Early Childhood Care and Development (ECCD) in Two Communities in Tijuana, Mexico: maternal and household characteristics and pediatric development

Abstract

"<bold>Objective</bold>": To describe the proportion of children overall and in each study arm who attain developmental milestones in two rural peri-urban communities in Tijuana, Mexico. To compare the specific proportions of milestone attainment in this region to an international standard comparison group. To describe baseline household and maternal characteristics of each study arm. To identify maternal and household factors associated with failure to meet early child development milestones. "<bold>Material and methods</bold>": This was a secondary analysis of data derived from baseline cross-sectional survey data that were collected using World Vision's early childhood care and development (ECCD) questionnaire on 226 women to obtain maternal demographics and achievement of developmental milestones of children 6-23.99 months old living in the household. The developmental status of all children age 6-11.99 months was evaluated by maternal self-report of attainment of the same 5 milestones; that of all children age 12-23.99 months was evaluated by maternal self-report on attainment of the same 12 milestones. The prevalence of maternal depressive symptoms was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale. Multivariate analyses were performed to assess associations between maternal and household characteristics and failure to achieve child developmental milestones. Failure to attain developmental milestones was defined as failure to attain any milestone evaluated in the ECCD questionnaire, based on maternal self-report. "<bold>Results</bold>": Overall, nearly 50% of study children 6-23.99 months old failed to achieve one or more of the developmental milestones assessed. In bivariate analyses, children of mothers at extreme ranges of age, of employed mothers, of mothers with higher educational attainment, and children who received an iron-fortified diet were least likely to fail milestones overall. In multivariate analysis, factors significantly associated with milestone failure included moderate and severe maternal depression and continuous breastfeeding, in addition to age. "<bold>Conclusions</bold>": In spite of the limitations conferred by small sample size, questionnaire design, the lack of objective assessments of child developmental and nutritional standard, and the absence of a simple, internationally validated instrument for assessment of child development, this baseline study has provided useful information about the prevalence of known risk factors for poor developmental outcomes in the study communities. It identified several potentially remediable factors previously shown to affect child development, such as maternal depression and iron fortification in the child's diet. The secondary analysis also identified recommendations for improved study design to produce more robust results and to standardize the data collected to international standards.