Early life risks and child development

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 2017.Background Exposure to biological and psychosocial risks, particularly during the first three years of life, affects brain development and compromises the short- and long-term health and development of children, as well as their educational achievement and long-term productivity. This study sought to determine the effects of maternal and child environmental and psychosocial exposures during pregnancy and the first two years of the child’s life on growth and development outcomes in early childhood (up to 5 years) in an urban South African birth cohort. Methods Data used for this study was from the Birth to Twenty Plus (Bt20+) longitudinal birth cohort study, initiated in 1990 in the greater Johannesburg metropolitan area, South Africa. First, the associations between exposure to nine maternal risks, assessed in 1228 women, and subsequent infant birth weight was assessed. Second, the study examined the effects of risk exposure to the mother (and child) during pregnancy and the first year of a child’s life on stunting at age 2 years in 1098 mother–child pairs. Finally, the associations between ten demographic and psychosocial exposures occurring during the third trimester of pregnancy and the first two years of a child’s life and child development age 5 were examined in 636 mother-child pairs. Multivariable regression analyses were used to investigate associations between exposures and outcomes. Further analysis was undertaken to assess whether early life growth mediated the associations between maternal and household exposures and child development outcome at age 5. Results Unwanted pregnancy (or ambivalence) was associated with a ~156 g reduction in infant birth weight (β = −0.32, 95% confidence interval (CI): −0.51, −0.14). Tobacco use during pregnancy was negatively associated with BWZ (β = −0.32, 95% CI: −0.59, −0.05). Exposure to both these risks was associated with cumulative reductions in birth weight. Approximately 1 in 5 children were stunted at age 2 years, with males at greater risk than females. Higher maternal education was protective for females (adjusted odds ratio (AOR) = 0.35; 95% CI: 0.14, 0.87), while higher household SES was protective for males (AOR for richest SES group = 0.39; 95% CI: 0.16, 0.92). Males scored significantly lower than females on the developmental measure at age 5. Improved child developmental outcome was associated with higher birthweight for both sexes and superior linear growth in males. R-DPDQ scores increased by 0.84 units for every 1 SD increase in relative linear growth between birth and two years (β = 0.84 [95% CI 0.30, 1.39]). Socio-economic status (for both sexes) and maternal education for males were significant predictors of better child development. Growth status did not mediate the effects of socio-economic status (either sex) or maternal education (males) on developmental outcome. Conclusion Social factors, especially social determinants such as household SES and maternal education, were associated with early childhood growth and development in this context. Prenatal (using birthweight as a proxy) and postnatal growth were important for child development. Males were particularly vulnerable to poor growth and development in this cohort. The effects of household SES and maternal education on child development at 5 years were not mediated by linear growth between birth and 4 years.LG201

Reflective portfolios support learning, personal growth and competency achievement in postgraduate public health education

Background. Portfolios are increasingly used across a range of disciplines in health professional education to support reflective practice and to help assess students’ academic and professional development. However, their value in postgraduate education is uncertain.Objectives. To identify the role of portfolios in the development and assessment of professional competencies in postgraduate maternal and child public health education.Methods. A qualitative retrospective review of 35 student portfolios was conducted. Thematic content analysis of portfolios was done, identifying emerging themes and analysing patterns.Results. Two major themes were explored – the benefit of the portfolio to the student and to faculty. For students, portfolios promoted reflective abilities and critical thinking and assisted them in planning learning needs. For faculty, the portfolios assisted in monitoring students’ growth over time, identified learning gaps, helped to establish if expected learning outcomes were being attained and provided feedback on students’ application of academic learning to professional practice. Portfolios also offered students an opportunity to provide critical feedback on curricula content and course pedagogic activities.Conclusion. Portfolios are an under-utilised assessment and self-development tool in postgraduate training. They allow students to self-assess their attainment of personal learning needs, professional growth and competency achievement and provide faculty with useful feedback on curriculum content, educational activities and competency attainment

Developing agency in a writing centre context: A Social Realist interpretation

The aim of this article is to explore how aspects of a Social Realist theoretical framework could be understood in relation to my professional development as a writing centre consultant and manager. I share the view that a Social Realist framework could enable consideration about processes of developing or extending knowledge about ourselves in relation to cultural and structural phenomena in society, and may explain how or why changes occur or remain unchanged in socio-cultural settings. The research question that this article sets out to address is: How can my internal reflexive conversations help explain my professional development? I begin the theoretical framing for this paper by means of a brief introduction to Critical Realism (Bhaskar 1998, 2008, 2009). This is followed by a discussion of Social Realism (Archer 1995, 1996, 2000, 2007, 2010). I present introductory explanations of the major concepts used in the Social Realist theoretical framework, namely ‘structure’, ‘culture and ‘agency’, and I explain related concepts necessary for analytical sense-making

An exploration of the link between selected women’s discourses and literacy resources in the working class township settlement of Wesbank, South Africa

