Community Determinants of Physical Growth and Cognitive Development among Indian Children in Early Childhood: A Multivariate Multilevel Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Outcome Measures
2.3. Individual-and Household-Level Characteristics
2.4. Community-Level Characteristics
2.5. Statistical Models
2.6. Sensitivity Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
HAZ | height-for-age z-score |
MATHZ | mathematics test scores |
PPVT | Peabody Picture Vocabulary Test |
PPVTZ | z-scores of the Peabody Picture Vocabulary Test scores |
WAZ | weight-for-age z-score |
References
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Level 1: Multivariate Outcomes | Mean | SD | |
---|---|---|---|
Height-for-age (z-score) | −1.5 | 1.0 | |
Weight-for-age (z-score) | −1.9 | 1.0 | |
Peabody Picture Vocabulary Test (z-score) | −0.01 | 1.0 | |
Mathematics test (z-score) | −0.001 | 1.0 | |
Level 2: Individual Characteristics (n = 1625) | N | % | |
Sex | Boys | 968 | 53.1 |
Girls | 856 | 46.9 | |
Ethnicity | Scheduled castes | 325 | 17.8 |
Scheduled tribes | 233 | 12.8 | |
Backward castes | 882 | 48.4 | |
Other categories | 384 | 21.1 | |
Caregiver’s education | No education | 984 | 53.9 |
Primary | 782 | 42.9 | |
Post-secondary or above | 58 | 3.2 | |
Family structure | Living with both parents | 1789 | 98.1 |
Living with single or no parent | 35 | 1.9 | |
Birth order | First | 703 | 38.5 |
Second | 712 | 39.0 | |
Third or later | 409 | 22.4 | |
Mother’s age at birth | 20 or below | 551 | 30.2 |
21–30 | 1175 | 64.4 | |
31 or above | 98 | 5.4 | |
Mean | SD | ||
Age in months | 95.8 | 3.8 | |
Mother’s height | 151.4 | 6.1 | |
Wealth index | 0.5 | 0.2 | |
Level 3: Community characteristics (n = 94) | Mean | SD | |
Local pollution problems | 2.7 | 1.7 | |
Local social problems | 1.8 | 1.1 | |
Access to local services | 11·5 | 4.1 | |
Local programs run by government and NGO/charity | 27.9 | 7.1 | |
Local healthcare resources | 2.1 | 2.6 |
HAZ | WAZ | PPVTZ | MATHZ | |||||
---|---|---|---|---|---|---|---|---|
Coeff. | SE | Coeff. | SE | Coeff. | SE | Coeff. | SE | |
Community-level variables | ||||||||
Local pollution problems | −0.001 | 0.02 | 0.02 | 0.02 | 0.01 | 0.03 | −0.04 | 0.03 |
Local social problems | −0.003 | 0.03 | −0.001 | 0.02 | 0.002 | 0.04 | −0.08 * | 0.04 |
Access to local services | −0.004 | 0.01 | 0.002 | 0.01 | 0.01 | 0.01 | 0.004 | 0.01 |
Local programs run by government and NGO/charity | −0.001 | 0.005 | 0.0004 | 0.004 | 0.01 * | 0.01 | 0.02 ** | 0.01 |
Local healthcare resources | 0.04 ** | 0.01 | 0.03 * | 0.01 | −0.02 | 0.02 | −0.01 | 0.02 |
Individual-level variables | ||||||||
Age (in months) | −0.02 | 0.02 | −0.08 *** | 0.02 | 0.07 *** | 0.02 | 0.11 *** | 0.02 |
Sex (reference: girls) | ||||||||
Boys | −0.05 | 0.04 | −0.16 *** | 0.04 | 0.27 *** | 0.04 | 0.08 * | 0.04 |
Ethnicity (reference: Backward castes) | ||||||||
Scheduled castes | 0.00 | 0.06 | 0.07 | 0.06 | 0.08 | 0.06 | −0.02 | 0.06 |
Scheduled tribes | −0.13 | 0.08 | 0.08 | 0.08 | −0.10 | 0.09 | −0.28 *** | 0.08 |
Other categories | 0.11 | 0.06 | 0.22 *** | 0.06 | 0.02 | 0.06 | 0.01 | 0.06 |
Caregiver’s education (reference: no education) | ||||||||
Primary or below | 0.13 * | 0.05 | 0.08 | 0.05 | 0.17 *** | 0.05 | 0.33 *** | 0.05 |
Post-secondary or above | 0.33 * | 0.14 | 0.44 ** | 0.14 | 0.52 *** | 0.13 | 0.66 *** | 0.13 |
Family structure (reference: living with both parents) | ||||||||
Living with single or no parent | −0.07 | 0.15 | −0.03 | 0.16 | 0.05 | 0.15 | 0.29 * | 0.14 |
Birth order (reference: first) | ||||||||
