Antenatal care and child development [PPT 929.00KB]
Download
Report
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