Violence against women and children is widespread globally, especially among refugees and underprivileged populations. We investigated the prevalence of violence against children (VAC) and intimate partner violence (IPV) among Rohingya refugee families and families from the neighboring host communities in Cox's Bazaar, Bangladesh. We also explored the predictors of VAC and IPV. This was a cross-sectional survey embedded into the endline of a cluster-randomized controlled trial of an early childhood parenting intervention for families with children aged 6-16 months. Mothers and fathers were interviewed on their use of VAC and their attitudes towards VAC. Mothers were asked about their experience of IPV. Fathers reported on their use of IPV, their use of violence in front of children, and their attitudes to IPV. We interviewed 689 and 87 fathers from the Rohingya community, and 862 mothers and 90 fathers from the host community. In both communities, over 45% of mothers reported IPV, and over two-thirds reported VAC. Fathers reported higher levels of VAC (85.6% in host community; 77% in Rohingya community) and over a quarter reported use of IPV. In both communities, lower household wealth was associated with increased odds of mothers experiencing IPV, and mothers who experienced IPV were more than twice as likely to report use of VAC Conversely, higher maternal education increased the odds of both mother- and father-reported IPV in the Rohingya community and of father-reported IPV in the host community. Participation in an early childhood parenting intervention led to less agreement with the use of VAC by mothers in both communities, while also increasing the odds of mother-reported IPV. It is important to integrate evidence-based interventions to reduce VAC and IPV into early childhood development programs within these communities. Ensuring a combined focus on mothers and fathers is also recommended.

Lack of indigenous instruments creates difficulty to measure early childhood development. Cultural validation is prerequisite for available foreign measures. Very few tools that assess cognitive development of children are culturally appropriate for Bangladesh. The aim of this study was to culturally validate the younger version of Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV) to assess cognitive abilities of children in rural Bangladesh. A systematic validation protocol was followed including forward and backward translation, modification of pictures, items, and questions without altering underlying construct. Then psychometric properties were tested by measuring reliability and validity of the WPPSI-IV. The results indicated perfect inter-observer reliability (r = 1), and strong test-retest reliability within an interval of 7 days (r = 0.63 to 0.92) of the WPPSI-IV. We found significant correlations among the subtests of the scales of WPPSI-IV indicating its internal consistency. A total of 107 children was included to test the concurrent validity of WPPSI-IV. Concurrent validity was determined by comparing the WPPSI-IV with Bayley-III and found significant moderate association between them (r = 0.51). Thus, the younger version of WPPSI-IV is a valid and reliable instrument to measure the cognitive ability of children in Bangladesh. This has important implications to reduce the developmental deficit of children in Bangladesh. Bioresearch Commu. 12(1): 2001-2009, 2026 (January)

Background:This study presents results of a cost and cost-effectiveness analysis of two parenting interventions (group-based and pairs) integrated into primary health care centers in rural Bangladesh. Methods:A within-trial cost-effectiveness analysis was conducted for two trials of parenting interventions aiming to support child development through play and interactions. Eligible participants for both trials were underweight children aged 5-24 months. Participants in the control arms in both trials received standard health services. Intervention costs were estimated rom the provider perspective over the time horizon of each study (21 months for the group-based intervention; 24 months for the pair-based intervention). Incremental cost effectiveness ratios were estimated for all primary child development outcomes and presented in terms of cost per standard deviation improvements in the outcomes. A series of cost scenario analyses were conducted to assess the effect of changing cost assumptions on the cost and cost-effectiveness results. All results are presented in 2022 USD. The studies were registered with ClinicalTrials.gov (NCT02208531). Findings:Total provider costs in the within-trial analysis were US$ 67,668 for the group-based intervention and US$ 117,028 for the pair intervention. Estimated cost per child covered by the interventions was US$ 156 for the group intervention and US$ 136 for the pair intervention, reflecting likely economies of scale in delivery of the pair intervention. An additional US$ 100 expenditure on the group intervention is estimated to lead to a 0.55 SD improvement in cognition, 0.44 SD in language development and 0.33 SD in motor development. For the pair intervention, the corresponding estimates are improvements of 0.95 SD, 0.81 SD, and 0.88 SD, respectively. Under potential scale up scenarios, the economic cost per child could reduce substantially to US$ 61 and US$ 77 for group and pair interventions, respectively. Interpretation:The findings indicates that cost-efficiency and cost-effectiveness results for both interventions are comparable with the results from limited similar interventions in LMICs. However, implementation costs of the interventions will be substantially lower at scale due to lower monitoring costs, economies of scale, and full integration into the public health system. Funding:This work was supported by Grand Challenges Canada. ICDDR,B and core unrestricted support form the Government of Bangladesh and the Government of Canada.

