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J Child Psychol Psychiatry. 2017 Nov;58(11):1264-1275. doi: 10.1111/jcpp.12751. Epub 2017 May 23.

Predictors and pathways of language and motor development in four prospective cohorts of young children in Ghana, Malawi, and Burkina Faso.

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Department of Nutrition, University of California Davis, Davis, CA, USA.
Department of Nutrition and Food Science, University of Ghana, Legon Accra, Ghana.
Center for Child Health Research, School of Medicine and Tampere University Hospital, University of Tampere, Tampere, Finland.
Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
Bill & Melinda Gates Foundation, Seattle, WA, USA.
Institut de Recherche en Sciences de la Santé/DRO, Bobo-Dioulasso, Burkina Faso.
Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
Divison of Psychiatry, University of Edinburgh, Edinburgh, UK.
Department of Agricultural and Resource Economics, University of California Davis, Davis, CA, USA.
Center for Education Policy Research, University of New Mexico, Albuquerque, NM, USA.



Previous reviews have identified 44 risk factors for poor early child development (ECD) in low- and middle-income countries. Further understanding of their relative influence and pathways is needed to inform the design of interventions targeting ECD.


We conducted path analyses of factors associated with 18-month language and motor development in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements (iLiNS) Project in Ghana (n = 1,023), Malawi (n = 675 and 1,385), and Burkina Faso (n = 1,122). In two cohorts, women were enrolled during pregnancy. In two cohorts, infants were enrolled at 6 or 9 months. In multiple linear regression and structural equation models (SEM), we examined 22 out of 44 factors identified in previous reviews, plus 12 additional factors expected to be associated with ECD.


Out of 42 indicators of the 34 factors examined, 6 were associated with 18-month language and/or motor development in 3 or 4 cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and child hemoglobin/iron status. Factors that were not associated with child development were indicators of maternal Hb/iron status, maternal illness and inflammation during pregnancy, maternal perceived stress and depression, exclusive breastfeeding during 6 months postpartum, and child diarrhea, fever, malaria, and acute respiratory infections. Associations between socioeconomic status and language development were consistently mediated to a greater extent by caregiving practices than by maternal or child biomedical conditions, while this pattern for motor development was not consistent across cohorts.


Key elements of interventions to ensure quality ECD are likely to be promotion of caregiver activities with children, a variety of play materials, and a diverse diet, and prevention of faltering in linear and ponderal growth and improvement in child hemoglobin/iron status.


Language development; growth; iLiNS Project; lipid-based nutrient supplements; low- and middle-income countries; motor development; nutrition; risk factors; stimulation

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