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OP13 Early child development at 2–5 years predicts cognitive outcomes at 6–9 years in Lao PDR: A case for population monitoring using the early Human Capability Index in low and middle income countries
  1. Alanna Sincovich1,2,
  2. Tess Gregory1,2,
  3. John Lynch1,3,
  4. Sally Brinkman1,2
  1. 1School of Public Health, University of Adelaide, Adelaide, Australia
  2. 2Telethon Kids Institute, University of Western Australia, Adelaide, Australia
  3. 3Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK


Background Beyond effects of linear growth on cognitive development, research has seldom focused on children’s developmental trajectories in low and middle income countries. This is limited by a lack of suitable measurement tools. Global commitment to tracking early child development, as outlined by the Sustainable Development Agenda, has spurred efforts to address this challenge. The early Human Capability Index (eHCI) has been shown to be a feasible and valid population monitoring measure across diverse contexts. This study investigated the comparative ability of the eHCI and direct assessment of children’s development at 2–5 years in predicting cognitive outcomes at 6–9 years.

Methods We used data collected as part of the Early Childhood Education Project, financed by the World Bank Group, in Lao PDR. Baseline data collected commenced in 2015. The sample was drawn from 376 villages in Northern Laos selected on the basis of poverty level. In each villages, 20 random households with at least one child aged between 2–5 years were selected. In 2020, children within the age range of 6–9 were surveyed again. The study population included all children for whom data were collected at both time points (n=5,269). Four measures of children’s development were used in this study; eHCI overall development, and direct assessment literacy, numeracy, and executive function. The eHCI, collected via caregiver report, includes 56 items designed to measure early child development across 8 domains. Children’s literacy, numeracy, and executive function were measured via 92 direct assessment items. Receiver Operating Characteristic (ROC) curves, C-statistics and 95% confidence intervals were estimated to determine the ability of scores at time 1 to predict poor scores at time 2.

Results The eHCI overall development score had the largest C-statistic when predicting all three cognitive development measures. For example, when predicting direct assessment numeracy at 6–9 years, eHCI overall development at 2–5 years had the strongest predictive ability (AUC 0.71, 95% CI 0.69–0.73), followed by eHCI numeracy (AUC 0.68, 95% CI 0.65–0.70) and direct assessment numeracy (AUC 0.67, 95% CI 0.65–0.70).

Conclusion Child development at 2–5 years, as measured by the eHCI, was able to predict poor cognitive outcomes at 6–9 years in Lao PDR. Findings indicate we need not rely on costly, individual level direct assessment of early child development. Rather, an adult-reported tool such as the eHCI can be used to identify where supports and greater investments are required to promote children’s later outcomes.

  • Child development
  • population monitoring
  • low and middle income countries

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