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Nutrition, Growth,
and Early Child Development
Maureen Black, Ph.D.
University of Maryland
RTI, Consultant
BRAIN DEVELOPMENT
• 100 billion neurons
• 60 trillion synapses
• 3 pounds
• How does it develop?
3
• 89 billion neurons
• 60 trillion synapses
• 3 pounds
• Adult size – age 6
Fetus Late Infancy/Toddler Pubertal
Developmental Perspective
Thompson & Nelson, 2000
1000 days
Fetus Late Infancy/Toddler Pubertal
Developmental Perspective
Thompson & Nelson, 2000
1000 days
Second 1000 days(age 2-5 years)
Gap in opportunities(child care)
WHO MULTICENTRE GROWTH Mean length of children age <24 mos
Children throughout the world grow similarly when their health care needs are met.
Worldwide timing of growth faltering from 54 countries
Victora et al. Pediatrics 2010;125:e473-e480
1000 days
Stunting occurs prenatally and before age 2
WASTING & STUNTING IN CHILDREN
BRAIN DEVELOPMENT
Early Stunting: Negative
Consequences for Learning
• Based on Poverty and Stunting:
• 219 million children (39%) < age 5 in low and middle income countries do not reach their developmental potential
• 19.8% deficit in adult annual income, largely attributed to schooling losses
Lancet series on child development, 2007, 2011, 2016
Countries With High Burden of
Malnutrition
These 34 countries account for 90% of the global burden of malnutrition
Global prevalence and numbers of
stunting and underweight 1990-2015
children < age 5
Globally, 24% of children <
age 5 years are stunted or
165,000,000 children.
Sub-Saharan Africa, Asia
STUNTING IN UGANDA
WHEN TO INVEST IN CHILD
DEVELOPMENT:
NUTRITION/CAREGIVING
Mother
Pre-conception
Prenatal
Child
Breast feeding
Complementary feeding
Responsive Caregiving
Storytelling
Play/Exploration
Early Learning
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.Brain
Development/ Functioning
Motor
Social Emotional
Growth
Cognitive Language
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.
Biological Factors
Brain Development/
Functioning
Motor
Social Emotional
Growth
Cognitive Language
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.
Socio-cultural
PovertyBiological
Factors
Brain Development/
Functioning
Motor
Social Emotional
Growth
Cognitive Language
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.
Socio-cultural
Poverty
Caregiving Factors
Biological Factors
Brain Development/
Functioning
Motor
Social Emotional
Growth
Cognitive Language
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.
Socio-cultural
Poverty
Caregiving Factors
Biological Factors
Brain Development/
Functioning
Motor
Social Emotional
Growth
Cognitive Language
Early learning opportunitiesResponsive caregiving
CONCEPTUAL FRAMEWORK:
EARLY CHILD DEVELOPMENT
.
Socio-cultural
Poverty
Caregiving Factors
Biological Factors
Brain Development/
Functioning
Motor
Social Emotional
Growth
Cognitive Language
Early learning opportunitiesResponsive caregiving
INTEGRATE NUTRITION &
PARENTING INTERVENTIONS (0-3)
• Home visits, guidance and support from health providers, and group parent training
• Impacts are larger when:
– parents and children participate together
– interventions involve modeling and practice of behavior
– most disadvantaged children targeted
Lancet series on child development, 2007, 2011
BOOKS & STORY TELLING
Vally Z et al., J of Child Psychology & Psychiatry, 2015
INTEGRATE NUTRITION & PRESCHOOL
INTERVENTIONS (3-5 yrs)
• Preschools improve children's cognitive & social-emotional development: school readiness
• Impact is greatest with high quality programs– Teacher-student ratio
– Developmental curriculum
– Student exploration
– Teacher responsivity
Lancet series on child development, 2007, 2011
Building blocks of adult health, earnings, & well-being occur in early child development
Campbell Science 2014 Gertler Science 2014
North Carolina35 years
Beneficial effects on blood pressure,
metabolic syndrome
Jamaica 25 years
Beneficial effects on wages
reduction in violence
LIFE COURSE PERSPECTIVE
TO CHILD DEVELOPMENT
Birth
Early Childhood
Childhood
Adolescence
Conception
Healthy nutrition and learning opportunities throughout life
GLOBAL GOALS
193 countries endorsed Early Childhood Development as the transformative solution
THANK YOU
27
Gender and Girls’ Education
Sustainable Development Goal 4:
• By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes
• ‘Leave no one behind’
yg
Closing the gender gap in schools: one of the biggest education successes since 2000
52 million fewer girls out of school
© UNICEF/NYHQ2015-2131/Grile
No country in sub-Saharan Africa has achieved gender parity in both primary and secondary education
In Africa16.7 million girls are out of school in the region, 9.3 million of which will never set foot in a classroom
© UNICEF/NYHQ2015-0770/Bindra
In Sub-Saharan Africa, 75 percent of girls start primary school but only 8 percent finish secondary school
Staying in and completing
school remains a challenge
Poorest girls are being
left behind
Rural students, especially girls are further behind
Gender discrimination holds girls
back
• Child Marriage
• Early pregnancy
• SRGBV
• Household work
Ugandan adolescent girls
still at risk
2/3 of all new HIV
Infections58%
suffered sexual
violence
1 in 4 girls is married
1 in 4 girls has at least 1 child
What works for girls?
