Imperial College London


Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health



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BibTex format

author = {Sania, A and Sudfeld, CR and Danaei, G and Fink, G and McCoy, DC and Zhu, Z and Fawzi, MCS and Akman, M and Arifeen, SE and Barros, AJD and Bellinger, D and Black, MM and Bogale, A and Braun, JM and van, den Broek N and Carrara, V and Duazo, P and Duggan, C and Fernald, LCH and Gladstone, M and Hamadani, J and Handal, AJ and Harlow, S and Hidrobo, M and Kuzawa, C and Kvestad, I and Locks, L and Manji, K and Masanja, H and Matijasevich, A and McDonald, C and McGready, R and Rizvi, A and Santos, D and Santos, L and Save, D and Shapiro, R and Stoecker, B and Strand, TA and Taneja, S and Tellez-Rojo, M-M and Tofail, F and Yousafzai, AK and Ezzati, M and Fawzi, W},
doi = {10.1136/bmjopen-2018-026449},
journal = {BMJ Open},
title = {Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries.},
url = {},
volume = {9},
year = {2019}

RIS format (EndNote, RefMan)

AB - OBJECTIVE: To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs). DESIGN: Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data. DATA SOURCES: We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study. ANALYSES: Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses. RESULTS: We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs. CONCLUSIONS: Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and develo
AU - Sania,A
AU - Sudfeld,CR
AU - Danaei,G
AU - Fink,G
AU - McCoy,DC
AU - Zhu,Z
AU - Fawzi,MCS
AU - Akman,M
AU - Arifeen,SE
AU - Barros,AJD
AU - Bellinger,D
AU - Black,MM
AU - Bogale,A
AU - Braun,JM
AU - van,den Broek N
AU - Carrara,V
AU - Duazo,P
AU - Duggan,C
AU - Fernald,LCH
AU - Gladstone,M
AU - Hamadani,J
AU - Handal,AJ
AU - Harlow,S
AU - Hidrobo,M
AU - Kuzawa,C
AU - Kvestad,I
AU - Locks,L
AU - Manji,K
AU - Masanja,H
AU - Matijasevich,A
AU - McDonald,C
AU - McGready,R
AU - Rizvi,A
AU - Santos,D
AU - Santos,L
AU - Save,D
AU - Shapiro,R
AU - Stoecker,B
AU - Strand,TA
AU - Taneja,S
AU - Tellez-Rojo,M-M
AU - Tofail,F
AU - Yousafzai,AK
AU - Ezzati,M
AU - Fawzi,W
DO - 10.1136/bmjopen-2018-026449
PY - 2019///
TI - Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries.
T2 - BMJ Open
UR -
UR -
VL - 9
ER -