About this srcd poster session

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Panel information
Panel 27. Solicited Content: Global South

Abstract

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Children in low- and middle-income countries (LMICs) are at heightened risk for undernutrition and adverse home environments, elevating their social-emotional risk. The deleterious effects of early-life undernutrition on physical and cognitive development are well-documented; however, its impact on social-emotional development is understudied, particularly in LMICs. Nutritional supplementation may be a modifiable resilience factor, buffering children against environmental risk concomitant with undernutrition. Using a randomized controlled trial of early-life nutritional supplementation in Ghana, we examined the direct and interactive effects of nutritional supplementation and the home environment on children’s social-emotional development.

Before the 20th week of pregnancy, 1,320 Ghanaian women were randomly assigned to receive either a lipid-based nutrient supplement (LNS Group, 34%) or to receive standard nutritional care (Control Group, 66%) during pregnancy until 6 months postpartum; infants then received LNS (or no treatment) to 18 months. When children were 4-6 years (n=966, 48.47% boys), the Home Observation Measure of the Environment was used to assess caregiver responsivity, caregiver punitive discipline, physical environment, learning materials, and academic stimulation, and mothers reported on children’s adjustment using the Strengths & Difficulties Questionnaire, and their own depression and agency.

We fit six path models to examine the direct effects of nutritional supplementation and the home environment factors predicting to children’s emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, total difficulties (sum of all problems), and prosocial behavior, while controlling for sociodemographics, data collector, and maternal depression and agency (Table 1). Children who received LNS had fewer total difficulties (β=-0.59, p=.023) and fewer peer relationship problems (β=-0.21, p=.034). More responsive caregiving was associated with fewer conduct problems (β=-0.124, p=.001), less hyperactivity/inattention (β=-0.115, p=.017), and greater prosocial behavior (β=0.198, p<.001). Caregivers who used less punitive discipline had children with fewer emotional (β=0.259, p<.001), conduct (β=0.228, p=.001), hyperactivity/inattention (β=0.228, p<.01), and peer relationship problems (β=0.277, p<.001) and fewer total difficulties (β=0.116, p<.001). Children with more learning materials also had fewer conduct problems (β=-0.058, p=.035) and greater prosocial behavior (β=0.074, p=.028). Children with greater academic stimulation had more emotional problems (β=0.145, p=.002) and less hyperactivity/inattention (β=-0.105, p=.033).

Multi-group comparisons revealed that nutritional supplementation moderated the relations between the home environment and children’s hyperactivity/inattention (χ²(5)=16.176, p=.006) and total difficulties (χ²(5)=13.746, p=.017). Children who received LNS had less hyperactivity/inattention (β=-0.166, p<.001) and fewer total difficulties (β=-0.184, p<.001) when living in safer physical environments, whereas the physical environment did not predict problems for the control group (Figure 1A). Conversely, children in the control group had more hyperactivity/inattention when they received less academic stimulation (β=-0.115, p=.005); this association was nonsignificant for children who received LNS (Figure 1B).

These findings underscore the importance of early-life nutritional supplementation and high-quality caregiving environments in reducing social-emotional difficulties among children in LMICs. Nutritional interventions appear particularly beneficial when combined with supportive home environments, especially in physically safe households. Interventions aimed at reducing punitive discipline and increasing caregiver responsivity are promising strategies for promoting social-emotional development in LMICs.

Author information

Author	Role
Lindsey C. Partington, University of California, Davis	Presenting author
Haiying Yuan, Texas Health & Human Services Commision	Non-presenting author
Maku E. Ocansey, McKing Consulting	Non-presenting author
Seth Adu-Afarwuah, University of Ghana	Non-presenting author
Amanda E. Guyer, University of California, Davis	Non-presenting author
Kathryn G. Dewey, University of California, Davis	Non-presenting author
Sika M. Kumordzie, University of California, Davis	Non-presenting author
Brietta M. Oaks, University of Rhode Island	Non-presenting author
Charles D. Arnold, University of California, Davis	Non-presenting author
Elizabeth L. Prado, University of California, Davis	Non-presenting author
Paul D. Hastings, University of California, Davis	Non-presenting author

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