BACKGROUND:There are indications that fluoride exposure considered to be beneficial for dental health may not be safe from a neurodevelopmental perspective. OBJECTIVE:We assessed the impact of prenatal and childhood fluoride exposure on cognitive abilities at 5 and 10 years of age. METHODS:We studied 500 mother-child pairs from the MINIMat (Maternal and Infant Nutrition Interventions in Matlab) birth cohort in rural Bangladesh. Urinary fluoride concentrations were measured in the pregnant women at gestational week 8 and in their children at 5 and 10 years of age using an ion-selective electrode and adjusting for specific gravity. Cognitive abilities were assessed using the Wechsler Preschool and Primary Scale for Intelligence, Third Edition, and the Wechsler Intelligence Scale, Fourth Edition, at 5 and 10 years of age, respectively. Associations of urinary fluoride concentrations (log2-transformed) with cognitive abilities (raw scores) were assessed with multivariable-adjusted linear or spline regression models. Water fluoride concentrations at the time of the follow-up of the children at 10 years of age were also measured. RESULTS:Maternal urinary fluoride concentrations (median: 0.63mg/L, 5th-95th percentiles: 0.26-1.41mg/L) were inversely associated with full-scale raw scores at 5 and 10 years [B (95% confidence interval): -2.8 (-5.1, -0.6) and -4.9 (-8.0, -1.8), respectively, by exposure doubling]. In cross-sectional analysis at 10 years, child urinary fluoride (overall median: 0.66mg/L, 5th-95th percentiles: 0.34-1.26mg/L) above -0.47 on the log2-scale (corresponding to 0.72mg/L) was inversely associated with full-scale raw scores [B (95% confidence interval): -12.1 (-21.2, -3.0)]. The association at 5 years of age was also negative but nonsignificant. For both prenatal and childhood exposure, associations were most noticeable with perceptual reasoning, but also verbal scores. The estimate for the association between urinary fluoride at 10 years of age and perceptual reasoning became 18% lower after adjustment for prenatal exposure. Inconsistent sex-specific differences were observed. CONCLUSION:Urinary fluoride concentrations measured prenatally and during childhood (child urinary fluoride concentrations above -0.47 on the log2 scale, corresponding to 0.72mg/L) were associated with lower cognitive abilities, especially perceptual reasoning and verbal abilities, in Bangladeshi children. https://doi.org/10.1289/EHP14534.

Background Past studies have documented detrimental effects of the COVID-19 pandemic on the learning and mental health of preschool- and school-age children. Few studies have examined effects on younger children's development, though this age group is extremely sensitive to economic and health shocks.Methods We assessed the effects of exposure to the pandemic on the cognitive, language, and motor development; behaviour; and growth among toddlers in rural Bangladesh. We estimated average differences between two repeated cross-sectional surveys of children and mothers living in the same villages. The first survey included 20-month-old children in 2019 and 2020 (unexposed group). The second survey took place in a randomly-selected subset of the same villages in 2022 among 20-month-old children, who had experienced pandemic-related lockdowns from approximately mid-gestation through their first year (exposed group). Both surveys used similar inclusion criteria and the same developmental assessments (Bayley's Scales of Infant and Toddler Development), behaviour observations, and field protocols.Results The exposed group (N = 526) had lower cognitive [Effect size = -0.45 (95% CI = -0.63 to -0.27)] and motor [-0.55 (-0.73 to -0.37)] composite scores, compared to the unexposed group (N = 1344). They were also observed to be less responsive to the examiner [-0.29 (-0.48 to -0.11)], less happy [-0.37 (-0.55 to -0.19)], less vocal [-0.57 (-0.73 to -0.4)] and less cooperative [-0.42 (-0.6 to -0.24)]. The pandemic increased depression among mothers with a primary education or less but not among better educated mothers. Children of less educated mothers also showed larger differences across exposed and unexposed groups in development and behaviour than those with better educated mothers.Conclusion The COVID-19 pandemic detrimentally affected cognitive and motor skills and behaviour of young children in rural Bangladesh. Disadvantaged young children's development appears to be extremely vulnerable to shocks. Without intervention these deficits will likely lead to later problems in learning and mental health.

