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IJE Advance Access published online on August 28, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp272
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Child development in a birth cohort: effect of child stimulation is stronger in less educated mothers

Aluísio JD Barros1,*, Alícia Matijasevich1, Iná S Santos1 and Ricardo Halpern2

1Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Pelotas, Brazil.
2Departamento de Pediatria e Puericultura, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.

* Corresponding author. Centro de Pesquisas Epidemiológicas, R. Mal. Deodoro, 1160 3° piso, 96020-220 Pelotas, RS, Brazil. E-mail: barros.aluisio{at}gmail.com


  Abstract

Background Child health has improved in many developing countries, bringing new challenges, including realization of the children's full physical and intellectual potential. This study explored child development within a birth cohort, its psychosocial determinants and interactions with maternal schooling and economic position.

Methods All children born in Pelotas, Brazil, in 2004, were recruited to a birth cohort study. These children were assessed at birth and at 3, 12 and 24 months of age. In this last assessment involving 3869 children, detailed information on socio-economic and health characteristics was collected. Child development was assessed using the screening version of Battelle's Development Inventory. Five markers of cognitive stimulation and social interaction were recorded and summed to form a score ranging from 0–5. The outcomes studied were mean development score and low performance (less than 10th percentile of the sample).

Results Child development was strongly associated with socio-economic position, maternal schooling and stimulation. Having been told a story and owning a book were the least frequent markers among children with score 1. These children were 8.3 times more likely to present low performance than those who scored 5. The effect of stimulation was much stronger among children from mothers with a low level of schooling—one additional point added 1.7 on the child's development for children of low-schooling mothers, whereas only 0.6 was added for children of high-schooling mothers.

Conclusions Our stimulation markers cannot be directly translated into intervention strategies, but strongly suggest that suitably designed cognitive stimulation can have an important effect on children, especially those from mothers with low schooling.

Keywords Child development, cognitive stimulation, social determinants of health, social inequalities, birth cohort, child, Brazil

Accepted 7 July 2009


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