As countries mobilize to reach Sustainable Development Goal 4.2, to ensure “access to quality early childhood development” (ECD), evidence is needed to inform the design of interventions. Previous reviews have identified 44 risk factors for poor ECD in low- and middle-income countries. Which of these factors are most important for strategic targeting to maximize the likelihood of making a difference?

Prado and collaborators on the International Lipid-Based Nutrient Supplements (iLiNS) Project had a unique opportunity to answer this question in the most comprehensive dataset that has examined this question to date. In four cohorts totaling 4205 children in Malawi, Ghana, and Burkina Faso, data were available on 22 of the 44 risk factors identified in previous reviews, plus 12 additional factors likely to be associated with ECD.

Six factors were consistently associated with language and/or motor development at age 18 months in 3 or 4 cohorts: children’s variety of play materials, activities with caregivers, dietary diversity, linear and ponderal growth, and hemoglobin/iron status. These are likely to be key factors for targeted interventions to enhance child development. Among factors that were only measured in one or two cohorts, factors that were associated with language development were maternal cognition, 6-mo home stimulation, and frequency of child feeding, while factors that were associated with motor development were maternal health literacy, maternal and child basal cortisol, 18-mo inflammation, and 18-mo physical activity, suggesting that these are important factors for further research.

At age 18 months, children from low socio-economic status (SES) households had fallen behind those from higher-SES households in language development in all four cohorts and in motor development in two cohorts, highlighting the importance of child development interventions targeting this early period. Associations between SES and language development were largely mediated by caregiving practices rather than maternal or child bio-medical conditions, suggesting that interventions to reduce socioeconomic disparities in child development should target caregiving behavior.


Prado, E. L., Abbeddou, S., Adu-Afarwuah, S., Arimond, M., Ashorn, P., Ashorn, U., Bendabenda, J., Brown, K. H., Hess, S. Y., Kortekangas, E., Lartey, A., Maleta, K., Oaks, B., Ocansey, E., Okronipa, H., Ouédraogo, J. B., Pulakka, A., Somé, J., Stewart, C., Stewart, R., Vosti, S. A., Yakes Jimenez, E., Dewey, K. G. (2017). Predictors and pathways of language and motor development in four large prospective cohorts of young children in Ghana, Malawi, and Burkina Faso. Journal of Child Psychology and Psychiatry. (Epub ahead of print).