Implementing evidence-based health promotion programmes at scale is important for achieving population-level health outcomes. However, achieving equitable reach can be challenging. An evidence-based early-life nutrition and movement intervention (INFANT) is currently being implemented at scale in Australia. This study explored practitioners' perceptions about reaching priority population groups through INFANT or similar universal preventive health programmes and services implemented at scale. Fifteen semi-structured online interviews were conducted with purposively selected experienced practitioners. Interviews were transcribed and analysed using reflexive thematic analysis. Two main themes were developed, representing the complexities of reaching priority population groups through universal health programmes and services in early childhood. Theme 1: "We're not hitting the mark"-Underlying issues influence universal healthcare access, highlighted (a) the perception that parents felt out of place through a sense of not belonging or being unfamiliar with universal services and (b) that practical constraints and pressing priorities impacted access. Theme 2: "There are no easy answers"-Varied approaches can enhance engagement, but the path is not straightforward, encompassed (a) the importance of trust and familiarity with providers, (b) the suitability of programmes and services for target communities, and (c) factors such as practitioner uncertainty regarding approaches that could address the needs of families from priority populations and resourcing that can limit targeted efforts. Our findings highlight the complexities of achieving equitable reach during scale-up and the varied decision-making and resourcing for addressing inequity in a local context. While our findings identify local-level strategies to address equitable reach during scale-up, we emphasise that striving to achieve health equity should be embedded and prioritised in scale-up efforts.

Parenting behavioural profiles differ across cultural, economic, and ethnic contexts. China, with one of the largest child populations worldwide, faces the challenge of poor developmental outcomes during early childhood in rural areas. Using a data-driven approach, we aimed to explore distinct parenting profiles, their corresponding developmental outcomes during early childhood, and the associated family risk factors.

We enrolled children and their caregivers from a national poverty-stricken county in China. We used the Bayley Scales of Infant and Toddler Development - Third Edition to measure their developmental outcomes by cognition, motor, and language, and we assessed their social-emotional development using the Chinese version of Ages and Stages Questionnaire: Social-Emotional, Second Edition. We used latent profile analysis to examine the patterns of parenting behaviour and examined the difference in developmental outcomes and familial risk factors via analysis of variance.

We interviewed 260 children (mean age = 9.62, standard deviation (SD) = 3.76 months; 51.5% female) and their caregivers from a national poverty-stricken county in China. The two-profile solution best fitted the data and indicated two parenting style patterns: low human stimulation (HS) & low social support (SS) group (n = 61, 23.46%) and high HS & high SS group (n = 199, 76.54%). There was a significant difference in children's social emotional development (P = 0.013) and mothers' depression score (P = 0.046) between the two parenting behavioural patterns.

Our study provides evidence on maternal parenting behaviour, associated risks, and child development outcomes in rural China, with significant implications for further high-quality interventions in regions of comparable economic level, particularly in the rural areas of Western China.

Research from high-income countries has found negative outcomes associated with physical punishment. Yet, the extent to which such research evidence generalizes to children in low- and middle-income countries (LMICs) is largely unknown. The objective of the current pre-registered study (PROSPERO: CRD42022347346 ) was to conduct a meta-analysis of the associations between childhood physical punishment and individual outcomes in LMICs. We identified eligible articles by searching for keywords related to physical punishment in six languages across 11 databases, with search periods from April to August 2021 and June to July 2024. This process yielded 5,072 unique records, of which 189 studies, comprising 1,490 unique effect sizes and representing 92 LMICs, met our inclusion criteria. Findings from random-effects multilevel meta-analyses indicated that physical punishment was associated with detrimental outcomes, including mental health problems, worse parent-child relationships, substance use, impaired social-emotional development, negative academic outcomes and heightened externalizing behaviour problems, among others. Despite some variation by contextual and study-level characteristics, all subgroup estimates were consistent in direction. Sensitivity checks indicated that these findings were not typical of other non-violent methods of discipline but were specific to physical punishment and psychological aggression. The analysis confirmed that physical punishment is associated with detrimental outcomes for individuals in LMICs. Additional research is needed to inform the design, implementation, and evaluation of policies and interventions to prevent the physical punishment of children and adolescents worldwide.

Biannual mass drug administration of azithromycin (MDA-azithromycin) has been proposed as a strategy to reduce childhood mortality in high-mortality regions, particularly sub-Saharan Africa. However, its effectiveness across different age groups and potential risks, including antibiotic resistance, require further evaluation.

We systematically searched PubMed, Cochrane CENTRAL, Web of Science and ClinicalTrials.gov through September 2024 for randomized controlled trials (RCTs) comparing biannual MDA-azithromycin to placebo in children aged 1-59 months. The primary outcomes were mortality in children <1 year and 12-59 months. Secondary outcomes included adverse events and antibiotic resistance. Data were analysed using a random-effects model in Review Manager 5.4, with heterogeneity assessed via I2. Trial sequential analysis (TSA) evaluated cumulative evidence reliability, and the Cochrane RoB2 tool assessed risk of bias. PROSPERO registration: CRD42024589170.

Five RCTs (691 235 children) were included. Among children <1 year, azithromycin showed a non-significant mortality reduction (RR: 0.90 [0.78, 1.04]; P = 0.14; I2 = 55%), with TSA indicating inconclusive evidence. Among children 12-59 months, MDA-azithromycin significantly reduced mortality (RR: 0.85 [0.79, 0.91]; P < 0.00001; I2 = 26%), with TSA confirming sufficient evidence. Adverse events were rare, but antibiotic resistance data were limited, warranting further monitoring. Evidence quality ranged from moderate to very low, with one trial at high risk of bias.

Biannual MDA-azithromycin significantly reduces mortality in children 12-59 months, supporting its use in high-mortality settings per WHO recommendations. Its impact on infants remains uncertain. Adverse events were minimal, but continued resistance surveillance is essential.

The divorce rate has increased globally and in China. Literature from developed countries and few developing countries has shown the negative impact of parental divorce on children's health and development. This cross-sectional study aimed to examine the association between parental divorce and early childhood development (ECD) in China.

