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Dose of early intervention treatment during children's first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries.

Wallander JL, Biasini FJ, Thorsten V, Dhaded SM, de Jong DM, Chomba E, Pasha O, Goudar S, Wallace D, Chakraborty H, Wright LL, McClure E, Carlo WA - BMC Pediatr (2014)

Bottom Line: Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear.Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes.To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.

View Article: PubMed Central - PubMed

Affiliation: Psychological Sciences and Health Sciences Research Institute, University of California, Merced, CA, USA. jwallander@ucmerced.edu.

ABSTRACT

Background: The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose.

Methods: Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates.

Results: Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose.

Conclusions: Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.

No MeSH data available.


Study flow chart.
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Fig1: Study flow chart.

Mentions: The sample size was determined to provide adequate power to test EDI treatment efficacy, the primary aim of BRAIN-HIT. As outlined in Figure 1, of 540 births screened from January 2007 through June 2008, 438 (81% of screened) were eligible. Only 3 infants were ineligible due to low birth weight or neurological exam, with the remaining 99 being due to mothers not being able to commit to staying in the study communities or could not be reached for screening within 7 days of birth. Informed consent was obtained for 407 (93% of eligible; 165 resuscitated, 242 not resuscitated) who were randomized into either EDI or a control intervention [20]. The 204 assigned to receive EDI (50.1% of those randomized) are relevant for this study, of whom 145 (71.1% of those assigned to EDI) were included in this analysis (Table 1). These participants had mean = 36.8 (range = 35-41) months of age at the time of the developmental assessment.Figure 1


Dose of early intervention treatment during children's first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries.

Wallander JL, Biasini FJ, Thorsten V, Dhaded SM, de Jong DM, Chomba E, Pasha O, Goudar S, Wallace D, Chakraborty H, Wright LL, McClure E, Carlo WA - BMC Pediatr (2014)

Study flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4288653&req=5

Fig1: Study flow chart.
Mentions: The sample size was determined to provide adequate power to test EDI treatment efficacy, the primary aim of BRAIN-HIT. As outlined in Figure 1, of 540 births screened from January 2007 through June 2008, 438 (81% of screened) were eligible. Only 3 infants were ineligible due to low birth weight or neurological exam, with the remaining 99 being due to mothers not being able to commit to staying in the study communities or could not be reached for screening within 7 days of birth. Informed consent was obtained for 407 (93% of eligible; 165 resuscitated, 242 not resuscitated) who were randomized into either EDI or a control intervention [20]. The 204 assigned to receive EDI (50.1% of those randomized) are relevant for this study, of whom 145 (71.1% of those assigned to EDI) were included in this analysis (Table 1). These participants had mean = 36.8 (range = 35-41) months of age at the time of the developmental assessment.Figure 1

Bottom Line: Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear.Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes.To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.

View Article: PubMed Central - PubMed

Affiliation: Psychological Sciences and Health Sciences Research Institute, University of California, Merced, CA, USA. jwallander@ucmerced.edu.

ABSTRACT

Background: The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose.

Methods: Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates.

Results: Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose.

Conclusions: Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.

No MeSH data available.