Magister Artium - MASouth Africa became a globally recognised democratic country in need of a development agenda after its first democratic elections were held in 1994. Democratising South Africa, however, requires rigorous attempts to open up spaces for and by the previously silenced and marginalised segments of society to become active and participatory citizens. Within the framework of New Literacy Studies and a “sociolinguistics of mobility” (Blommaert 2010), this study explored the link between selected discourses and literacy resources used by three groups of Coloured women in the working class township of Wesbank in Cape Town, South Africa. The study was framed as ethnographic, qualitative research and Appraisal Theory (a branch of Systemic Functional Linguistics) was applied to analyse the identified discourses. Based on the research findings, I also identified what literacy resources these women used for the purposes of empowering one another and the broader space of Wesbank. In addition, I proceeded to label several “transportable literacies” that my research participants from this hybrid community – where everyone “…is a migrant from elsewhere” (Dyers 2008) - appeared to be sharing in order to co-create the spaces which they use in Wesbank

School health in South Africa : reflections on the past and prospects for the future

This in-depth report examines the South African school health service, and considers its design and intentions against international models. Across countries of all income levels, the dual role of school health in contributing to both the health and education status of children has been recognised. The paper provides an overview of school health services and the integrated school health policy (ISHP) in particular: its evolution and current implementation progress. The review emphasises need for close collaboration between health and education, regardless of which department leads. It also highlights challenges with modes of delivery, resource constraints, and inter- and intra-sectoral relationships

Improving the early development of children through quality health care

Ensuring that the package of services provided during the first 1 000 days is more comprehensive, and includes the services envisaged in the Nurturing Care Framework and the ECD Policy, will require substantial changes in how services are organised, delivered and monitored.http://www.journals.co.za/content/journal/healthram2020School of Health Systems and Public Health (SHSPH

The association between preschool behavioural problems and internalizing difficulties at age 10-12 years

The aim was to study the association between preschool behavioural problems and emotional symptoms in 10- to 12-year-old children. The study was based on the Aarhus Birth cohort, Denmark, and included 1,336 children. Based on the parent-administered preschool behaviour questionnaire (PBQ), we identified three not mutually exclusive preschool behavioural categories: anxious–fearful (n = 146), hyperactive–distractible (n = 98), and hostile–aggressive (n = 170). Children without any known symptoms were considered well adjusted (n = 1,000). Borderline emotional (n = 105) and emotional difficulties (n = 136) were measured at age 10–12 years with the parent-administered strength and difficulties questionnaire (SDQ). Multinomial logistic regression analyses were used to adjust for potential confounding factors. We found that anxious–fearful behaviour and hostile–aggressive preschool behaviour were associated with twice the risk of school-age emotional difficulties. Comorbidity or confounding failed to explain these results. Hyperactive–distractible preschool behaviour was not associated with school-age emotional difficulties. Preschool anxious–fearful behaviour was associated with school-age emotional difficulties, suggesting internalizing symptom stability in some children from early childhood. Preschool hostile–aggressive behaviour was also associated with school-age emotional difficulties, which suggests transformation of one behavioural dimension into another through childhood, and the need to focus on both early internalizing difficulties and hostile–aggressive behaviour as risk factors for later internalizing difficulties

Measurement for Change: Reflections from innovators' experiences with monitoring, evaluation, and learning systems for Early Childhood Development

In this review paper, we explore how on-the-ground Early Childhood Development (ECD) innovators are using monitoring, evaluation, and learning (MEL) systems to guide the design and implementation of ECD programs, as well as how MEL systems can influence policy and support the achievement of impact at scale. We reflect on articles in the Frontiers series “Effective delivery of integrated interventions in early childhood: innovations in evidence use, monitoring, evaluation, and learning.” The 31 contributions to the series reflect the breadth and depth of complexity that characterizes ECD, including global geographic spread, with studies from Asia, Europe, Africa, and Latin America and the Caribbean. Our synthesis finds that integrating MEL processes and systems into the fabric of a program or policy initiative can broaden the underlying value proposition. Specifically, ECD organizations sought to design their MEL systems to ensure programs fit the values, goals, experiences and conceptual frameworks of diverse stakeholders, so that participating makes sense to all. For example, formative, exploratory research identified the priorities and needs of the target population and frontline service providers, and informed the content and delivery of an intervention. ECD organizations also designed their MEL systems to support a shift of accountability toward broader ownership: They included delivery agents and program participants alike as subjects rather than objects, through active participation in data collection, and by providing opportunities for equitable discussion of results and decision-making. Programs collected data to respond to specialized characteristics, priorities and needs, embedding program activities into existing day-to-day routines. Further, papers pointed to the importance of intentionally involving a variety of stakeholders in national and international dialogues to ensure that diverse ECD data collection efforts are aligned and multiple perspectives are considered in the development of national ECD policies. And, several papers illustrate the value of creative methods and measurement tools to integrate MEL into a program or policy initiative. Finally, our synthesis concludes that these findings align with the five aspirations that were formulated as part of the Measurement for Change dialogue, which motivated the launch of the series

Contextualising school readiness in South Africa: Stakeholders’ perspectives

Preparing children for mainstream school occurs in systems that act as an overarching context. The perspectives of stakeholders influence how they prepare children for mainstream education.The aim of this study was to develop an understanding of the contextual factors that affect school readiness as identified by stakeholders. School readiness was conceptualised as a function of contextual influences and connections between individual and systemic factors enabling the child to benefit from the curriculum