This study used data collected from four provinces in China and reported by parents or other caregivers of 62 899 children, aged 3-5 years old, in 2017 and 2018. We constructed three types of ECD outcomes: (1) overall score of the early Human Capability Index (eHCI), (2) score of each domain of the eHCI, and (3) a dichotomous variable indicating a child developmentally on track, defined by ranking above the 20th percentile of overall eHCI scores in the corresponding age group in the pooled dataset. To understand the link between parental divorce and ECD outcomes, we used the propensity score matching method to match children from divorced families to those from intact families. We applied generalised linear regression models in data analysis using both the full sample and matched sample.

A total of 3.8% (N=2409) of young children came from divorced families. Children whose parents divorced had significantly lower overall eHCI scores (OR: 0.95, 95% CI 0.92 to 0.98) and lower odds of being developmentally on track (OR: 0.79, 95% CI 0.71 to 0.89), compared with their counterparts after matching. Statistically significant differences were observed in nearly all of nine domains of eHCI, especially for physical health, reading and social and emotional skills. Subgroup analyses showed more prominent associations in Shanghai.

Children from divorced families showed slower early sociopsychological and physical development than their peers. Efforts are needed to help this vulnerable group minimise the differences.

Engagement in stimulation activities by both parents can have synergistic effects on early childhood development (ECD). While the role of maternal stimulation is well known, the association with paternal stimulation remains underexplored and inconsistent. The current study aimed to assess the distribution of different combinations of maternal and paternal stimulation and explore their associations with ECD in the context of sub-Saharan Africa (SSA).

Using the Multiple Indicator Cluster Surveys and Demographic and Health Surveys from 26 SSA countries, we included 69 637 children aged 3-4 years in the analysis. The standardised ECD z-score was constructed using the ECD index. We estimated three-level linear regressions to assess its association with parental engagement in stimulation activities which was classified into four categories: mother low, father low (fewer than four activities); mother high, father low; father high, mother low; mother high, father high. Stratification analyses were conducted to examine whether the association differs by socioeconomic, geographic and learning-related variables.

Only 4% of parents provided high stimulation jointly (both high), which was associated with higher ECD z-score compared with both parents providing low stimulation (both low), after adjusting for covariates (b=0.04, 95% CI=0.01, 0.08). The association between joint parental stimulation and ECD was greater for children from wealthier households compared with their poorer counterparts (interaction p=0.012).

Children showed better developmental status when both parents jointly provided high stimulation. Policies and interventions should target both mothers and fathers, and transform traditional norms about parenting to achieve the most optimal development outcomes of children.

In low-and-middle-income countries (LMICs), children are exposed to multiple risks that may compromise their neurodevelopment, especially during the early years. Early childhood developmental trajectories are crucial, especially in such at-risk populations as they help predict future neurocognitive potential. In LMICs where numerous factors shape child neurodevelopment, describing neurodevelopment trajectories and understanding the predictors that shape them is imperative for early intervention. The systematic review and meta-analysis will determine the predictors of trajectories of child neurodevelopment during the first 2 years of life in LMICs.

The Preferred Reporting Items for Systematic Review and meta-analysis protocols (PRISMA-P) guidelines will be followed while performing this review. PubMed, Psych INFO, EMBASE, and Google Scholar databases and reference lists of relevant articles will be searched for articles. Selected publications will be uploaded to Endnote to remove duplicates and reviewed by title, abstract, and full text to identify those meeting the eligibility criteria. Longitudinal studies on child neurodevelopment and associated predictors among children aged ≤ 24 months in LMICs will be included. Screening, data extraction, and critical appraisal will be done by two autonomous reviewers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will evaluate the risk of bias and funnel plot asymmetry, publication bias. The I 2 statistics will be used to test for heterogeneity in the selected studies and STATA-18 and EPPI-reviewer software for statistical analysis. A random-effects meta-analysis will be undertaken.

The protocol describes a systematic review and meta-analysis aimed at identifying factors influencing neurodevelopment trajectories during the first 2 years of life in LMICs. The review findings may provide a comprehensive understanding of the factors that influence child neurodevelopment, particularly in the first 2 years of life in LMICs, help identify critical windows of opportunity for intervention, and potentially guide the design of age and contextually appropriate interventions for optimizing neurodevelopmental outcomes, especially in this context.

International Prospective Register of Systematic Reviews (PROSPERO), CRD42023421753.

Neurodevelopment spans from conception to adulthood, encompassing the growth and maturation of the nervous system. Indigenous children living in the Amazon face several circumstances that can adversely impact their neurodevelopment, including prenatal care, birth conditions, malnutrition, infectious diseases, and socioeconomic challenges. Prenatal exposure to toxic substances configures another determinant influencing neurodevelopment. Exposure to methylmercury is associated with the maternal consumption of contaminated fish. After birth, children continue to undergo exposure by breastfeeding or feeding. This trial aimed to develop a theoretical model to find the determinants of neurodevelopment in the first 1,000 days of life considering prenatal exposure to methylmercury in Indigenous children. The seven steps of the Checklist for Theoretical Report in Epidemiological Studies were followed to elaborate this theoretical model. We offer theoretical-methodological reflections on the dimensions and explanatory variables that highlight how exposure to adverse conditions since intrauterine life worsens in the presence of methylmercury, which can damage human health. This theoretical model is unprecedented in considering the complex causal network involved and contributes to research and actions on maternal and child health.

The early identification of developmental concerns requires understanding individual differences that may represent early signs of neurodevelopmental conditions. However, few studies have longitudinally examined how child and maternal factors interact to shape these early developmental characteristics.

We aim to identify factors from the perinatal to infant periods associated with early developmental characteristics that may precede formal diagnoses and propose a method for evaluating individual differences in neurodevelopmental trajectories.

A prospective longitudinal observational study of 147 mother-child pairs was conducted from gestation to 12 months post partum. Assessments included prenatal questionnaires and blood collection, cord blood at delivery, and postpartum questionnaires at 1, 6, and 12 months. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to evaluate developmental characteristics that might indicate early signs of atypical neurodevelopment. Polychoric or polyserial correlation coefficients assessed relationships between M-CHAT scores and longitudinal variables. L2-regularized logistic regression and Shapley Additive Explanations predicted M-CHAT scores and determined feature contributions.

