@article{a12e083aedfa4de3bf98264a553d4ff3,
title = "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",
abstract = "Background: The positive effects of early developmental intervention (EDI) on early child development have beenreported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy ofEDI 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 whenEDI was implemented in three low and low-middle income countries as well as demographic and child health factorsassociated with treatment dose.Methods: Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received aparent-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 theBayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed andparent-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 average62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associatedwith greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variableswere associated with treatment dose.Conclusions: Receiving a higher dose of EDI during the first 36 months of life is generally associated with betterdevelopmental outcomes. The higher benefit appears when receiving ≥ 91% of biweekly home visits and programactivities on ≥ 67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high doseto achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require specialattention to ensure adequate effect.",
keywords = "Birth asphyxia, Developing countries, Early developmental intervention, Neurodevelopmental disability, Treatment dose",
author = "Wallander, {Jan L.} and Biasini, {Fred J.} and Vanessa Thorsten and Dhaded, {Sangappa M.} and {de Jong}, {Desiree M.} and Elwyn Chomba and Omrana Pasha and Shivaprasad Goudar and Dennis Wallace and Hrishikesh Chakraborty and Wright, {Linda L.} and Elizabeth McClure and Carlo, {Waldemar A.}",
note = "Funding Information: This research were funded in part by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Global Network for Women{\textquoteright}s and Children{\textquoteright}s Health Research (HD034216), the National Institute of Neurological Disorders and Stroke and NICHD (HD43464, HD42372, HD40607, and HD40636), the Fogarty International Center (TW006703), the Children{\textquoteright}s of Alabama Centennial Scholar Fund, and the Perinatal Health and Human Development Research Program and the Children{\textquoteright}s of Alabama Centennial Scholar Fund of the University of Alabama at Birmingham. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH); NIH staff contributed to the design of the study and approved of the final manuscript, but had no influence on the analysis and interpretation of the data or the decision to submit the manuscript. Funding Information: Acknowledgements This research were funded in part by grants from the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD) Global Network for Women's and Children's Health Research (HD034216), theNational Institute of Neurological Disorders and Stroke and NICHD (HD43464, HD42372, HD40607, and HD40636), the Fogarty International Center(TW006703), the Children's of Alabama Centennial Scholar Fund, and thePerinatal Health and Human Development Research Program and theChildren's of Alabama Centennial Scholar Fund of the University of Alabamaat Birmingham. The content is solely the responsibility of the authors anddoes not necessarily represent the official views of the National Institutes ofHealth (NIH); NIH staff contributed to the design of the study and approvedof the final manuscript, but had no influence on the analysis andinterpretation of the data or the decision to submit the manuscript. Publisher Copyright: {\textcopyright} 2014 Wallander et al.",
year = "2014",
month = oct,
day = "25",
doi = "10.1186/1471-2431-14-281",
language = "English (US)",
volume = "14",
journal = "BMC Pediatrics",
issn = "1471-2431",
publisher = "BioMed Central",
number = "1",
}