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| EDITORIAL |
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| Year : 2022 | Volume
: 15
| Issue : 3 | Page : 299-300 |
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Early childhood development – Let us build together
Pramila Menon
Department of Paediatrics and Medical Education, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| Date of Submission | 18-Mar-2022 |
| Date of Decision | 19-Mar-2022 |
| Date of Acceptance | 20-Mar-2022 |
| Date of Web Publication | 7-Apr-2022 |
Correspondence Address:
Pramila Menon
Department of Paediatrics and Medical Education, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mjdrdypu.mjdrdypu_223_22
How to cite this article:
Menon P. Early childhood development – Let us build together. Med J DY Patil Vidyapeeth 2022;15:299-300 |
Nurturing care of child, also known as early childhood development (ECD), is a very important economic agenda. The nurturing care has great impact on child's future earning potential, and indirectly, it reflects the financial potential of a community and the nation. During these early years of life, the brain is in molding phase, which responds to adequate nutrition and stimulation by caretakers, thus giving good developmental potential to the child.[1] The protection of young generation is our responsibility. Hence, we must focus on ECD during the coronavirus disease 2019 (COVID-19) pandemic and post-pandemic recovery. This can minimize preventable child deaths and help in economic recovery and productivity.
Sustainable Development Goal 2 is to make the world free of hunger and malnutrition by 2030, which looked doubtful to achieve in COVID-19 pre-pandemic period.[2] Globally, 43% of under 5 children were at risk and could not reach their developmental potential in the pre-COVID-19 pandemic period. The reduction of 15% coverage of life-saving essential health interventions may increase under 5 child mortality by 9.8% and maternal mortality by 8.3%. The International Monetary Fund predicted a global economic recession, which may extend beyond 2021, even after the control of pandemic.[3] The pandemics and disasters do cause negative impact on the developing brain due to environmental adversities altering the quality of life.[4] Food insecurity further damages the health and nutritional status of young children. It can change the child's life and future generations through epigenetic changes in utero.[5] The World Health Organization's Pulse Survey, United Nations International Children's Emergency Fund (UNICEF), and the World Bank's high-frequency monitoring phone reported health service disruptions in 90% of the 105 countries surveyed across five regions; 70% reported disruptions in routine immunization and 30% reported overall reduction in the coverage of essential nutrition services. Similar reports were shared by the World Bank's high-frequency monitoring phone surveys in four African countries.[6],[7],[8] Particularly, immunization and supplementary nutrition services, which are critical for children, got disrupted during the pandemic. Our National Family Health Survey-5 (NFHS-5) shows quite disappointing results on maternal and child nutrition indicators in many states of India.[9] School closure has led to physical and mental health issues in children due to lack of social interaction and outdoor play. The global economic recession due to the pandemic has put brake on global nutrition targets set for 2025 for maternal anemia, wasting, stunting, and breastfeeding, leading to worsening of maternal and child undernutrition in low- and middle-income countries.[2] The COVID-19 pandemic has affected businesses, education, and child health nutrition programs. The Lancet Global Health paper highlighted decreased utilization of routine health services and unavailability of food leading to 9.8%–44.7% increase in under 5 child deaths per month.[10] The variability in the guidelines for labor, delivery, and breastfeeding for COVID-19–positive patients created uncertainty, leading to harm. COVID-19 pandemic affected antenatal healthcare due to strained health infrastructure. The policies that were implemented with little evidence affected children and mothers in high- and low-/middle-income countries. The maternal mental health problems like anxiety and depression, and domestic violence were reported in many countries. We need to focus on epidemiological studies. The focus should be on maternal mental health, particularly during the epidemic.[11] Nguyen et al.[12] compared health service provision during pandemic to pre-pandemic levels and found it to be reduced by 83%–98% during the lockdown. Though health services resumed in July 2020 to some extent, lack of trained manpower and lack of protective equipment were the real challenges.
UNICEF is committed to protect children. The five opportunities for children are immunization, digital education, gender discrimination, mental health, and climate change, which can be changed by building trust, providing quality education, and changing to focus on mental health and climate. The investment in health and education should be directed to resilient system to reach all children. The economic crisis should not harm the children.