Twenty-one factors (4 prenatal, 3 at birth, and 14 postnatal) showed significant associations with M-CHAT scores (adjusted P values<.05). The predictive accuracy for M-CHAT scores demonstrated reasonable predictive accuracy (area under the receiver operating characteristic curve=0.79). Key predictors included infant sleep status after 6 months (nighttime sleep duration, bedtime, and difficulties falling asleep), maternal Kessler Psychological Distress Scale scores, and Mother-to-Infant Bonding Scale scores after late gestation.

Maternal psychological distress, mother-infant bonding, and infant sleep patterns were identified as significant predictors of early developmental characteristics that may indicate emerging developmental concerns. This study advances our understanding of early developmental assessment by providing a novel approach to identifying and evaluating early indicators of atypical neurodevelopment.

The climate crisis is the biggest threat to the health, development, and wellbeing of the current and future generations. While there is extensive evidence on the direct impacts of climate change on human livelihood, there is little evidence on how children and young people are affected, and even less discussion and evidence on how the climate crisis could affect violence against children.

In this commentary, we review selected research to assess the links between the climate crisis and violence against children.

We employ a social-ecological perspective as an overarching framework to organize findings from the literature and call attention to increased violence against children as a specific, yet under-examined, direct and indirect consequence of the climate crisis.

Using such a perspective, we examine how the climate crisis exacerbates the risk of violence against children at the continually intersecting and interacting levels of society, community, family, and the individual levels. We propose increased risk of armed conflict, forced displacement, poverty, income inequality, disruptions in critical health and social services, and mental health problems as key mechanisms linking the climate crisis and heightened risk of violence against children. Furthermore, we posit that the climate crisis serves as a threat multiplier, compounding existing vulnerabilities and inequities within populations and having harsher consequences in settings, communities, households, and for children already experiencing adversities.

We conclude with a call for urgent efforts from researchers, practitioners, and policymakers to further investigate the specific empirical links between the climate crisis and violence against children and to design, test, implement, fund, and scale evidence-based, rights-based, and child friendly prevention, support, and response strategies to address violence against children.

The multifaceted issue of childhood stunting in low- and middle-income countries has a profound and enduring impact on children's well-being, cognitive development, and future earning potential. Childhood stunting arises from a complex interplay of genetic, environmental, and socio-cultural factors. It requires a comprehensive approach across nutrition, education, healthcare, and poverty reduction sectors to mitigate its prevalence and short- and long-term effects. The Mexican case presents a distinct challenge, as the country has experienced the recent dissolution of social health security programmes, rising poverty rates, and reduced government expenditures for childhood well-being.

We propose a machine learning approach to understand the contribution of social and economic determinants to childhood stunting risk in Mexico. Using data from the 2006-2018 population-based Mexican National Health and Nutrition Surveys, six different machine learning classification algorithms were used to model and identify the most important predictors of childhood stunting.

Among the six classification algorithms tested, Extreme Gradient Boosting (XGB) obtained the highest Youden Index value, effectively balancing the correct classification of children with and without stunting. In the XGB model, the most important predictor for classifying childhood stunting is the household's socioeconomic status, followed by the state of residence, the child's age, indigenous population status, the household's portion of children under five years old, and the local area's deprivation level.

This paper contributes to understanding the structural determinants of stunting in children, emphasising the importance of implementing tailored interventions and policies, especially given our findings that highlight indigenous status and local deprivation as key predictors. In the context of diminishing health initiatives, this underscores the urgent need for specific, targeted, and sustainable actions to prevent and address a potential rise in stunting in similar settings.

social and economic deprivation, stunting, children, machine learning, XGB model, Mexico.

This study investigated the neurodevelopmental impacts of displacement on resettled Syrian refugee children in Canada, focusing on how the timing and duration of adversity experienced during displacement influence neural network organization. Using graph theoretical approaches within a network neuroscience framework, we examined how the developmental timing of displacement (age of displacement, duration of displacement) related to functional integration, segregation, and small-worldness. Syrian refugee children (n = 61, MAge=14 Range = 8-18), completed a resting state scan using functional Near Infrared Spectroscopy (fNIRS) neuroimaging. Data were analyzed to assess the link between neural network properties and developmental timing of adversity. Results indicate that prolonged displacement experienced earlier in life was significantly linked with neural network organization, impacting the balance between the brain's functional integration and segregation as quantified by the overall reduced small worldness in comparison to experiencing displacement at an older age. This study leverages the experiences of refugee children to advance our understanding of how the timing of adversity affects development, providing valuable insights into the broader impacts of early adversity on neurodevelopment.

Although children across low- and middle-income countries (LMICs) are increasingly surviving, many are not fully thriving. Both stunting and off-track early child development (ECD) hinder children's potential to thrive.

To estimate the global prevalence of the co-occurrence of stunting and off-track ECD and explore its association with nurturing care and sociodemographic factors.

This cross-sectional study pooled data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2020) on 173 416 children aged 36-59 months in 41 LMICs. Statistical analysis was conducted from February to December 2024.

Risk factors pertaining to inadequate nurturing care, low socioeconomic status, and other sociodemographic characteristics.

Children were classified into 4 groups with respect to thriving: children who were stunted only (height-for-age z score <-2 SD), off-track ECD only (measured using the Early Childhood Development Index), both stunted and off-track ECD (co-occurrence), or neither.

In the pooled sample of 173 416 children, the mean (SD) child age was 47.1 (6.8) months, and 88 242 (50.9%) were boys. Approximately 1 in 6 children (17.0% [95% CI, 16.8%-17.2%]) were both stunted and had off-track ECD, 17.1% (95% CI, 16.9%-17.3%) were stunted only, 27.8% (95% CI, 27.6%-28.0%) had off-track ECD only, and 38.1% (95% CI, 37.9%-38.4%) were neither stunted nor had off-track ECD. Socioeconomic gradients were observed, with more co-occurrence in lower-income countries (18.2% [95% CI, 17.9%-18.6%]), poorer households (22.1% [95% CI, 21.7%-22.5%] for poorest wealth quintile), mothers with lower educational levels (20.8% [95% CI, 20.6%-21.0%] for primary education or less), and rural settings (19.3% [95% CI, 19.1%-19.6%]). Various indicators of inadequate nurturing care along with low socioeconomic status were associated with co-occurrence. The top 5 factors associated with co-occurrence were poorest wealth quintile (adjusted odds ratio [AOR], 2.75; 95% CI, 2.53-2.99), no early childhood education (AOR, 2.22; 95% CI, 2.10-2.34), low maternal educational level (AOR, 1.44; 95% CI, 1.37-1.51), no toys at home (AOR, 1.43; 95% CI, 1.35-1.51), and diarrhea (AOR, 1.38; 95% CI, 1.31-1.45). The associations of poor household wealth, no birth registration, and no early childhood education with co-occurrence were significantly larger than their associations with stunting only or off-track ECD only.