Second | −0.12 * | 0.05 | −0.11 * | 0.05 | −0.09 | 0.05 | −0.04 | 0.05 |
Third or greater | −0.36 *** | 0.06 | −0.37 *** | 0.07 | −0.22 *** | 0.06 | −0.22 *** | 0.06 |
Mother’s age at birth (reference: 20 or below) | ||||||||
21–30 | 0.20 *** | 0.05 | 0.17 *** | 0.05 | 0.19 *** | 0.05 | 0.08 | 0.05 |
31 or above | 0.37 *** | 0.11 | 0.23 * | 0.11 | 0.14 | 0.10 | 0.14 | 0.10 |
Mother’s height | 0.24 *** | 0.02 | 0.16 *** | 0.02 | −0.01 | 0.02 | 0.03 | 0.02 |
Wealth index | 0.18 *** | 0.03 | 0.21 *** | 0.03 | 0.18 *** | 0.03 | 0.21 *** | 0.03 |
Random Effects | Model 1 | Model 2 | Model 3 | |||
---|---|---|---|---|---|---|
Estimate | SE | Estimate | SE | Estimate | SE | |
Level 3 (Community) | ||||||
HAZ | 0.14 | 0.03 | 0.03 | 0.01 | 0.03 | 0.01 |
WAZ | 0.14 | 0.03 | 0.01 | 0.01 | 0.01 | 0.01 |
PPVTZ | 0.17 | 0.03 | 0.11 | 0.02 | 0.10 | 0.02 |
MATHZ | 0.22 | 0.04 | 0.14 | 0.03 | 0.11 | 0.02 |
Level 2 (Individual) | ||||||
HAZ | 0.90 | 0.03 | 0.80 | 0.03 | 0.80 | 0.03 |
WAZ | 0.97 | 0.03 | 0.89 | 0.03 | 0.88 | 0.03 |
PPVTZ | 0.82 | 0.03 | 0.74 | 0.03 | 0.74 | 0.03 |
MATHZ | 0.76 | 0.03 | 0.66 | 0.02 | 0.66 | 0.02 |
Model 1 | Model 2 | Model 3 | ||||
---|---|---|---|---|---|---|
PPVTZ | MATHZ | PPVTZ | MATHZ | PPVTZ | MATHZ | |
Level 3 (Community) | ||||||
HAZ | 0.095 (0.024) | 0.098 (0.026) | 0.012 (0.011) | 0.001 (0.012) | 0.017 (0.011) | 0.003 (0.010) |
WAZ | 0.117 (0.025) | 0.100 (0.026) | 0.028 (0.011) | 0.008 (0.011) | 0.029 (0.010) | 0.010 (0.017) |
Level 2 (Individual) | ||||||
HAZ | 0.126 (0.021) | 0.188 (0.020) | 0.088 (0.019) | 0.129 (0.018) | 0.086 (0.019) | 0.129 (0.018) |
WAZ | 0.126 (0.022) | 0.179 (0.021) | 0.098 (0.020) | 0.129 (0.019) | 0.097 (0.020) | 0.129 (0.019) |
Model 1 | Model 2 | Model 3 | ||||
---|---|---|---|---|---|---|
PPVTZ | MATHZ | PPVTZ | MATHZ | PPVTZ | MATHZ | |
Level 3 (Community) | ||||||
HAZ | 0.61 | 0.55 | 0.20 | 0.19 | 0.11 | 0.10 |
WAZ | 0.76 | 0.57 | 0.21 | 0.18 | 0.12 | 0.17 |
Level 2 (Individual) | ||||||
HAZ | 0.15 | 0.23 | 0.11 | 0.17 | 0.11 | 0.17 |
WAZ | 0.14 | 0.21 | 0.12 | 0.17 | 0.12 | 0.17 |
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Heo, J.; Krishna, A.; Perkins, J.M.; Lee, H.-y.; Lee, J.-k.; Subramanian, S.V.; Oh, J. Community Determinants of Physical Growth and Cognitive Development among Indian Children in Early Childhood: A Multivariate Multilevel Analysis. Int. J. Environ. Res. Public Health 2020, 17, 182. https://doi.org/10.3390/ijerph17010182
Heo J, Krishna A, Perkins JM, Lee H-y, Lee J-k, Subramanian SV, Oh J. Community Determinants of Physical Growth and Cognitive Development among Indian Children in Early Childhood: A Multivariate Multilevel Analysis. International Journal of Environmental Research and Public Health. 2020; 17(1):182. https://doi.org/10.3390/ijerph17010182
Chicago/Turabian StyleHeo, Jongho, Aditi Krishna, Jessica M. Perkins, Hwa-young Lee, Jong-koo Lee, S.V. Subramanian, and Juhwan Oh. 2020. "Community Determinants of Physical Growth and Cognitive Development among Indian Children in Early Childhood: A Multivariate Multilevel Analysis" International Journal of Environmental Research and Public Health 17, no. 1: 182. https://doi.org/10.3390/ijerph17010182
APA StyleHeo, J., Krishna, A., Perkins, J. M., Lee, H. -y., Lee, J. -k., Subramanian, S. V., & Oh, J. (2020). Community Determinants of Physical Growth and Cognitive Development among Indian Children in Early Childhood: A Multivariate Multilevel Analysis. International Journal of Environmental Research and Public Health, 17(1), 182. https://doi.org/10.3390/ijerph17010182