Limits...
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.


Mental (MDI) and Psychomotor (PDI) Development Index by treatment dose quintiles.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Mental (MDI) and Psychomotor (PDI) Development Index by treatment dose quintiles.

Mentions: Higher home visits dose was associated with higher MDI at 36-months (Figure 2). Specifically, quintiles 1–2 mean MDI = 98, while quintiles 3–5 mean MDI = 103 (Table 2). General linear models of MDI supported this relationship when home visits dose was entered as a primary predictor and site, resuscitation status at birth, and 12-month MDI were entered as covariates (Table 2). Most notably, in the model with only home visits dose (Model 1) and the model which included site (Model 2), mean MDI for quintiles 1 and 2 was significantly lower than quintiles 3–5. A step-down test comparing mean MDI for those with home visit dose below the 40th percentile (quintiles 1 and 2) to those with home visit dose above the 40th percentile (quintiles 3–5), provided estimates of 97.8 and 103.4 (p = 0.0017), respectively . Adjusting by site increased the magnitude of the difference by at least 25% (96.8 vs. 103.9, p = 0.0005). When adjusting for 12-month MDI and the interaction between dose and 12-month MDI (Model 5), the adjusted mean scores for the dose quintiles mirrored unadjusted scores, with quintiles 1–2 consistently lower than quintiles 3–5 (p <0.0001). The lower limit for quintile 3 includes those receiving a minimum of 91% of all the planned home visits.Figure 2


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)

Mental (MDI) and Psychomotor (PDI) Development Index by treatment dose quintiles.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Mental (MDI) and Psychomotor (PDI) Development Index by treatment dose quintiles.
Mentions: Higher home visits dose was associated with higher MDI at 36-months (Figure 2). Specifically, quintiles 1–2 mean MDI = 98, while quintiles 3–5 mean MDI = 103 (Table 2). General linear models of MDI supported this relationship when home visits dose was entered as a primary predictor and site, resuscitation status at birth, and 12-month MDI were entered as covariates (Table 2). Most notably, in the model with only home visits dose (Model 1) and the model which included site (Model 2), mean MDI for quintiles 1 and 2 was significantly lower than quintiles 3–5. A step-down test comparing mean MDI for those with home visit dose below the 40th percentile (quintiles 1 and 2) to those with home visit dose above the 40th percentile (quintiles 3–5), provided estimates of 97.8 and 103.4 (p = 0.0017), respectively . Adjusting by site increased the magnitude of the difference by at least 25% (96.8 vs. 103.9, p = 0.0005). When adjusting for 12-month MDI and the interaction between dose and 12-month MDI (Model 5), the adjusted mean scores for the dose quintiles mirrored unadjusted scores, with quintiles 1–2 consistently lower than quintiles 3–5 (p <0.0001). The lower limit for quintile 3 includes those receiving a minimum of 91% of all the planned home visits.Figure 2

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.