Early childhood development (ECD) in low to middle-income nations has been a pressing concern for the last two to three decades. It is estimated that approximately 250 million children under the age of five are not reaching their full developmental potential due to factors such as poverty, malnutrition, and insufficient home stimulation. It is estimated that in Bangladesh, 44

OBJECTIVES:In 2019, >71 million children aged <5 had spent their entire lives in conflict-affected settings. Compounding adversities including violence, poverty, and displacement have immediate and long-term effects on early childhood development, health, behavior, and well-being. In response, adaptations of Reach Up have been implemented in conflict and crisis settings.METHODS:This article uses exploratory multiple case study methodology, drawing from implementation and qualitative data from 3 interventions: a mobile phone-based intervention promoting nurturing care among Rohingya and crisis-affected host communities in Bangladesh; Reach Up amid acute violence and displacement in Northeast Syria; and Reach Up group sessions and home visits integrated with health services for an indigenous population in Venezuela.RESULTS:In Bangladesh, tailoring interactive voice response messages improved responsiveness to the developmental needs of young children, yet complementary in-person services were identified as a key program enhancement. In Syria, rapid adaptations of Reach Up addressed the needs of families in acute crisis, including social-emotional learning games for school-aged children. In Venezuela, Reach Up, coupled with complementary lactation counseling, yielded high rates of uptake and satisfaction, and children's language development was highlighted as a key area of growth.CONCLUSIONS:Recommendations to promote early childhood development in crisis and conflict settings include: (1) cultural adaptation based on a holistic understanding of children and caregivers' needs; (2) the integration of child and family safety and linkages with complementary services on the basis of community needs and priorities, and (3) the importance of designing for scale through blended models and costing analyses.

Background: Anemia and iron deficiency have been associated with poor child cognitive development. A key rationale for the prevention of anemia using supplementation with iron has been the benefits to neurodevelopment. However, little causal evidence exists for these gains. Objectives: We aimed to examine effects of supplementation with iron or multiple micronutrient powders (MNPs) on brain activity measures using resting electroencephalography (EEG). Methods: Children included in this neurocognitive substudy were randomly selected from the Benefits and Risks of Iron Supplementation in Children study, a double-blind, double-dummy, individually randomized, parallel-group trial in Bangladesh, in which children, starting at 8 mo of age, received 3 mo of daily iron syrup, MNPs, or placebo. Resting brain activity was recorded using EEG immediately after inter-vention (month 3) and after a further 9-month follow-up (month 12). We derived EEG band power measures for delta, theta, alpha, and beta frequency bands. Linear regression models were used to compare the effect of each intervention with that of placebo on the outcomes. Results: Data from 412 children at month 3 and 374 at month 12 were analyzed. At baseline, 43.9% were anemic and 26.7% were iron deficient. Immediately after intervention, iron syrup, but not MNPs, increased the mu alpha-band power, a measure that is associated with maturity and the production of motor actions (iron vs. placebo: mean difference = 0.30; 95% CI: 0.11, 0.50 ??V2; P = 0.003; false discovery rate adjusted P = 0.015). Despite effects on hemoglobin and iron status, effects were not observed on the posterior alpha, beta, delta, and theta bands, nor were effects sustained at the 9-month follow-up. Conclusions: The effect size for immediate effects on the mu alpha-band power is comparable in magnitude with psychosocial stimulation interventions and poverty reduction strategies. However, overall, we did not find evidence for long-lasting changes in resting EEG power spectra from iron interventions in young Bangladeshi children. This trial was registered at www.anzctr.org.au as ACTRN12617000660381.

