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There is an urgent need for effective, affordable interventions to
prevent child mental health problems in low- and middle-income
To determine the effects of a universal pre-school-based intervention on
child conduct problems and social skills at school and at home.
In a cluster randomised design, 24 community pre-schools in inner-city
areas of Kingston, Jamaica, were randomly assigned to receive the
Incredible Years Teacher Training intervention (n = 12)
or to a control group (n = 12). Three children from each
class with the highest levels of teacher-reported conduct problems were
selected for evaluation, giving 225 children aged 3–6 years. The primary
outcome was observed child behaviour at school. Secondary outcomes were
child behaviour by parent and teacher report, child attendance and
parents' attitude to school. The study is registered as
Children in intervention schools showed significantly reduced conduct
problems (effect size (ES) = 0.42) and increased friendship skills (ES =
0.74) through observation, significant reductions to teacher-reported (ES
= 0.47) and parent-reported (ES = 0.22) behaviour difficulties and
increases in teacher-reported social skills (ES = 0.59) and child
attendance (ES = 0.30). Benefits to parents' attitude to school were not
A low-cost, school-based intervention in a middle-income country
substantially reduces child conduct problems and increases child social
skills at home and at school.
To examine the evidence as to whether the relationship between undernutrition and poor child development is causal.
Selected studies from developing countries were discussed. Observational studies were first considered then experimental studies of preventative and remedial supplementation. The type of functions affected, the presence of sensitive periods and the role of protein and energy versus that of micronutrients were reviewed.
Childhood undernutrition is generally associated with concurrent and longer term deficits in cognition, behaviour and motor skills, although the relationship is likely to be confounded by socio-economic factors. Supplementation trials have had many design problems. However, those beginning at any age from pregnancy up to 24 months have consistently had concurrent benefits suggesting a causal relationship. Supplement begun in older children had little or no effect, albeit there are too few studies to conclude with confidence. The limited evidence suggests that benefits are more likely to be sustained if supplementation begins in late pregnancy or at birth and is continued until the child is at least 24 months old.
Deficits in cognition tend to be global and there is insufficient evidence of specific deficits. There is some evidence that the first 2 years of life are most sensitive to the effects of undernutrition. Most studies have failed to separate the effects of energy and protein from those of micronutrients. One study showed that energy and/or protein affects children's development. Psychosocial stimulation has had consistent benefits on undernourished childrens' development
Public health nutrition programmes should include a component in which children who are at risk are targeted during the first 2 years of life with combined interventions involving nutrition, health care and early stimulation.
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