In high-income countries, early life experiences, such as fetal growth restriction, preterm birth, and early childhood education have been shown to have long-term cognitive consequences. Children in low and middle-income countries bear a greater burden of early life risk factors for poor early child development. In five longitudinal cohort studies, we have shown the importance of early nutrition and the even greater importance of early life nurturing and developmentally stimulating experiences for child development. Among > 2000 school-age children in Indonesia, we found that socioenvironmental factors, such as measures of the home environment and maternal depression, showed stronger and more consistent significant associations with school-age cognitive, motor, and socioemotional scores, as compared with biomedical factors, such as maternal nutritional status during pregnancy and preterm birth. In four prospective cohorts totaling > 4000 children in Africa, 6 out of 42 factors we examined were consistently associated with language and/or motor development at age 18 months in three or four cohorts: child linear and ponderal growth, variety of play materials, activities with caregivers, dietary diversity, and hemoglobin/iron status. These are likely to be key factors for targeted interventions to enhance child development.

In the same four cohorts, predictors of children’s growth in height (length for age z-scores: LAZ) were partly distinct and partly shared. Shared correlates were child dietary diversity, hemoglobin concentration, and LAZ at birth. Key predictors of LAZ but not developmental scores were maternal height and BMI, pregnancy duration, and diarrhea incidence. Key predictors of developmental scores but not LAZ were indicators of the child’s variety of play materials and activities with caregivers. These findings suggest that environmental factors constraining growth and development overlap only in part and stunted growth is a marker of an environment that constrains growth and development through partly overlapping mechanisms.

Ongoing Data Analysis of Longitudinal Cohorts Enrolled before Birth

International Lipid-Based Nutrient Supplements (iLiNS) DYAD-G preschool follow-up study in Ghana. Funded by the Bill & Melinda Gates Foundation. PI: Kay Dewey.

Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) preschool follow-up study and 10-year follow-up study in Indonesia. Funded by the Allen Foundation and Grand Challenges Canada. PIs: Anuraj Shankar and Husni Mu’adz.



Prado, E. L., E. Yakes Jimenez, S. Vosti, R. Stewart, C. P. Stewart, J. Somé, A. Pulakka, J. B. Ouédraogo, H. Okronipa, E. Ocansey, B. Oaks, K. Maleta, A. Lartey, E. Kortekangas, S. Y. Hess, K. Brown, J. Bendabenda, U. Ashorn, P. Ashorn, M. Arimond, S. Adu-Afarwuah, S. Abbeddou and K. Dewey. (2019). Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso. British Medical Journal Global Health 4(1): e001155.

Prado E.L., Sebayang S.K., Apriatni M., Hidayati N., Adawiyah S.R., Islamiyah A., Siddiq S., Harefa B., Alcock K.J., Ullman M.T., Muadz, H., Shankar A.H. (2017). Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children’s cognition at age 9-12 years in Indonesia: follow-up of the SUMMIT randomised trial. The Lancet Global Health, 5(2), e217-e228.

Kumwenda, C., Hemsworth, J., Phuka, J., Ashorn, U., Arimond, M., Maleta,  K.,Prado, E. L., Haskell, M. J., Dewey, K. G., Ashorn, P. (2018). Association between breast milk intake at 9-10 months of age and growth and development among Malawian young children. Matern Child Nutr, 14(3),  e12582.

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).

Prado E. L., Abbeddou S., Adu-Afarwuah S., Arimond M., Ashorn P., Ashorn U., Brown K.H., Hess S.Y., Lartey A., Maleta K., et al. (2016). Linear growth and child development in Burkina Faso, Ghana, and Malawi. Pediatrics. 138(2).