 25 ]. Rewari is covered by the Integrated Child Development Services, which provides complementary nutrition to all pregnant and lactating women and children [ 26 ].…”

“…One sample size calculation was done for the SPRING-ELS substudy of which the observed feeding tool formed a part. The aim was to explore the effect of adversity on growth [25]. A minimum of 25 children per cluster was needed to give 90% power at the 5% level of significance to detect effect sizes between 0.4SD & 0.5SD, assuming an intra-cluster correlation of 0.05, using an established formula [27].…”

“…The child's weight was then calculated by subtracting the weight of the child's clothes to the weight of the fully-clothed child. Length was measured by two assessors with a precision of 0.1cm using the SECA-417 infantometer [25,28].…”

The contribution of childhood adversity to cortisol measures of early life stress amongst infants in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS)

“…Further details on each adversity are provided below. These descriptions were published previously (Bhopal et al, 2019).…”