How are we going to change the scenario? For scaling up the nutrition interventions to address these effects, an additional US$1.2 billion per year will be needed and governments and all stakeholders must consider nutrition as a priority.[13] We must utilize all the existing platforms of health, nutrition platforms, and school feeding programs within COVID-19 response to integrate ECD. Integration of ECD in COVID-19–related awareness program can bring focus on family and responsive care. At the same time, mental health and financial capacity of the family, particularly of caretakers, is very important not only for child survival, but also for improving the quality of life, which will help the child to thrive well.[14] An innovative approach deals with multiple domains of children's health and development, like social prote ction, along with emergency food provision, like ready-to-use food, multi-micronutrient supplementation, and cash transfer.[15] We must continue to provide health, nutrition, social protection, and childcare services during the early years of child in respect to parenting programs. Multistakeholder consultations and coordinated efforts for universal paid child care are required in post-COVID-19 society. This should include counseling on health/breastfeeding/care during COVID-19, utilizing health and nutrition platforms for delivering messages on parenting and early stimulation, hygiene, targeted childcare, and psychosocial support for the frontline workers, supplying education material, and exploring distance-learning programs and social media. The policies like cash transfer programs, social safety nets, and agriculture extension programs should be effectively implemented. The overall focus for research priorities in Maternal child health (MCH) in India during and after the COVID-19 pandemic should be on strengthening existing services and service delivery.[16]
To conclude, the importance of childcare should be brought to the notice of policymakers as it is the backbone of the economy of a country. The coordinated actions and shared responsibility to address them may not only build recovery, but better, more resilient and equitable societies to address current and future global child health nutrition crisis.
| References | |  |
| 1. | Hoynes H, Schanzenbach DW, Almond D. Long-run impacts of childhood access to the safety net. Am Econ Rev 2016;106:903-34.  |
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| 3. | Black MM, Walker SP, Fernald LC, Andersen CT, DiGirolamo AM, Lu C. Early childhood development coming of age: Science through the life course. Lancet 2017;389:77-90. |
| 4. | Shonkoff JP, Garner AS, Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012;129:e232-46. |
| 5. | Stenz L, Schechter DS, Serpa SR, Paoloni-Giacobino A. Intergenerational transmission of DNA methylation signatures associated with early life stress. Curr Genomics 2018;19:665-75. |
| 6. | Walker D, Krubiner C, Chi Y-L. What Do We Really Know About COVID-19's Impact on Essential Health Services? (Center for Global Development, 2021). Available from: https://www.cgdev.org/blog/what-do-we-6. [Last accessed on 2021 Feb 20]. |
| 7. | Pulse Survey on Continuity of Essential Health Services during the COVID-19 Pandemic: Interim Report, 27 August 2020 (World Health Organization, 2020). Available from: www.who.int/publications/i/item/WHO-2019- nCoV-EHS_continuity-survey-2020.[Last accessed on 2020 Aug]. |
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| 10. | Roberton T, Carter ED, Chou VB, Stegmuller AR, Jackson BD, Tam Y, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Global Health 2020;8:e901-8. |
| 11. | Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: A scoping review. Reprod Health; 18:10. doi: 10.1186/s12978-021-01070-. |
| 12. | Nguyen RH, Kachwaha S, Pant A, Tran LM, Walia M, Ghosh S, et al. COVID-19 Disrupted provision and utilization of health and nutrition services in Uttar Pradesh, India: Insights from service providers, household phone surveys, and administrative data. J Nutr 2021;151:2305-16. |
| 13. | Osendarp S, Akuoku JK, Black RE, Headey D, Ruel M, Scott N, et al. Nature food article the COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries. Nat Food 2021;2:476-84. |
| 14. | Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T. Nurturing care: Promoting early childhood development. Lancet 2017;389:91-102. |
| 15. | Fernald LC, Gertler PJ, Neufeld LM. Role of cash in conditional cash transfer programmes for child health, growth, and development: An analysis of Mexico's Oportunidades. Lancet 2008;371:828-37. |
| 16. | Mehta K, Zodpey S, Banerjee P, Pocius SL, Dhaliwal BK, DeLuca A, et al. Shifting research priorities in maternal and child health in the COVID-19 pandemic era in India: A renewed focus on systems strengthening. PloS One 2021;16:e0256099. |
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