This cross-sectional study of young children in LMICs suggests that a significant proportion were both stunted and had off-track ECD. These findings underscore the need for multisectoral interventions that holistically target nutrition, health, and ECD risks to ensure that all children globally can thrive, especially those facing the double burden of stunting and off-track ECD.

Historically, low referral rates of 3-4 % have been reported from Singapore primary health care. Early identification of and intervention for developmental delays and autism enable achievement of optimal outcomes. An enhanced developmental screening (EDS) programme was introduced in primary care to improve identification of developmental delays and autism for children aged 18 and 30 months. This study evaluated prevalence of positive screening for developmental delays/autism at 18 months, identified associated socio-demographic risk factors and studied the correlation between primary care screening tools with outcomes following tertiary care assessments.

In primary care, EDS was conducted using Parents' Evaluation of Developmental Status (PEDS), Parents' Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), Ages & Stages Questionnaires-Third Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised - Follow-Up (M-CHATR/F) along with collection of socio-demographic data. Tertiary care assessment included Developmental Profile-3 (DP-3) screening and, a developmental paediatrician consultation.

Of 4212 children screened at 18 months, 14 % screened positive for developmental delays and 2 % for autism at primary care. Lower maternal education, ethnic minority status and lower socioeconomic status were associated with a positive screen. Moderate- strong correlation was seen between the ASQ-3 gross motor domain and DP-3 physical domain, moderate correlation between the communication domains of the 2 tools and the ASQ-3 personal-social domain with DP-3 adaptive domain.

EDS enabled improved identification of children for developmental delays/autism. Identification of socio-demographic risk factors will enable children from such families to be identified early and referred for intervention.

In Japan, the child development support initiative is one of the government's daycare support programs for children with disabilities. Children, aged 0-6 years, who are not attending elementary school can participate in the initiative and receive various support. Reports on the approaches taken by private child development support centers and the guardians' perceptions are increasing. Conversely, information from public child development support centers, which serve as places for initial developmental consultation, is extremely scarce. Moreover, there are no nationwide reports on the main complaints from each region, which are of concern to the parents. This study aimed to clarify children's gender and age, presence of referral sources, and characteristics of the main complaints obtained during the initial consultation with parents of children with developmental delays, who used a public developmental support center in a medium-sized city in Tokyo.

This study included 1,241 parents of children with developmental delays (average 40.3 months, range 2-87 months). Five questions regarding each child's characteristics (gender, age in months, and medical diagnosis), referral sources for the use of support centers, and main complaints that they would like to discuss at the initial consultation, were asked. The participants were asked to describe their main complaints (specific consultation details) as precisely as possible. From the free-form descriptions of the main complaints, 137 codes were extracted and grouped into 13 categories. Participants were divided into two groups according to the presence (n = 122) or absence (n = 1,119) of a medical diagnosis. The t-test, chi-square test, and Fisher's exact probability test were used to examine differences between the two groups. Logistic regression analysis with forced entry was performed to examine whether the factors related to the main complaints raised by parents of children with developmental delays differed depending on the presence or absence of a medical diagnosis.

The most common chief complaint at the time of the initial consultation was "language development" (43.9%), followed by "childcare and preschool counseling" (15.4%), "hyperactivity/inattention" (13.9%), and "general developmental issues" (13.6%). The regression analysis revealed that gender, age (months), and general developmental issues were factors associated with the presence or absence of a medical diagnosis were gender, age in months, and general developmental issues. The odds ratios (95% confidence intervals) were 1.573 (1.056-2.343) for gender, 0.988 (0.976-1.000) for age (months), and 0.421 (0.200-0.886) for general developmental issues.

Professionals involved in child development support are expected to have broad knowledge of various developmental issues as well as comprehensive knowledge of local childcare and schooling systems.

This study aimed to determine whether associations of antenatal maternal anaemia with smaller corpus callosum, caudate nucleus, and putamen volumes previously described in children at age 2-3 years persisted to age 6-7 years in the Drakenstein Child Health Study (DCHS).

This neuroimaging sub-study was nested within the DCHS, a South African population-based birth cohort. Pregnant women were enrolled (2012-2015) and mother-child dyads were followed prospectively. A sub-group of children had magnetic resonance imaging at 6-7 years of age (2018-2022). Mothers had haemoglobin measurements during pregnancy and a proportion of children were tested postnatally. Maternal anaemia (haemoglobin < 11 g/dL) and child anaemia were classified using WHO and local guidelines. Linear modeling was used to investigate associations between antenatal maternal anaemia status, maternal haemoglobin concentrations, and regional child brain volumes. Models included potential confounders and were conducted with and without child anaemia to assess the relative roles of antenatal versus postnatal anaemia.

Overall, 157 children (Mean [SD] age of 75.54 [4.77] months; 84 [53.50%] male) were born to mothers with antenatal haemoglobin data. The prevalence of maternal anaemia during pregnancy was 31.85% (50/157). In adjusted models, maternal anaemia status was associated with smaller volumes of the total corpus callosum (adjusted percentage difference, - 6.77%; p = 0.003), left caudate nucleus (adjusted percentage difference, - 5.98%, p = 0.005), and right caudate nucleus (adjusted percentage difference, - 6.12%; p = 0.003). Continuous maternal haemoglobin was positively associated with total corpus callosum (β = 0.239 [CI 0.10 to 0.38]; p < 0.001) and caudate nucleus (β = 0.165 [CI 0.02 to 0.31]; p = 0.027) volumes. In a sub-group (n = 89) with child haemoglobin data (Mean [SD] age of 76.06 [4.84]), the prevalence of antenatal maternal anaemia and postnatal child anaemia was 38.20% (34/89) and 47.19% (42/89), respectively. There was no association between maternal and child anaemia (χ2 = 0.799; p = 0.372), and child anaemia did not contribute to regional brain volume differences associated with maternal anaemia.

