Inequalities in early childhood care and development in low/middle-income countries: 2010–2018
Open accessAbstract
Background: Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind. Methods: Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36-59 months; 65 and 17 countries), home stimulation (36-59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36-59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains-child gender, household wealth and residential area-and compared across regions and country income groups. Results: 63% of children were not exposed to stunting or extreme poverty; 39% of 3-4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds. Conclusions: Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.
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The same analysis highlighted that the children had less home stimulation and low attendance at early childcare education, indicators associated with a poorer status in subsequent school learning, labour market productivity and health.
“The study also highlighted that the children had less home stimulation and low attendance at early childcare education; indicators associated with a poorer status in subsequent school learning, labour market productivity and health [3].”
From Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development (2021) · cites this paper as [3]
The Results report that 69% of children received adequate home stimulation and 39% of 3–4-year-olds attended early care and education, supporting the claim of limited access. The Introduction says early childhood development is a foundation for later education, work productivity and health, but this analysis does not establish that its home-stimulation or attendance indicators are associated with those later outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe authors of this study correctly highlight that these studies were handicapped by the lack of reliable data from several low-income countries and poor representation of rural communities.
“The authors of this study correctly highlight that these studies were handicapped by the lack of reliable data from several low-income countries and in cases where there were data available; there was poor representation of rural communities [3].”
From Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development (2021) · cites this paper as [3]
The Discussion (page not provided) says the analysis covered only a limited number of low- and middle-income countries and that high-quality, comparable developmental data remain limited. It does not say rural communities were poorly represented in the available surveys; its rural–urban findings concern differences in children’s outcomes, not survey representation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe analysis also showed that children in urban areas or those in the richest household scored better on all indicators of child development than those in rural areas or those from poorer households.
“Furthermore, the analysis also showed that children in urban areas or those in the richest household scored better on all indicators of child development than those in rural areas or those from poorer households.”
From Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using the Griffiths Scales of Child Development (2021) · cites this paper as [3]
The Discussion (page not specified) says that, in most countries, urban children and children in the wealthiest households fared better on the four indicators than rural children and those in the poorest households. The claim omits the ‘most countries’ qualifier and broadens ‘poorest’ to ‘poorer’; the Methods also state that wealth inequality was not measured for the risk-exposure indicator. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA recent analysis of indicators of early childhood experiences and outcomes in low and middle-income countries indicated that children in sub-Saharan Africa were exposed to stunting or extreme poverty.
“A recent analysis of indicators of early childhood experiences and outcomes in low and middle-income countries comprised of 135 national household surveys, collected between 2010 and 2018 from 94 countries indicated that children in sub-Saharan Africa were exposed to stunting or extreme poverty [3].”
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- Authors
- Lu, C., Cuartas, J., Fink, G., McCoy, D., Liu, K., Li, Z., Daelmans, B., & Richter, L.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Swiss Tropical and Public Health Institute (CH)
- Renmin University of China (CN)
- World Health Organization (CH)
- University of the Witwatersrand (ZA)
- Corresponding author
- Lu, Chunling
- ORCID
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2020-02
- Volume
- 5
- Issue
- 2
- Pages
- e002314
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC7042597
- OpenAlex
- W3004471233
- Cited by
- 188
- References
- 18
- Citations by year
- 2026: 20 · 2025: 33 · 2024: 28 · 2023: 42 · 2022: 26 · 2021: 35 · 2020: 4
- FWCI
- 17.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Global Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- edoc (University of Basel)
- Funders
- Countdown to 2030 for Maternal Child and Adolescent Health
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Social Sciences › Education › Early Childhood Education and Development
- Social Sciences › Safety Research › Poverty, Education, and Child Welfare
- Keywords
- early childhood care and development, inequality, stunting, extreme poverty, early care and education, home stimulation, child development, household wealth, residential areas, gender inequality, urban-rural differences, low-middle income countries, sub-Saharan Africa
- MeSH terms
- Adult, Child, Child, Preschool, Developing Countries, Humans, Income, Infant, Poverty, Surveys and Questionnaires, Socioeconomic Factors
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