Defining multidimensional criteria for inclusion in a global norming study of early development

• In Event: Creating Global Developmental Norms for Young Children: Opportunities and Challenges

Abstract

Undertaken between 1997 and 2003, the WHO’s Multicenter Growth Reference Study (MGRS) demonstrated the universality of children’s growth potential – in every region of the world – when children are born, fed and nurtured without nutritional or environmental constraints on their growth (de Onis & Onyango, 2008). More recent evidence has shown that children growing in these unconstrained conditions demonstrate a high degree of consistency in achieving key developmental milestones (e.g., walking) and in developmental competencies at age 2 years (Ertem et al., 2018; Villar et al., 2019), providing supporting evidence for the main assumption underlying the GSED study: that conditional on living in conditions without constraints, children – on average – will develop similarly everywhere.

As with prior studies of global norms, to test this assumption, we need a restricted (non-representative) sample of children, from diverse global contexts, who differ in their cultural, ethnic, and linguistic background, but have not experienced environmental, health or nutritional constraints on their development. This paper outlines the multi-step process to establish a set of eligibility criteria that were agreed upon through group consensus involving a team of subject matter experts and representatives from all country sites. These criteria will be used to identify children for this restricted sample.

The three-step selection process began by proposing an initial set of criteria based on experience from GSED validation efforts, literature reviews, and reviews of other norming studies (e.g., MGRS and INTERGROWTH-21st). Criteria included representations of physical health, nurturing care and a supportive home environment. Second, evidence of the relevance of each criterion to early childhood development was assembled, including published evidence on associations with child development and policy evidence of criterion relevance (e.g., inclusion in the SDGs). Third, the evidence was reviewed by the team to weigh challenges of identifying a restricted sample against practical recruitment needs for the study. Recommendations were made about which criteria to keep and how each would be operationalized and reliably assessed in all countries.

In making their recommendations, the team considered whether narrowly defined criteria (e.g., recurring diarrheal illness) would be captured by broad umbrella criteria (measurement of underweight or frequent hospital admission). Consideration was also given to highly correlated conditions for which screening for one would sufficiently capture another. The final eligibility criteria for inclusion in the norming study include: 1) pregnancy-related conditions, such as gestational age, and multiple birth; 2) child health conditions, such as birth weight, neonatal complications, neurological diseases, and hearing or vision disorders; 3) demographic factors such as primary caregiver education; and 4) psychosocial conditions, such as lack of stimulating activities or experience of physical punishment.

Once obtained, data from the restricted sample will be used to test the hypothesis of conditional independence across contexts. If successful in establishing developmental norms for children under three, we will use the norms to set standards for on- and off- track development at the population or group level. Global norms and standards would allow countries to track progress toward the SDGs and to strategically design programs to promote children’s early development.

Group Authors

GSED Team

Authors

• Ann Weber, University of Nevada, Reno
  Presenting Author

• Vanessa Cavallera, World Health Organization

• Susanne P Martin Herz, University of California - San Francisco

• Dana Charles McCoy, Harvard University

• Sunil Sazawal, Johns Hopkins University

• Tarun Dua, World Health Organization