Associations between maternal anaemia and regional child brain volumes previously reported at 2-3 years of age were consistent and persisted to 6-7 years of age. Findings support the importance of optimising antenatal maternal health and reinforce these brain regions as a future research focus.

Linear growth faltering continues to negatively affect children in low- and middle-income countries and is associated with poor cognitive, developmental, and educational outcomes. Laboratory and observational data suggest that aflatoxin (AF) is a contributor to stunting.

The Mycotoxin Mitigation Trial was a cluster-randomized, community-based 2-group trial conducted in Kongwa District, Tanzania, between 2018 and 2020. The trial assessed whether a 12-mo intervention to reduce AF consumption increased length-for-age z-scores (LAZ) at 18 mo.

Low-AF maize and groundnut flours were provided to the intervention group each month; skin lotion was distributed to the control group monthly. Infant and young child feeding education was delivered equally in 52 health facilities (clusters). Anthropometry and the AF blood biomarker serum AF-albumin (AF-alb) were assessed at 6, 12, and 18 mo of age. Outcomes were analyzed as intention-to-treat and per-protocol using linear mixed-effects models.

Two thousand eight hundred forty-two maternal-infant dyads were recruited into the study. The intervention did not create a contrast in AF-alb. At 18 mo, 36% (n = 186/520) of infants had detectable levels of AF-alb compared with 54% (n = 195/364) at baseline, with no difference between groups. Mean LAZ in the intervention group at 18 mo was -1.83 (n = 1231, 95% CI: -1.93, -1.73) compared to -1.90 (n = 1287, 95% CI: -1.99, -1.82) in the control group (P = 0.28).

An intervention to reduce AF exposure did not alter AF-alb nor anthropometric measures between treatment groups. Drought and agricultural data indicated less favorable conditions for toxin production, resulting in low levels of exposure in both trial arms. Annual, seasonal, and geographic heterogeneity of AF contamination make it difficult to study in an ethically designed trial. Our formative research and early trial data indicate that stunting and intermittent AF exposure continue to be a problem in this region. However, the low-AF exposure levels during the trial led to inconclusive results.

NCT03940547 (ClinicalTrials.org).

Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14-55 years) with their children (born 2002-18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5-18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.

Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2-14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68-1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4-30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3-17·6), translating into a mean difference of 12·3 (95% CI 11·9-12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.

ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include the health outcomes of multiple children within families.

NIHR Policy Research Programme.

Prenatal depression is a potentially important fetal exposure as it may alter fetal development and have lasting effects.

We examined all live births from 2001 to 2012 in British Columbia with follow-up data on the Early Development Instrument (EDI) in Kindergarten. The odds of developmental vulnerability on EDI domains among those with and without depression during pregnancy were estimated. A matched sibling analysis was run using conditional logistic regression within the same birth parent.

We included 130,631 births among 108,340 pregnant people, with 6089 children (4.7%) exposed to prenatal depression. Children exposed to depression during pregnancy were significantly more likely to be considered vulnerable on physical health and well-being (OR, 1.19 [95% CI, 1.10-1.29]), social competence (OR, 1.25 [95% CI, 1.15-1.36]), emotional maturity (OR, 1.18 [95% CI, 1.08-1.28]), language and cognitive development (OR, 1.14 [95% CI, 1.04-1.26]), and multiple domains (OR, 1.18 [95% CI, 1.09-1.27]). No significant associations were found in our matched sibling pair analysis, but effect sizes remained above 1 for physical health and social competences.

More research is needed to determine whether fetal exposure to prenatal depression may predispose to childhood vulnerability on physical health and well-being, language and cognition, and socio-emotional domains.

Prenatal depression is common (9-22% of pregnancies) and research has suggested a negative impact on the developing fetal brain but data on long term child development following prenatal depression is sparse. Using a unique population-based dataset with developmental data from children, we found increased risk for developmental vulnerability in physical health and well-being and socio-emotional development. Sibling matched analyses suggested the presence of some residual confounding and associations were no longer statistically significant but effects sizes did not substantially attenuate for physical health and social competence.

Sub-Sahara Africa (SSA) children are at high-risk neurodevelopmentally due to the prevalence of infectious disease, nutritional deficiencies and compromised caregiving. However, few mental health screening measures are readily available for general use. The Strengths and Difficulties Questionnaire (SDQ) has been used as a mental health screening measure in the SSA, but its psychometric properties are not well understood. Five hundred and sixty-six mothers completed the SDQ for their 6-year-old children in rural Benin north of Cotonou. These were mothers who had been part of a malarial and intestinal parasite treatment program and micronutrient fortification intervention program during pregnancy for these children. Their study children (N = 519) completed the computerized Tests of Variables of Attention (TOVA-visual) as a performance-based screening assessment of attention deficit and hyperactivity disorders. In evaluating the relationship between the SDQ and TOVA, we controlled for maternal risk factors such as depression, poor socioeconomic status and educational level, along with the child's schooling status. TOVA measures of impulsivity were significantly related to SDQ emotional and hyperactivity/inattention difficulties. TOVA inattention was related to SDQ emotional difficulties. The triangulation of maternal risk factors (e.g., depression), the SDQ and the TOVA can provide effective screening for mental health issues in SSA children.

Community-based video interventions offer an effective and potentially scalable early interaction coaching tool for caregivers living in low resource settings. We tested the Universal Baby (UB) video innovation; an early interaction coaching tool using video sourced and produced locally with early child development (ECD) expert supervision.

This proof-of-concept study enrolled 40 caregivers of children ages 10-18 months assigned to intervention and control groups by health establishments in Carabayllo, Lima, Peru. Mother/child dyads received 12 weekly group health education sessions with social support. Of those, 16 caregivers also received 6 UB videos featuring brain science education and local clips of responsive, reciprocal interaction, also known as "serve and return" interaction. Survey data assessed feasibility and acceptability of the intervention. We assessed improved quality of mother/child interaction using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO).

We found the program feasible. We successfully trained the local team to produce UB videos using locally-sourced footage and delivered the videos as part of a community-based intervention. We also found it to be acceptable in that participants enthusiastically received the UB videos, reporting they enjoyed being videotaped, and learned how to recognize and appropriately respond to their child's nuanced sounds and gestures. The median change in total PICCOLO scores favored the intervention group compared to the control group.