Background: Iron deficiency and anemia have been associated with poor cognition in children, yet the effects of iron supplementation on neurocognition remain unclear. Objective: We aimed to examine the effects of supplementation with iron on neural indices of habituation using auditory event-related brain potentials (ERPs). Methods: This substudy was nested within a 3-arm, double-blind, double-dummy, individual randomized trial in Bangladesh, in which 3300 8-mo-old children were randomly selected to receive 3 mo of daily iron syrup (12.5 mg iron), multiple micronutrient powders (MNPs) (including 12.5 mg iron), or placebo. Children were assessed after 3 mo of intervention (mo 3) and 9 mo thereafter (mo 12). The neurocognitive substudy comprised a randomly selected subset of children from the main trial. Brain activity elicited during an auditory roving oddball task was recorded using electroencephalography to provide an index of habituation. The differential response to a novel (deviant) compared with a repeated (standard) sound was examined. The primary outcome was the amplitude of the mismatch response (deviant minusstandard tone waveforms) at mo 3. Secondary outcomes included the deviant and standard tone-evoked amplitudes, N2 amplitude differences, and differences in mean amplitudes evoked by deviant tones presented in the second compared with first half of the oddball sequence at mo 3 and 12. Results: Data were analyzed from 329 children at month 3 and 363 at mo 12. Analyses indicated no treatment effects of iron interventions compared with placebo on the amplitude of the mismatch response (iron syrup compared with placebo: mean difference (MD) = 0.07 mu V [95% CI: similar to 1.22, 1.37]; MNPs compared with placebo: MD = 0.58 mu V [95% CI: similar to 0.74, 1.90]) nor any secondary ERP outcomes at mo 3 or 12, despite improvements in hemoglobin and ferritin concentrations from iron syrup and MNPs in this nested substudy. Conclusion: In Bangladeshi children with >40% anemia prevalence, iron or MNP interventions alone are insufficient to improve neural indices of habituation.

BackgroundOver 250 million children globally do not reach their developmental potential. We tested whether integrating a group-based, early childhood parenting program into government healthcare clinics improved children’s development, growth, and behavior.MethodsWe conducted a cluster-randomized controlled trial in 40 community clinics in the Kishorganj district of Bangladesh. We randomly assigned clinics (1:1) to deliver a group-based parenting interventions or to a comparison group that received no intervention. Participants were children aged 5–24 months, with weight-for-age z-score of ≤ −1.5 SDs of the WHO standards, living within a thirty-minute walking distance from the clinic (n = 419 intervention, 366 control). Government health staff facilitated parenting sessions in the clinic with groups of four mother/child dyads fortnightly for one year as part of their routine duties. Primary outcomes measured at baseline and endline were child development assessed using the Bayley scales, child behaviors during the test by tester ratings, and child growth. The trial is registered at ClinicalTrials.gov, NCT02208531.Findings:91% of children were tested at endline (396 intervention, 319 control). Multilevel analyses showed significant benefits of intervention to child cognition (effect size 0.85 SDs, 95% CI: 0.59, 1.11), language (0.69 SDs, 0.43, 0.94), and motor development (0.52 SDs, 0.31, 0.73), and to child behaviors during the test (ranging from 0.36 SDs, 0.14, 0.58, to 0.53 SDs, 0.35, 0.71). There were no significant effects on growth.ConclusionA scalable parenting intervention, integrated into existing government health services and implemented by government health staff, led to significant benefits to child development and behavior.

