PMID- 31560687 OWN - NLM STAT- MEDLINE DCOM- 20200224 LR - 20220129 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 16 IP - 9 DP - 2019 Sep TI - Risk and protective factors for child development: An observational South African birth cohort. PG - e1002920 LID - 10.1371/journal.pmed.1002920 [doi] LID - e1002920 AB - BACKGROUND: Approximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities. METHODS AND FINDINGS: The Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks' gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning 1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [beta = -0.74; 95% CI -1.46 to -0.03, p = 0.042], receptive language [beta = -1.10; 95% CI -1.70 to -0.49, p < 0.001], expressive language [beta = -1.65; 95% CI -2.46 to -0.84, p < 0.001], and fine motor [beta = -0.70; 95% CI -1.20 to -0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed. CONCLUSIONS: This study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother-child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group. FAU - Donald, Kirsten Ann AU - Donald KA AUID- ORCID: 0000-0002-0276-9660 AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. AD - Neuroscience Institute, University of Cape Town, Cape Town, South Africa. FAU - Wedderburn, Catherine J AU - Wedderburn CJ AUID- ORCID: 0000-0002-4887-1644 AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. AD - Neuroscience Institute, University of Cape Town, Cape Town, South Africa. AD - Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom. FAU - Barnett, Whitney AU - Barnett W AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. AD - Unit on Child and Adolescent Health, South African Medical Research Council (SAMRC), Cape Town, South Africa. FAU - Nhapi, Raymond T AU - Nhapi RT AUID- ORCID: 0000-0003-1144-7038 AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. FAU - Rehman, Andrea M AU - Rehman AM AUID- ORCID: 0000-0001-9967-5822 AD - Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom. FAU - Stadler, Jacob A M AU - Stadler JAM AUID- ORCID: 0000-0003-1704-5208 AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. FAU - Hoffman, Nadia AU - Hoffman N AUID- ORCID: 0000-0002-7269-1416 AD - Department of Psychiatry and Mental Health, University of Cape Town, South Africa. FAU - Koen, Nastassja AU - Koen N AD - Department of Psychiatry and Mental Health, University of Cape Town, South Africa. AD - Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, Cape Town, South Africa. FAU - Zar, Heather J AU - Zar HJ AUID- ORCID: 0000-0002-9046-759X AD - Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. AD - Unit on Child and Adolescent Health, South African Medical Research Council (SAMRC), Cape Town, South Africa. FAU - Stein, Dan J AU - Stein DJ AD - Department of Psychiatry and Mental Health, University of Cape Town, South Africa. AD - Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, Cape Town, South Africa. LA - eng GR - U24 AA014811/AA/NIAAA NIH HHS/United States GR - R21 AA023887/AA/NIAAA NIH HHS/United States GR - MR/R010161/1/MRC_/Medical Research Council/United Kingdom GR - K012126/1/MRC_/Medical Research Council/United Kingdom GR - R01 AA026834/AA/NIAAA NIH HHS/United States GR - WT_/Wellcome Trust/United Kingdom GR - 203525/Z/16/Z/WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20190927 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Age Factors MH - Birth Weight MH - *Child Behavior MH - *Child Development MH - Child, Preschool MH - Developmental Disabilities/*epidemiology/physiopathology/prevention & control/psychology MH - Educational Status MH - Female MH - Humans MH - Male MH - Maternal Health MH - Protective Factors MH - Risk Assessment MH - Risk Factors MH - Sex Factors MH - *Social Determinants of Health MH - *Socioeconomic Factors MH - South Africa/epidemiology PMC - PMC6764658 COIS- The authors have declared that no competing interests exist. EDAT- 2019/09/29 06:00 MHDA- 2020/02/25 06:00 PMCR- 2019/09/27 CRDT- 2019/09/28 06:00 PHST- 2019/02/22 00:00 [received] PHST- 2019/08/23 00:00 [accepted] PHST- 2019/09/28 06:00 [entrez] PHST- 2019/09/29 06:00 [pubmed] PHST- 2020/02/25 06:00 [medline] PHST- 2019/09/27 00:00 [pmc-release] AID - PMEDICINE-D-19-00678 [pii] AID - 10.1371/journal.pmed.1002920 [doi] PST - epublish SO - PLoS Med. 2019 Sep 27;16(9):e1002920. doi: 10.1371/journal.pmed.1002920. eCollection 2019 Sep.