UB offers great potential as a sustainable, potentially scalable, and culturally appropriate tool to promote equity for child development among young children living in low resource homes globally.

Maternal post-natal depression is a global public health problem. Parenting interventions targeting children's development may also bring benefits to mothers, but few parenting interventions have been studied thoroughly.

The study aimed to measure the effect of a parenting intervention using culturally appropriate and locally made toys, along with nutrition education and unconditional cash, on maternal depressive symptoms (MDS) and quality of life (QoL).

The study was a cluster randomised controlled trial with two arms: i) intervention: parenting with nutrition education and unconditional cash and ii) comparison: unconditional cash in an urban setting in Bangladesh. Twenty clusters were randomised to either the intervention or control group. Community Health Workers (CHWs) delivered parenting and nutrition education sessions fortnightly in households for one year. The participants were mother-child (6-16 months) dyads. The MDS and QoL were measured using the Self-Reporting Questionnaire-20 and a brief version of the QoL questionnaire. Linear regression analysis was used to assess the treatment effects.

After one year of intervention, 547 mothers (93%) completed the study. The mothers in the intervention group had lower MDS [Regression coefficient (β)=-1.53, Confidence interval (95% CI)=-2.28, -0.80] and higher QoL scores in physical health [β = 4.21 (95% CI = 1.71, 6.73)], psychological health [β = 3.14 (95% CI = 1.10, 5.19)], social relationships [β = 3.21 (95% CI = 0.76, 5.66)] and environment [β = 3.40 (95% CI = 1.37, 5.44)] compared with the comparison group.

Parenting interventions including nutrition education and unconditional cash, aimed at improving children's development, resulted in a reduction in maternal depressive symptoms and improvement in quality of life.

Childhood is a period marked by dynamic growth. Evidence of the association between childhood linear growth and school achievement comes mostly from cross-sectional data. We assessed associations between birth length, childhood linear growth velocities, and stunting with school achievement.

Newborns were recruited into the Ethiopian infant Anthropometry and Body Composition (iABC) birth cohort and followed from birth to 10 years. Velocities from 0 to 6 years were computed using linear spline mixed effect modelling. Stunting (height-for-age < -2 z-scores) was assessed at the ages of 1, 2, 4, 5, and 6 years. School achievement was measured by having a high (≥ 80%) combined high math, English, and science (MES) score and being at appropriate grade-for-age. Logistic regression models assessed associations between birth length, linear growth velocities and stunting with school achievement.

Children's mean age was 9.8 years (standard deviation, SD 1.0, range 7-12 years). A 1 SD greater birth length increased the odds of achieving a high MES combined score by 1.42 (95% CI: 0.99, 2.03). A 1 SD increase in linear growth velocity from 6 to 24 months increased the odds of being in the appropriate grade-for-age by 1.66 (95% CI: 1.14, 2.43). Stunting at ages 4 and 6 years was associated with lower odds of achieving a high MES combined score: 0.43 (95% CI: 0.20, 0.93) and 0.31 (95% CI: 0.11, 0.89), respectively. Faster post-natal linear growth was not associated with school achievement.

Greater birth length and higher growth velocity from 6 to 24 months were associated with higher school achievement and being in the appropriate grade-for-age, respectively. Children who experienced growth failure were less likely to achieve a high MES score. Interventions aimed at improving school achievement should address maternal and fetal nutrition and health, and monitor post-natal growth.

Impaired growth in childhood can lead to poor cognitive development and low school performance. However, literature on the effects of stunting on school trajectory is very limited. The primary objective of this research was to estimate the age at which children start school according to levels of height-for-age z-score (stunting). A second objective was to estimate the gain in terms of age at school entry associated with an improvement in height-for-age z-score. A third objective was to explore the relationship between stunting, grade repetition, and school dropout.

We used longitudinal data from the Ouagadougou (Burkina Faso) Health and Demographic Surveillance System. Data from a 2010 health survey of children under 5 years of age were merged with subsequent longitudinal schooling data. The study included 767 children globally who participated in the health and education surveys. Education data allowed us to apprehend academic trajectory measured by age at school entry, repetition, and dropout. The health survey gathered anthropometric information that was used to measure stunting. The adjusted age at school entry was estimated using a Poisson model. The gain represents the difference in adjusted age at school entry for different values of height-for-age. The relationship between stunting and grade repetition and dropout was studied using a discrete-time survival model.

Results showed that children entered school on average at 5.7 years old, and the incidence of grade repetition and dropout was 17.7 and 6.6 per 100 persons-years, respectively. The adjusted age at school entry of severely stunted children was 6.2 years [95% confidence intervals (CI): 6.1; 6.3] compared to 5.1 years [95% CI: 5.0; 5.3] for children who had normal growth. The difference (gain) in adjusted age at school entry between severely and non-stunted children was thus 1.06 [95% CI: 0.87; 1.25] years. If a child's growth changed from severe stunting to normal growth, their risk of repeating a grade decreased by 5.0 [95% CI: 0.0; 9.0] per 100 persons-years. We did not observe a relationship between height-for-age and dropout.

The results show that schooling is affected in several ways for children who are stunted. The age at school entry of stunted children is more likely to be delayed. Also, being stunted is associated with higher incidence of grade repetition. However, the relationship between stunting and dropout was inconclusive.

Childhood infection might be associated with adverse child development and neurocognitive outcomes, but the results have been inconsistent.

Two population-based record-linkage cohorts of all singleton children born at term in New South Wales, Australia, from 2001 to 2014, were set up and followed up to 2019 for developmental outcome (N=276 454) and school performance (N=644 291). The primary outcome was developmentally high risk (DHR) at age 4-6 years and numeracy and reading below the national minimum standard at age 7-9 years. Cox regression was used to assess the association of childhood infection ascertained from hospital records with each outcome adjusting for maternal, birth and child characteristics, and sensitivity analyses were conducted assessing E-values and sibling analysis for discordant exposure.

A higher proportion of children with an infection-related hospitalisation were DHR (10.9% vs 8.7%) and had numeracy (3.7% vs 2.7%) and reading results (4.3% vs 3.1%) below the national minimum standard, compared with those without infection-related hospitalisation. In the multivariable analysis, children with infection-related hospitalisation were more likely to be DHR (adjusted HR 1.12, 95% CI 1.08 to 1.15) and have numeracy (adjusted HR 1.22, 95% CI 1.18 to 1.26) and reading results (adjusted HR 1.16, 95% CI 1.12 to 1.20) below the national minimum standard. However, these results may be impacted by unmeasured confounding, based on E-values of 1.48-1.74, and minimal association with education outcome was found in the sibling analysis.

