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Contextual and socioeconomic variation in early motor and language development
  1. Günther Fink1,
  2. Dana Charles McCoy2,
  3. Aisha Yousafzai3
  1. 1Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
  2. 2Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA
  3. 3Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Professor Günther Fink, Epidemiology and Public Health, Swiss TPH, Basel 4051, Switzerland; guenther.fink{at}


Objective To compare early motor and language development of children <3 years of age growing up in high-income and low-income contexts.

Design Cross-sectional study.

Setting We analysed differences in motor and language skills across study sites in Cambodia, Chile, Ghana, Guatemala, Lebanon, Pakistan, the Philippines and the USA.

Main outcome measure Cognitive and language development assessed with the Caregiver Reported Early Development Instruments (CREDI) tool.

Results 4649 children aged 0–35 months (mean age=18 months) were analysed. On average, children in sites with a low Human Development Index (HDI) had 0.54 SD (95% CI –0.63 to –0.44) lower CREDI motor scores and 0.73 SD (95% CI –0.82 to –0.64) lower language scores than children growing up in high HDI sites. On average, each unit increase in national log income per capita was associated with a 0.77-month (95% CI –0.93 to 0.60) reduction in the age of motor milestone attainment and a reduction in the age of language milestone attainment of 0.55 months (95% CI –0.79 to –0.30). These observed developmental differences were not universal: no developmental differences across sites with highly heterogeneous socioeconomic contexts were found among children growing up in households with highly educated caregivers providing stimulating early environments.

Conclusion Developmental gaps in settings with low HDI are substantial on average, but appear to be largely attributable to differences in family-level socioeconomic status and caregiving practices. Programmes targeting the most vulnerable subpopulations will be essential to reduce early life disparities and improve long-run outcomes.

  • neurodevelopment
  • child psychology
  • epidemiology
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  • Funding This project was supported by Grand Challenges Canada through the Saving Brains Platform.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Given that no names or other identifiable information were collected from caregivers, this project was designated exempt from review by the (redacted) University’s ethics board (IRB15-3833).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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