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Poster #161 - Factors Associated with Lower-development in Young Malagasy Children in an Area of High Malnutrition Rates

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Background: Madagascar has one of the highest rates of stunting and at-risk child development in the world—50% of Malagasy children have moderate to severe stunting. In 2016, a new 10 year National Nutrition Action Plan (PNAN III), supported by the World Bank, was initiated to help address stunting and developmental delay. A new health care NGO operating in collaboration with the MOH conducts a longitudinal study, the IHOPE, to assess the population level impact of their collaborative health system strengthening activities on the rural district of Ifanadiana in southeastern Madagascar. We report factors associated with risk to developmental delay in children ages 3 and 4 years old in Ifanadiana district in 2016.

Methods: The household survey data are from a cross-sectional analysis of a one wave of panel data in 2016, at the time of the initiation of PNAN III. Women ages 15-49 were interviewed, using the MICS Early Child Development Indicator (ECDI) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. ECDI data were analyzed using standardized z scores for relative relationships. We defined the outcome as lower-development if ECDI z scores were <1 standard deviation below the study mean. Covariates included demographics (maternal age, education level, household wealth, number of other children under 5 in the house), adult involvement (reading, singing, playing with child), household environment (number and type of children’s books or toys, whether child was left alone or in the care of another child <10 years), and child health (wasting, stunting, underweight, ill in last 4 weeks, vaccination status). We included variables significant in univariable analysis at an alpha of <0.1 in a multivariable model. We constructed the final model using backward stepwise regression on generalized linear models, clustered at the sampling level.

Results: Of 432 children ages 3 and 4 years, 69 children (16.0%) were considered lower-development compared to their peers. 50.5% of the children had moderate to severe stunting and 19.0% had severe stunting. Factors associated with being lower-development based on ECDI z scores <-1 included: having other children under age 5 in the household, having a teenaged mother (age <20 years), having an adult take the child outside the house complex in last 3 days, if child’s main toys are found objects (rather than store-bought or home-made). Factors associated with less developmental risk included increased number of developmentally stimulating activities by someone other than a parent, and having an adult who recently sang songs with the child. Household wealth was not independently associated.

Discussion: In this setting of high malnutrition, stunting in children is not associated with lower-development compared to their peers, when adjusting for other factors. Families with teenaged mothers or multiple young children competing for adult attention are more likely to have children with lower-development. Non-parent adult involvement seems very relevant to children’s development in this setting. Further research in the IHOPE longitudinal study may help to clarify directionality of association. Interventions targeting adolescent girls before they become parents may be of particular utility in this setting.

Authors