@article{fdi:010078026,
  title = {{F}actors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition : a cross-sectional analysis of data from the {IHOPE} study, {M}adagascar},
  author = {{M}iller, {A}. {C}. and {G}architorena, {A}ndres and {R}abemananjara, {F}. and {C}ordier, {L}. and {R}andriamanambintsoa, {M}. and {R}abeza, {V}. and {R}azanadrakoto, {H}. {T}. {R}. and {R}amakasoa, {R}. {R}. and {R}amahefarison{T}iana, {O}. and {R}atsimbazafy, {B}. {N}. and {O}uenzar, {M}. {A}. and {B}onds, {M}. {H}. and {R}atsifandrihamanana, {L}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground 50% of {M}alagasy children have moderate to severe stunting. {I}n 2016, a new 10 year {N}ational {N}utrition {A}ction {P}lan ({PNAN} {III}) was initiated to help address stunting and developmental delay. {W}e report factors associated with risk of developmental delay in 3 and 4 year olds in the rural district of {I}fanadiana in southeastern {M}adagascar in 2016. {M}ethods {T}he data are from a cross-sectional analysis of the 2016 wave of {IHOPE} panel data (a population-representative cohort study begun in 2014). {W}e interviewed women ages 15-49 using the {MICS} {E}arly {C}hild {D}evelopment {I}ndicator ({ECDI}) module, which includes questions for physical, socio-emotional, learning and literacy/numeracy domains. {W}e analyzed {ECDI} data using standardized z scores for relative relationships for 2 outcomes: at-risk-for-delay vs. an international standard, and lower-development-than-peers if {ECDI} z scores were > 1 standard deviation below study mean. {C}ovariates included demographics, adult involvement, household environment, and selected child health factors. {V}ariables significant at alpha of 0.1 were included a multivariable model; final models used backward stepwise regression, clustered at the sampling level. {R}esults {O}f 432 children ages 3 and 4 years, 173 (40%) were at risk for delay compared to international norms and 68 children (16.0%) had lower-development than peers. {T}his was driven mostly by the literacy/numeracy domain, with only 7% of children considered developmentally on track in that domain. 50.5% of children had moderate to severe stunting. 76 (17.6%) had > = 4 stimulation activities in past 3 days. {G}reater paternal engagement ({OR} 1.5 (1.09, 2.07)) was associated with increased delay vs. international norms. {A}dolescent motherhood ({OR}. 4.09 (1.40, 11.87)) decreased children's development vs. peers. {E}ngagement from a non-parental adult reduced odds of delay for both outcomes ({OR} (95%{CI} = 0.76 (0.63, 0.91) & 0.27 (0.15, 0 48) respectively). {S}tunting was not associated with delay risk (1.36 (0.85, 2.15) or low development (0.92 (0.48, 1.78)) when controlling for other factors. {C}onclusions {I}n this setting of high child malnutrition, stunting is not independently associated with developmental risk. {A} low proportion of children receive developmentally supportive stimulation from adults, but non-parent adults provide more stimulation in general than either mother or father. {S}timulation from non-parent adults is associated with lower odds of delay.},
  keywords = {{C}hild development ; {S}tunting ; {D}evelopmental risk factors ; {M}adagascar ; {MICS} ; {P}opulation survey ; {MADAGASCAR}},
  booktitle = {},
  journal = {{BMC} {P}ediatrics},
  volume = {20},
  numero = {1},
  pages = {art. 108 [11 p.]},
  year = {2020},
  DOI = {10.1186/s12887-020-1985-6},
  URL = {https://www.documentation.ird.fr/hor/fdi:010078026},
}