Nurturing care and child linear growth in relation to cognitive development and academic achievement in the first 10 years of life: prospective cohort study in Vietnam Restricted; Files Only
Tran, Lan (Fall 2024)
Abstract
Nurturing care (NC) is essential for children to meet their optimal development. However, less is known about patterns of NC from preconception through adolescence and how it impacts cognitive development trajectories and schooling achievement outcomes. This dissertation aims to explore the patterns of five NC dimensions (health, nutrition, safety/security, learning, and relationships) and multidimensional NC across the first 10 years of life, and to examine relationships of NC with cognitive development and academic achievement (mathematics and reading scores) among Vietnamese children. This dissertation used data from a prospective birth cohort of 1040 mother-child dyads in Vietnam from 2011 to 2023 (PRECONCEPT). Mothers were recruited before pregnancy and followed during pregnancy, and their offsprings were followed from birth to age 2y, at 6y and 10y. The age-specific NC indicators varied across dimensions and life stages, resulting in variations of specific and multidimensional NC scores. Distinct trajectories of NC throughout the periods (low ~ 12.4%, middle ~ 74.7%, and high ~ 12.9%) were significantly associated with outcomes at 10y (coefficients ranged 3.3 - 7.8 points ~ 0.3 - 0.6 SD for cognitive score, 1.9 - 2.1 points ~ 0.4 - 0.5 SD for mathematics score, and 1.1 - 1.9 points ~ 0.2 - 0.4 SD for reading score). Both NC and child linear growth trajectories in the first 2y were also associated with later cognitive outcomes. We identified four different cognitive development trajectories (low-increase ~ 8.1%, middle-decrease ~ 19.2%, middle-stable ~ 66.0%, and middle-increase ~ 6.7%) from 1y to 10y and the gaps in cognitive z-scores among the trajectories remained unchanged throughout the period. NC dimensions at most periods were informative for differentiating the cognitive trajectories. The safety/security, learning, and nutrition dimensions were most important to differentiate the cognitive trajectories. The findings provide comprehensive insights into the patterns and variations of NC environments in rural areas in low- and middle-income countries. The dissertation emphasizes the role of NC from preconception through childhood in addressing inequities in child development and demonstrates the importance of underlying factors of safety and security (wealth and violence) in addition to the immediate factors of nutrition and learning in improving child development. Further research is needed to develop and validate life-stage-specific NC scales, and to replicate the findings in diverse populations across different contexts.
Table of Contents
Chapter 1. Introduction. 1
Chapter 2. Literature review.. 6
2.1. Human development to age 20 years. 6
2.2. Nurturing care from preconception through adolescence and its associations with human development 8
2.2.1. Health dimension. 11
2.2.2. Nutrition dimension. 12
2.2.3. Safety/security dimension. 15
2.2.4. Learning dimension. 19
2.2.5. Relationships dimension. 21
2.3. Nurturing care measures. 22
2.4. Child development and nurturing care in the context of Vietnam.. 27
2.5. References. 29
Chapter 3. Expanded Methods. 35
3.1. Study settings and participants. 35
3.2. Selections of analytic sample. 36
3.3. Statistical methods. 44
3.3.1. Imputation of missing data. 44
3.3.2. Latent Class Growth Analysis. 46
3.3.3. Conditional nurturing care. 48
3.3.4. Discriminant analysis. 50
3.4. References. 52
Chapter 4. Nurturing care in the first 10 years of life. 54
4.1. Abstract 54
4.2. Introduction. 55
4.3. Methods. 57
4.4. Results. 64
4.5. Discussion. 67
4.6. Tables and Figures. 72
4.7. Supplementary Tables and Figures. 79
4.8. References. 88
Chapter 5. Nurturing care and child growth in the first 2 years in relation to cognitive development and academic achievement in school-age children. 93
5.1. Abstract 93
5.2. Introduction. 94
5.3. Methods. 95
5.4. Results. 100
5.5. Discussion. 103
5.6. Tables and Figures. 107
5.7. Supplementary Tables and Figures. 113
5.8. References. 120
Chapter 6. Relationships between patterns of nurturing care and child development in the first 10 years of life. 123
6.1. Abstract 123
6.2. Introduction. 124
6.3. Methods. 126
6.4. Results. 130
6.5. Discussion. 133
6.6. Tables and Figures. 138
6.7. Supplementary Tables and Figures. 143
6.8. References. 152
Chapter 7. Discussion and conclusions. 155
7.1. Summary findings. 155
7.2. Strengths and Limitations. 157
7.3. Implications. 160
7.4. Recommendations for future research. 164
7.5. Conclusions. 167
7.6. References 168
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