Considerations for Uganda
• Address costs especially for rural girls – Ensure education must be free – really free
• Make every year count –– Start on time; target transitions
• Focus on adolescent girls and their issues; – Work to eliminate child marriage, reduce early
pregnancies and end SRGBV
• Support teachers to address gender inequality; build women education leaders
A journey toward
gender equality in education
Making Schooling More Meaningful: The
benefits of learning to read in mother
tongue in the early grades
The Issues
• Statistics of low literacy (reading) achievement
among of primary school learners
• Evident causes of low levels, with reference to
home and schooling experiences
• Available solutions, emphasizing mother tongue
reading and writing programs in lower grades
• Evidence of gains from systematic mother tongue
reading instruction demonstrated by SHRP
• How Government can institutionalize these gains
The Problem
• NAPE data (2014) of 64.2% of P3 learners being
proficient in English literacy and 48.6% in oral reading.
• UWEZO data (2013) of 47% of 10 year olds in Uganda
reading.
• School Health and Reading Program EGRA data (2013)
shows low abilities ranging between 0 and 0.3 wpm
among P1 children for Atɛsͻ, Lëblaŋo, Luganda and
Runy-Ruk.
• Statistics suggest learning failure, given the critical role
of reading in learning.
• Statistics are in spite of the Thematic Curriculum which
emphasizes teaching in the child’s familiar language.
A Review of the Causes
• The Thematic Curriculum emphasizes the existing
speaking and listening competences of the child as a
basis for early reading and writing.
• Children come to school with a level of competence
in speaking and listening in mother tongue.
• Children joining P1 are exposed to content in an
unfamiliar language, and are expected to know how
to read in it.
• Few teachers are equipped with knowledge of how
children learn to read and the methods of teaching
reading in early grades.
• Children have had no print to read from in class.
Solution
• Learning to read in a familiar language strengthens
a child’s reading abilities which are transferable to
second and third language learning experiences.
• Teaching is effective only if done in a systematic
manner focusing on:
adequate instructional time
a familiar language
age and grade level appropriate texts
trained teachers and teacher support
continuous assessment of learners
Age and Grade Level Appropriate Text
in a Familiar Language
• developed on the basis of an orthography validated
by the speech community (language board is key)
• reflecting the five components of reading, so as to
build the foundational competences that are
transferable to other languages
• aligning content with the themes and sub-themes of
the TC so that children can draw on their real world
experiences, progressing from known to unknown
• incorporating the value of Oral Literature and News
for mastering listening, speaking, vocabulary,
structures and critical thinking
Benefits: Local Language Oral Reading Fluency
(wpm) Baseline March 2013 and Follow-up Oct 2014
(SHRP EGRA data)
0 1.9 0.1 2 0.2
9.2
0.3
6.9
0 0.5 0 0.9 0.1
5.5
0.3
4.4
Baseline Follow-up 2 Baseline Follow-up 2 Baseline Follow-up 2 Baseline Follow-up 2
Ateso Leblango Luganda Run/Rukiga
School Health and Reading Program
Control
Benefits: Percentage of Local Language
Comprehension Questions Answered - End of P2
(SHRP EGRA data)
1 1
3 3
0.2 0
2.5
0.4
Ateso Leblango Luganda Run/Rukiga
Local Language English
Benefits: Number of Reading Comprehension
Questions Answered Correctly – End of P2
(SHRP EGRA data)
Act to Institutionalize …
• EGR reading methodology, for teachers to change classroom practices - teach reading from print, emphasize the phonic approach, conduct continuous assessment;
• provision of adequate primers (1:1) and teachers’ guides;
• college based training of pre-service teachers in EGR reading methodology;
• classroom support for reading teachers, involving head teachers, CCTs, district education officers, and
• EGRA to scale.