Micronutrients, especially iron, play a critical role in the developing infant brain. Yet, the causal effects of iron supplementation on neurocognitive functioning in a low-income anemic population of children have not been examined. This study sought to evaluate the effects of supplementation with iron syrup and iron-containing multiple micronutrient powders (MNPs) in Bangladeshi children on habituation to familiar sounds, a marker for healthy memory development, using auditory event-related brain potentials (ERPs). This study was nested within the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, a double blinded double dummy randomized controlled trial (RCT). At 8 months of age, 3300 children were randomized to receive 3 months of 1) iron syrup + placebo MNPs, or 2) MNPs (containing iron, retinol, zinc, and Vitamin C) + placebo iron syrup, or 3) placebo iron syrup and placebo MNPs. ERPs in response to an auditory roving oddball paradigm were measured in a random subset of 441 children at 3 months post-intervention (11 months of age) and 595 children after a further 9 months follow-up (20 months of age). ERP measures indexing aspects of habituation included the [deviant minus standard] difference waveform amplitude, N2 waveform amplitude, and the difference in deviant-evoked ERP amplitudes between the first and second half of the paradigm. Intention-to-treat analyses on ERP outcomes using linear models were used at 11 and 20 months of age separately. Baseline characteristics were balanced between treatment groups. Overall prevalence of anemia was 43.7% and iron deficiency was 28.4%. Intention-to-treat analyses indicated no significant treatment effects of iron or MNPs on the difference waveform amplitude at 11 months of age [mean difference (MD, 95% CI) iron vs placebo 0.24 (–1.03, 1.51); MNP vs placebo 0.59 (–0.70, 1.88)] and 20 months of age [(MD, 95% CI) iron vs placebo 0.50 (–0.62, 1.63); MNP vs placebo 0.24 (–0.89, 1.38)]. There were no differences by treatment arm for the other ERP measures. Results from a rigorous prospectively powered sub-study of an RCT in an iron deficient population indicated no significant effects of supplementation with iron or MNPs on neural indices of habituation. NHMRC and The University of Melbourne.

Background: The Benefits and Risks of Iron interventionS in Children (BRISC) trial will evaluate the impact of universal supplementation with iron supplements or iron-containing multiple micronutrient powders (MNPs) compared with placebo given for 3 months on child development, growth, morbidity, laboratory indices of anaemia, iron deficiency, and inflammation at end of intervention and after a further 9 months post intervention in children aged 8 months living in rural Bangladesh. This paper describes the statistical analysis plan. Methods: BRISC is a multi-site, three-arm, double-dummy blinded, parallel group, randomised control superiority trial in 3300 children. The statistical analysis plan was developed by the trial statistician in consultation with the trial steering committee and trial management committee based on the protocol, data collection forms, and study outcomes available in the blinded study database. Conclusion: This detailed statistical analysis plan published prior to unblinding the allocated treatments will support the statistical analyses and reporting of the BRISC trial to be undertaken after unblinding. It allows for transparency as well as reproducibility of statistical analyses and reporting. Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000660381 (registered on 8 May 2017); World Health Organization Universal Trial Number U1111-1196-1125.

Background Stay-at-home orders (lockdowns) have been deployed globally to control COVID-19 transmission, and might impair economic conditions and mental health, and exacerbate risk of food insecurity and intimate partner violence. The effect of lockdowns in low-income and middle-income countries must be understood to ensure safe deployment of these interventions in less affluent settings. We aimed to determine the immediate impact of COVID-19 lockdown orders on women and their families in rural Bangladesh. Methods An interrupted time series was used to compare data collected from families in Rupganj upazila, rural Bangladesh (randomly selected from participants in a randomised controlled trial), on income, food security, and mental health a median of 1 year and 2 years before the COVID-19 pandemic to data collected during the lockdown. We also assessed women's experiences of intimate partner violence during the pandemic. Results Between May 19 and June 18, 2020, we randomly selected and invited the mothers of 3016 children to participate in the study, 2424 of whom provided consent. 2414 (99.9%, 95% CI 99-6-99.9) of 2417 mothers were aware of, and adhering to, the stay-at-home advice. 2321(96.0%, 95.2-96-7) of 2417 mothers reported a reduction in paid work for the family. Median monthly family income fell from US$212 at baseline to $59 during lockdown, and the proportion of families earning less than $1.90 per day rose from five (0.2%, 0.0-0.5) of 2422 to 992 (47.3%, 45.2-49-5) of 2096 (p<0.0001 comparing baseline with lockdown period). Before the pandemic, 136 (5.6%, 4.7-6.6) of 2420 and 65 (2.7%, 2-1-3.4) of 2420 families experienced moderate and severe food insecurity, respectively. This increased to 881(36.5%, 34.5-38-4) of 2417 and 371 (15-3%, 13.9-16-8) of 2417 during the lockdown; the number of families experiencing any level of food insecurity increased by 51.7% (48.1-55-4; p<0-0001). Mothers' depression and anxiety symptoms increased during the lockdown. Among women experiencing emotional or moderate physical violence, over half reported it had increased since the lockdown. Interpretation COVID-19 lockdowns present significant economic, psychosocial, and physical risks to the wellbeing of women and their families across economic strata in rural Bangladesh. Beyond supporting only the most socioeconomically deprived, support is needed for all affected families. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

