title: Diarrhea, stimulation and growth predict neurodevelopment in young North Indian children.
abstract: OBJECTIVE
  Infants and young children in low to middle-income countries are at risk for adverse neurodevelopment due to multiple risk factors. In this study, we sought to identify stimulation and learning opportunities, growth, and burden of respiratory infections and diarrhea as predictors for neurodevelopment.
  
  
  METHODS
  We visited 422 North Indian children 6 to 30 months old weekly for six months. Childhood illnesses were assessed biweekly. At end study, we assessed neurodevelopment using the Ages and Stages Questionnaire 3rd ed. (ASQ-3) and gathered information on stimulation and learning opportunities. We identified predictors for ASQ-3 scores in multiple linear and logistic regression models.
  
  
  RESULTS
  We were able to explain 30.5% of the variation in the total ASQ-3 score by the identified predictors. When adjusting for child characteristics and annual family income, stimulation and learning opportunities explained most of the variation by 25.1%. Height for age (standardized beta: 0.12, p<.05) and weight for height z-scores (std. beta: 0.09, p<.05) were positively associated with the total ASQ-3 score, while number of days with diarrhea was negatively associated with these scores (std. beta: -0.13, p<0.01).
  
  
  CONCLUSIONS
  Our results support the importance of early child stimulation and general nutrition for child development. Our study also suggests that diarrhea is an additional risk factor for adverse neurodevelopment in vulnerable children.
authors.affiliation: Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kvestad
authors.affiliation: Society for Applied studies, New Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
authors.forename: Mari
authors.initials: M
authors.lastname: Hysing
authors.affiliation: Society for Essential Health Action and Training, New Delhi, India.
authors.forename: Tivendra
authors.initials: T
authors.lastname: Kumar
authors.affiliation: Society for Applied studies, New Delhi, India.
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway; Department of Laboratory Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: Tor A
authors.initials: TA
authors.lastname: Strand
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000503:physiopathology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D007223:Infant; D008297:Male; D009420:Nervous System / Q000254:growth & development*; D010919:Placebos
chemical_list: D010919:Placebos
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