Early Child Development Centers Positively Impact Food Security, Dietary Diversity, Growth, and Developmental Outcomes: an Analysis of Two Early Child Development Centers in Estancia, El Salvador

Abstract

Purpose: In El Salvador, it is estimated that 35% of households live in multidimensional poverty with limited access to education, adequate nutrition, and economic opportunities. Poverty is known to affect child development and educational outcomes. An estimated 25% of three and four-year children in El Salvador have a low Early Childhood Development Index (ECDI) score. Doctors for Global Health partnered with a local non-governmental organization, La Asociación de Campesinos para el Desarrollo Humano (Peasant Association for Human Development, CDH), and facilitated the creation of Centers for Integrated Child Development (CICD) for children two – six years of age; children receive a curriculum that includes motor, language, and socio-emotional activities and nutritional supplementation. The effect of these centers on child development outcomes are unknown. Methods: We conducted 256 in-home surveys across eight communities in Estancia from September 2015 through February 2016. Two of the eight communities surveyed had CDH-sponsored CICD’s. We collected the following information: sociodemographic including factors influencing poverty; food security using the Latin American and Caribbean Household Food Security Scale, which incorporates food availability, access, and allocation of food within the household to estimate vulnerability (ELCSA has been internally and externally validated across Latin America); dietary diversity using a 22-item food frequency questionnaire adapted to the local diet; child development using Ages and Stages (available in Spanish and validated in low and middle-income countries), and child anthropometric data (weight, length/height). Using SPSS software, we analyzed the impact of early child development centers on nutritional status and achieving age-appropriate developmental milestones. Results: Children attending CICD’s had statistically significantly better communication scores, fine motor skills, social interaction skills, and problem solving. There was no association between attending CICD’s and improved gross motor skills. Additionally, children who attended CICD’s appeared to have improvement in their weight-for-age Z-scores. Conclusions: Children who attended CICD’s in Estancia, El Salvador had better nutritional status and developmental measures than those who did not attend. The dual focus of the CICD’s on nutrition and early stimulation/education may provide a useful model for mitigating the effects of poverty on child development and nutritional outcomes in rural El Salvador and similar settings.