Environmental Determinants of Early Childhood Development in Rural Kenya

Author(s): Milner, Erin Michelle | Advisor(s): Spear, Robert C; Fernald, Lia C | Abstract: Environmental risk factors can play an important and immediate role in limiting early childhood development in low- and middle-income countries (LMICs). Forty-three percent of children under five years in LMICs are at risk of not meeting their developmental potential, with children in sub-Saharan Africa being at greatest risk. Children under age three years are particularly vulnerable due to their rapid brain development and sensitivity to nutrient effects on growth, cognition, and school attainment. Climate and weather shifts can also drive disease patterns, like the spread of malaria. Environmentally-driven food security, dietary patterns, and malaria are understudied in relation to early childhood development. However, these factors may be associated with developmental outcomes among children before the age of five years due to their hypothesized impacts on nutrition, brain growth, and overall health with lifelong and intergenerational implications. Kenya has a large rural population facing challenges adapting to climate change and coping with food insecurity. While the country has a national early childhood development policy, much of the curriculum focuses on preschool-aged children and measures of early childhood development in Kenya are limited and vary by region, measure or domain assessed, and cultural differences. About one-quarter of Kenya’s population is chronically food insecure and levels of stunting and underweight in rural areas, western Kenya, and around Lake Victoria are high. Malaria is also endemic in Kenya and a leading cause of child morbidity and mortality. Kenya therefore serves as an optimal place to study associations between food insecurity, children’s fatty acid and fish intake, malaria, and early childhood development. The association between three dimensions of food insecurity (timing, intensity, and duration) and three domains of early childhood development (gross motor, communication, and personal social) were examined. Longitudinal data were collected from 303 households (including 309 children under age two years at baseline) visited nine times over two years in a community around Lake Victoria in rural Kenya. Children in households experiencing more severe food insecurity three months prior (timing) had significantly lower gross motor, communication, and personal social developmental scores using lagged models controlling for current food insecurity. Children in households that experienced greater aggregate food insecurity over the past two years (intensity) had significantly lower gross motor, communication, and personal social developmental scores. Amount of time exposed to food insecurity (duration) was associated with lower gross motor, communication, and personal social developmental scores. All results were attenuated with the addition of maternal education, household wealth, and child anthropometry to models. Fatty acid and fish consumption among children around Lake Victoria in the same population in rural Kenya was evaluated in relation to gross motor, communication, and personal social development. The majority of fatty acids, including long-chain polyunsaturated fatty acids that are important for early childhood development, in this population’s diets came from fish. Nile perch and dagaa were the most common fish species consumed. Lagged longitudinal analyses over a two year period show that greater amounts of fish consumed three months ago were associated with higher current gross motor, communication, and personal social developmental scores among children under 13.5 months, controlling for current fish consumption, child characteristics, and household demographics. Larger amounts of fatty acids (total omega 3 fatty acids, AA, EPA, and DHA) consumed three months ago were associated with higher current communication developmental scores, controlling for current fatty acid intake, child characteristics, and household demographics. Higher intake of EPA and AA three months ago was associated with greater current personal social developmental scores among children under 13.5 months. In this highly food insecure population, fishery resources can help mitigate nutrient deficiencies, especially of fatty acids, which can be particularly threatening during the complementary feeding stage. Fish may serve as a nutritional safety net where access to nutrient-dense foods is often limited. Findings provide evidence supporting the conservation of natural resources in LMICs and around Lake Victoria by enforcing resource use regulations and implementing market systems to benefit local communities and children’s development. The association between malaria and gross motor, communication, and personal social development was analyzed among 652 children 24 months of age in rural western Kenya. Eighteen percent of children had malaria and 20% of children were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was significantly associated with increased odds of a child being at risk for gross motor, communication, and personal social delay adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggest that anemia was a significant mediator in the pathway between malaria infection and being at risk for gross motor, communication, and personal social development delays. The proportions of the total effect of malaria on being at risk for developmental delay that is mediated by anemia across subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term child development delays during a vulnerable period in early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.