Infection-related hospitalisation was modestly associated with adverse child development and school performance, but the association may be explained by shared familial factors, particularly in those with most socioeconomic disadvantages.

Violence against women (VAW) is a global challenge also in the childbearing period. Despite high gender equality, there is a high prevalence of VAW in the Nordic countries. This scoping review aims to explore predictors for and consequences of a history of violence on women's pregnancy and childbirth in the Nordic countries, including women's experience of the impact of violence and the interventions used to detect, address consequences, and prevent further violence. The framework by Arksey and O'Malley was followed, and English, Finnish, Icelandic, Norwegian, Danish, and Swedish literature was included. The population was women aged ≥18 residing in the Nordic countries during the perinatal period. Eight databases were searched: MEDLINE, CINAHL, PubMed, PsycINFO, Web of Science, ASSIA, Social Services-, and Sociological abstracts. There was no limitation of the search time frame. The initial screening resulted in 1,104 records, and after removing duplicates, 452 remained. Finally, 61 papers met the inclusion criteria. The results covering the past 32 years indicated that childbearing women with a history of violence are at greater risk of common complaints and hospitalization during pregnancy, fear of childbirth, Cesarean section, breastfeeding difficulties, and physical and mental health problems. While extensive research was found on the associations between a history of and current violence and outcomes related to pregnancy, there was a lack of intervention studies and studies from Finland. Efforts must be made to scientifically test the methods used to reduce and treat the adverse effects of a history of violence and prevent further violence.

Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2-5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs. Paper 2 focuses on the cost of inaction and the implications of not investing in the next 1000 days. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. Intervention research in LMICs in the next 1000 days is scarce. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals.

This study aims to examine the association for paternal care and father-child screen use with early childhood development and children's temper tantrums.

Study file included questions about paternal characteristics, child care, father-child screen habits, and utilized the UNICEF Early Childhood Development Index (ECDI). Factors influencing ECDI-on-track status and children's responses when screen use was restricted were investigated with Chi-square test and multiple logistic regression.

The study included 464 fathers having children aged 3-4 years. The findings showed that 89.7% of the children were on track in three out of the four ECDI subgroups. When screen use was restricted, 55.6% of the children engaged in another activity, while 44.4% reacted by crying. Multiple logistic regression analysis revealed that the father's education level, the child's age and gender, the starting age for screen usage, the child's reaction to screen restriction, and having three or more books were associated with ECDI. Furthermore, the child's reaction to screen restriction was related to the child's and father's screen time, the presence of three or more books, the adequacy of care, and being on track in the literacy-numeracy ECDI subgroup.

Screen usage habits significantly impact early childhood development and children's reactions to screen restrictions. These findings underscore the importance of educating fathers about the effects of their own and their child's media habits, the quality of fatherly caregiving, and the presence of books in fostering positive child development.

This scoping review aims to identify and map interventions and/or strategies used to support the initiation and continuation of breastfeeding for women at risk of delaying initiation, early cessation, or not breastfeeding due to low levels of education, psychosocial problems, and/or socioeconomic challenges in high-income countries.

While breastfeeding has lifelong beneficial health effects for women and infants, there is a risk of delaying initiation, early cessation, or not initiating breastfeeding at all due to factors related to health inequalities, such as low levels of education, psychosocial problems, and/or socioeconomic constraints.

This review will include eligible quantitative, qualitative, and mixed methods studies, as well as systematic reviews and gray literature. We will include studies conducted in high-income countries, focusing on interventions and/or strategies to support women with low levels of education, psychosocial problems, and/or socioeconomic constraints in the initiation and continuation of breastfeeding for up to 6 months postpartum.

This review will follow the JBI methodology for scoping reviews, using the Participants, Concept, and Context framework. The primary search will be performed in MEDLINE (Ovid), PsycINFO (EBSCOhost), Embase (Ovid), and CINAHL (EBSCOhost). We will include publications in English, Swedish, Norwegian, Danish, German, Bulgarian, Arabic, and Spanish, published from 1991 until the present. A data charting form will be developed and used for all the included articles.

Open Science Framework https://osf.io/tmp4v/.

As health-related social needs (HRSN) screening increases, attention to families' resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families' needs and, when HRSN persisted, families' reasons for declining resources.

This retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families' resource preferences, and explored demographic characteristics associated with ongoing HRSN.

Half of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60-100%); 20-58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive.

Pediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Health care systems should advocate for resources that families need and want.

Social determinants of health (SDH) have a critical role in child development. Yet these determinants are often overshadowed. This study examines the effect of composites of five SDH on early childhood development (ECD) of children of age 36-59 months.

We used two 2013 and 2019 rounds of Multiple Indicator Cluster Survey Bangladesh data. The analytical sample included ECD data for 25 721 children. ECD was computed following United Nations International Children's Emergency Fund's psychometric approach. Three composite indices of SDH were developed to examine their gradient effects on ECD. Poisson regression with robust variance was used to examine the relationship between SDH indices and ECD. The concentration index was computed, and a concentration curve was developed to measure inequalities in being on track of ECD among children with various levels of SDH.

Almost 69% of children were on track in their ECD, a higher percentage in 2019 (74.85%) than in 2017 (65.37%). The prevalence of children on track in their ECD significantly rises per unit in the score of three SDH composites (adjusted prevalence ratios are 1.04 (95% confidence interval (CI): 1.03-1.04) for summative and standardised indexes and 1.49 (95% CI: 1.41-1.58) for weighted index). There is almost a linear positive relationship between the SDH composite and ECD. Significant concentration indexes suggest SDH-related inequalities in ECD.

Children's early development can be hampered due to unfavourable SDH. Although ECD plays a vital role in creating and maintaining socio-economic and health inequalities through to adulthood, favourable SDH needs to be ensured during childhood.

