Comment

Investment in early childhood development

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

This study aims to reveal the trajectory of disparity in receptive vocabulary developments attributable to early-life circumstances. Using the cohort data collected from Ethiopia (N = 840), India (N = 1777), Peru (N = 1624) and Vietnam (N = 1831) as the Young Lives study, this study explores the dynamics of variation in receptive vocabulary acquisitions over a 15-year period. The random forest, which is one of the most popular and versatile machine learning algorithms, is adopted to model the association between receptive vocabulary skills and early-life circumstances. Then the constructed model quantifies how much of the observed variation is due to the early-life circumstances. Such variation has already been shaped by the age of 5 and it persists even when children reach early adolescence. The prediction by the random forest suggests that compensation for disadvantaged circumstances at the early developmental stage would help marginalised children catch up and mitigate the disparity when they reach early adolescence.

This study explores the inequality of opportunity in child malnutrition in ten developing countries in Asia, where a high proportion of children still remain vulnerable to food insecurity. This study takes account of multidimensional aspects of household and parental socio-economic status, and partitions children into distinct types through a data-driven clustering method. This is followed by a comparison of the malnutrition rates between types. Next, we decompose the observed disparity into the factors that are associated with the between-type disparity in malnutrition rates through a non-linear decomposition method. The results indicate that in all 10 countries, significant between-type disparities are found. We find the largest difference in Pakistan as 21.7 percentage points and the smallest difference in Maldives as 5.9 percentage points. In five of the ten countries, the difference in household affluence explains the largest part of the observed between-type disparity. All the results suggest that priority should be given to protecting children from marginalised households in order to mitigate the inequality in child health.

This article reviews the central role of nutrition in advancing the maternal, newborn, and child health agenda with a focus on evidence for effective interventions generated using randomized controlled trials in low- and middle-income countries (LMIC). The 1000 days spanning from conception to 2 years of life are a critical period of time when nutritional needs must be ensured can lead to adverse impacts on short-term survival as well as long-term health and development. The burden of maternal mortality continues to be high in many under-resourced settings; prenatal calcium supplementation in populations with low intakes can reduce the risk of pre-eclampsia and eclampsia morbidity and mortality and is recommended, and antenatal iron−folic acid use in many countries may reduce anemia, a condition that may be an underlying factor in postpartum hemorrhage. Sufficient evidence exists to promote multiple micronutrient supplementation during pregnancy to reduce fetal growth restriction and low birth weight. Early initiation of breastfeeding (within an hour), exclusive breastfeeding in the first 6 months of life, and vitamin A supplementation in the first few days of life in Asia (but not in Africa) reduce infant mortality. Biannual large-dose vitamin A supplements to children 6–59 months of age and zinc for treatment of diarrhea continue to be important strategies for improving child health and survival. Early nutrition and micronutrient status can influence child development but should be integrated with early responsive learning interventions. Future research is needed that goes beyond the 1000 days to ensure adequate preconceptional nutrition and health, with special emphasis on adolescents who contribute to a large proportion of first births in many LMIC. Thus, we make the case for integrating proven nutrition interventions with those for health in pregnant women, and with those for health and child development in neonates, infants, and young children to help advance the global MNCH agenda.