There is sufficient evidence that psychosocial stimulation (PS) benefits children’s neurocognitive behavior, however, there is no information on how it works when delivered through an Unconditional Cash Transfer (UCT) platform for poor rural population in developing countries. The objective of this study is to measure effects of adding PS for children of lactating mothers enrolled to receive UCT with health education (HE) on neurocognitive behavior of children in rural Bangladesh. The study will be conducted at 11 unions of Ullapara sub-district in Bangladesh. The study is a cluster randomized controlled trial with three-arms; (i) PS and UCT with HE (ii) UCT with HE and iii) Comparison arm. The cluster will be considered as an old Ward of a Union, the lowest tier of local government system in rural Bangladesh. There are three old Wards in a union. These three clusters will be randomized to one of the three arms. Similarly, randomization will be done for each 11 Unions and then 11 clusters will be assigned to an arm. Eighteen participants will be recruited from each cluster randomly (n = 196 in each arm). The intervention designed for one year includes UCT with HE for the poor as a safety net program in rural Bangladesh with or without PS. An age-based curriculum of PS is already available for Bangladeshi children and this will be administered by trained local women; play leaders (PL) in intervention clusters. The government of Bangladesh is providing UCT of taka 500 ($6.25) as maternity allowance per month with HE. The primary outcomes will be cognitive, motor and language composite scores measured by Bayley-III and behavior using Wolke’s behavior rating scale. The secondary outcomes will be children and mothers’ growth, family food security status, health seeking behavior, mothers’ depressive symptoms and self-esteem and violence against mothers. The study will provide a unique opportunity to assess an integrated early childhood development intervention using UCT platform to mitigate developmental delays in poor vulnerable children of rural Bangladesh. ClinicalTrials.gov NCT03281980, registered on September 13, 2017.

Objectives The majority of global health studies use behavioural assessments to measure early child development. Few studies have examined neural indices of cognition using electroencephalography (EEG) in low-income settings. Using data from the Benefits and Risks of Iron Supplementation in Children (BRISC) trial, we examined cognitive development and neural indices of memory and attention in 11 month-old Bangladeshi children and their environmental, socio-demographic, and biological predictors. Methods At 8 months of age, 3300 children were randomized to iron syrup, multiple micronutrient supplementation, or placebo for 3 months. The main trial outcomes include child development measured using the Bayley Scales of Infant and Toddler Development (BSID)-III, anthropometry, haemoglobin, morbidity, and iron indices. EEG is being conducted to measure event-related brain potentials (ERPs) in a random subset of 250 children at 11 months of age. ERPs are measured in response to auditory and visual stimuli, using roving oddball and attention orienting tasks. Generalized linear mixed models estimated the predictors of BSID-derived cognitive development and EEG-derived neural indices of memory and attention. Potential predictors include psychosocial stimulation, anthropometry, haemoglobin, socio-economic status, food security, sex, and parental education. Additionally, we examined correlations between the BSID cognitive scores and EEG-derived neural indices of cognition. Results Preliminary BSID data up to December 2018 indicates that 1749 children have completed measurements at 11 months of age. Psychosocial stimulation was significantly associated with BSID cognitive development scores. ERPs in children at 11 months of age are expected to be completed by May 2019 and relevant results will be presented. Conclusions This study is the first to acquire ERP data in children at 11 months of age in rural Bangladesh. Our findings will identify significant predictors of cognitive functioning measured using the BSID (a well-established developmental test) and using EEG (a sensitive neurophysiological approach) in young children in this setting. Results will indicate the agreement between child cognition outcomes using the BSID and EEG. Funding Sources NHMRC and The University of Melbourne.