In the transition period from breastfeeding to the introduction of complementary feeding, the choice of food is extremely important for the child's development as many factors may be related. This study aims to investigate, through a systematic review and qualitative meta-synthesis, influence in the selection of foods in the introduction of complementary foods for children, including qualitative studies without language or publication period restrictions. Searches were performed in PubMed, LILACS, SciELO, Cinahl, Embase, Web of Science, and Scopus. Initially, 12,489 articles were selected for tittle reading, 13 were included in the review. Four analytical themes related to factors influencing complementary feeding were identified: family socioeconomic conditions, cultural and family aspects, guidance and advice from health professionals, and factors inherent to the infant. Economic factors, such as the opportunity to offer foods not consumed during the parents' childhood, were emphasized. The influence of grandmothers' opinions and community beliefs and traditions were considered. Trust in pediatricians and community health agents' advice, although considered, conflicted with cultural and family traditions. Mothers/caregivers often preferred to offer foods the child shows preference for, rather than introducing new flavors. The findings underscore the need for a better understanding of qualitative aspects.

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

To the best of our knowledge, no previous studies have examined the relationship between childhood developmental milestones and risk of adulthood cerebrovascular disease (CeVD). We studied whether the risk of adult CeVD is associated with delayed attainment of motor and language milestones.

Within the Northern Finland Birth Cohort 1966, a total of 11,688 persons were followed from birth to either death, moving abroad or 54 years of age. CeVD diagnoses, i.e., ischemic and hemorrhagic strokes and transient ischemic attacks, were extracted from national registers with diagnostic coding based on recommendations of the World Health Organization. Cox proportional hazard models stratified by sex were used to estimate associations of motor development and language milestones between ages 0 and 4 years and adult CeVD women-to-men relative hazard ratios (RHRs) were estimated for each developmental milestone. Analyses were adjusted for family socioeconomic status and birth weight for gestational age.

Altogether 498 (4.3%) CeVDs were recorded during follow-up. Among both sexes, later turning from back to tummy was associated with ischemic CeVD in adulthood with an adjusted hazard ratio (aHR) of 1.25 and 95% confidence interval (CI) 1.06-1.46 for men and an aHR: 1.20 (CI: 1.02-1.42) for women per 1 month delay in achievement. Delayed overall motor development, modeled by motor milestone principal component score, was related to increased risk of ischemic CeVD (aHR: 1.50; CI: 1.03-2.19) among men. Later achievement of making sounds was associated with any CeVD (aHR: 2.74; CI: 1.39-5.40) and especially ischemic CeVD (aHR: 3.41; CI: 1.65-7.06) among men with women-to-men RHR's of 0.17 (95% CI: 0.04-0.81) for any CeVD and RHR 0.18 (95% CI: 0.04-0.89) for ischemic stroke indicating risk to be lower in women compared to men.

These findings suggest that later achievement of childhood milestones could be a predictor for development of CeVD risk. The results point toward a common neurodevelopmental background and could in part explain lifetime CeVD risk accumulation.

Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs). Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5-5). Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]). Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions.

Research on the specific pathways from maternal nurturance to early child development remains limited. Grounded in transactional theory, this study is the first to examine these pathways through the parent-child relationship.

This longitudinal study involved mothers of children aged 1-3 years. Data on sociodemographic characteristics, Comprehensive General Parenting Questionnaire, and Child-Parent Relationship Scale were collected at Time 1, when children were 1 year old. At Time 2, when children were 3 years old, Caregiver-Reported Early Development Instruments were measured. Structural equation modeling (SEM) was used to explore direct and indirect pathways from maternal nurturance to early child development.

A total of 1145 mother-child dyads participated, with children averaging 32 months (SD = 6.4) and mothers averaging 28.7 years (SD = 4.0). Maternal nurturance had significant direct (β = 0.271), indirect (β = 0.065), and total (β = 0.336) effects on early child development. Direct effects accounted for 80.7% of the total effects, while indirect effects accounted for 19.3%. Maternal nurturance indirectly predicted higher early child development through increased parent-child closeness (β = 0.048), explaining 14.3% of the total effects. Maternal nurturance indirectly promoted early child development through reduced parent-child conflict (β = 0.017), explaining 5.1% of the total effects.

The novelty of this study lies in its demonstration of the mediating role of the parent-child relationship in the effect of maternal nurturance on early child development. This longitudinal study provides insights for governments agencies, policymakers, and healthcare workers to develop intervention programs that enhance maternal nurturance through the parent-child relationship to promote early child development.

Poor early childhood development (ECD) is a major global health concern that is associated with various adverse outcomes over the lifecourse. Parenting interventions especially during the earliest years of life can benefit ECD. However, there is limited evidence from Kenya about the effectiveness of parenting interventions for improving ECD outcomes especially across rural disadvantaged communities. This paper describes the study protocol for an impact and implementation evaluation of a community-based group parenting program that aims to improve ECD in rural Kenya.

We will conduct a cluster-randomized controlled trial to determine the effectiveness of a parenting program for caregivers of young children in Homabay and Busia counties in Western Kenya. Sixty-four village clusters will be randomly assigned to either the parenting intervention arm or the waitlist control arm with stratification by county. In each village, 10 primary caregivers with a child aged 0-24 months will be enrolled. The parenting program will be delivered through existing peer groups within communities whereby caregivers will receive counseling and psychosocial support to enhance their parenting skills and wellbeing to in turn promote ECD. The intervention curriculum comprises 21 sessions targeting various nurturing care messages, including early learning, responsive caregiving, child nutrition, health, protection, and caregiver mental health. Group sessions are facilitated by a trained volunteer biweekly for a total of 11 months. The primary trial outcome is an overall measure of ECD using the Global Scales of Early Development long form version. Secondary outcomes include various caregiver outcomes (e.g., parenting practices, mental health) and other child outcomes (e.g., socioemotional development, dietary diversity). All outcomes will be assessed at baseline and endline. We will also conduct a qualitative implementation evaluation at endline and interview various stakeholders to assess program fidelity, quality, and sustainability.

This trial will evaluate the effectiveness of a parenting intervention on ECD and caregiving outcomes and assess program implementation quality as delivered through existing community-based peer groups. This study will provide rigorous evidence that can be used to inform scale-up of this program model that leverages existing community social networks and resources for improving caregivers' parenting skills and promoting ECD in rural Kenya and other similar settings across LMICs.

ClinicalTrials.gov #NCT06165315. Registered on December 11, 2023.