Transcript Antenatal care and child development [PPT 929.00KB]

THE ROLE OF ANTENATAL CARE FOR
CHILD GROWTH AND COGNITIVE
DEVELOPMENT:
A COMPARATIVE
ANALYSIS IN ETHIOPIA, PERU, AND
INDIA
Mariachiara Di Cesare & Ricardo Sabates
Centre for Internationa Education (CIE)
University of Sussex
BACKGROUND
“Reducing social inequalities in health is an issue
of social justice” (Marmot, 2005)
 Social gradient in health within and between
countries - Health inequalities
 Health and nutrition strongly associated with
school outcomes.



Micronutrient deficiencies impacts cognitive
development
Positive life-course trajectories and adult
outcomes linked to educational attainment.
EARLY INTERVENTIONS
School health programmes are beneficial for at
risk and not at risk children
 Targeted interventions at school:
 Leave out a significant # out-school children
 Start at school age
 Health or educational interventions alone will
not close the health gradient across generations
(CSDH, 2008)
 Importance of early interventions

RESEARCH QUESTION
 Is
there evidence than early interventions
can weaken the transmission of
inequalities during early childhood?
 Early
interventions: prenatal care
 Tranmission of inequalities: from health to
cognitive development
WHY PRENATAL CARE?
 Better
prenatal care has direct positive
effects on mother’s and foetus’ health
 Reduces mothers’ burden of
responsibilities and increases meaning of
motherhood
 Improves mothers’ confidence with health
services and health care access
DATA
Young Lives (YL)
 YL is a long-term international research project
investigating the changing nature of childhood
poverty in order to:

causes and consequences of childhood poverty
 how policies affect children’s well-being
 development and implementation of policies


12,000 children over 15 years in Ethiopia, the
state of Andhra Pradesh in India, Peru and
Vietnam.
SAMPLE
Sample strategy “sentinel site surveillance”.
 Sample not nationally representative, but
households are representative within sites.
 Index children: Group of 2000 children born in
the year 2000/1 (an average of 1 year old during
round one and aged 4 - 5 at round 2).
 Data used for first and second round

ATTRITION RATES
(Outes-Leon and Dercon, 2008)



Attrition rates are relatively low by international
standards.
Attrited households do not differ systematically from
non-attrited households.
Attrition on observables is unlikely to lead to
significant biases on antrophometrics (Index cohort)
COHORT AND INFORMATION

Index cohort
R1 (5-22 months)
Child’s nutritional
status
Mother’s access to
prenatal care
R2 (~5 yrs)
Cognitive
Development
THE MODEL
Prenatal care
Stunting
(1 yrs)
Cognitive
Development
(5 yrs)
Outcome: children’s scores on Cognitive
Developmental Assessment (CDA) test
 Stunting < -2 height for age z-score
 Prenatal care access if: first visit during first
trimester, at least 4 visits during pregnancy or
health professional at delivery

OTHER COVARIATES
Child variables
Mother variables
In school (pre-school or
formal school)
Gender
Age in months
Language (country specific)
Level of education
Age
Number of children
(excluding IC)
Household
Wealth index at round 1
Wealth index worsening over time
Place of residence
RESULTS
RESULTS
Access to antenatal care is positively associated
with CDA in Ethiopia, Peru, and Vietnam.
 In all countries, children whose mothers had
access to antenatal care services and who were
not stunted during the first two years of life
achieved the highest test scores.
 The effect of early nutritional deficiencies on
subsequent cognitive development can be in part
weakened if the mother had access to antenatal
care in Peru and Vietnam.

DISCUSSION
As an early intervention, ANC services has the
potential to reduce the impact of health
inequalities on educational inequalities (in Peru
& Vietnam).
 Lack of results in Andhra Pradesh and Ethiopia
may be linked to quality of ANC.

“If the major determinants of health are social so
must be the remedies” (Marmot, 2005)
THANK YOU
Project funded by The BUPA
Foundation, grant TBF-509-034