Housing Environment And Early Childhood Development In Sub-Saharan Africa: A Cross-Sectional Analysis

Author summaryWhy was this study done?Sub-Saharan Africa (SSA) had the largest number of children (29.4 million) with low cognitive and/or social-emotional development worldwide in 2010.Housing might be linked to early childhood development (ECD) by affecting a child's health and a parent's ability to provide adequate care but is neglected in public health, especially in low- and middle-income countries (LMIC).What did the researchers do and find?We tested the hypothesis that improved housing is associated with on-track development in 2 ECD domains (cognitive and social-emotional).We analyzed data from 88,271 children aged 36 to 59 months in 20 SSA countries collected from nationally representative surveys conducted between 2010 and 2019.Improved housing was associated with 15% higher odds of being developmentally on track in the cognitive domain. Overall, improved housing was associated with on-track social-emotional development in girls but not boys.What do these findings mean?Housing improvement in SSA may be associated not only with benefits for children's physical health but also with broader aspects of healthy child development.Future work to establish a causal link between housing and ECD and to assess its underlying mechanisms is crucial for the designing of cost-effective ECD interventions in SSA.BackgroundThe influence of the safety and security of environments on early childhood development (ECD) has been under-explored. Although housing might be linked to ECD by affecting a child's health and a parent's ability to provide adequate care, only a few studies have examined this factor. We hypothesized that housing environment is associated with ECD in sub-Saharan Africa (SSA).Methods and findingsFrom 92,433 children aged 36 to 59 months who participated in Multiple Indicator Cluster Survey (MICS) in 20 SSA countries, 88,271 were tested for cognitive and social-emotional development using the Early Childhood Development Index (ECDI) questionnaire and were thus included in this cross-sectional analysis. Children's mean age was 47.2 months, and 49.8% were girls. Children were considered developmentally on track in a certain domain if they failed no more than 1 ECDI item in that domain. In each country, we used conditional logistic regression models to estimate the association between improved housing (housing with finished building materials, improved drinking water, improved sanitation facilities, and sufficient living area) and children's cognitive and social-emotional development, accounting for contextual effects and socioeconomic factors. Estimates from each country were pooled using random-effects meta-analyses. Subgroup analyses were conducted by the child's gender, maternal education, and household wealth quintiles. On-track cognitive development was associated with improved housing (odds ratio [OR] = 1.15, 95% CI 1.06 to 1.24, p < 0.001), improved drinking water (OR = 1.07, 95% CI 1.00 to 1.14, p = 0.046), improved sanitation facilities (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.014), and sufficient living area (OR = 1.06, 95% CI 1.01 to 1.10, p = 0.018). On-track social-emotional development was associated with improved housing only in girls (OR = 1.14, 95% CI 1.04 to 1.25, p = 0.006). The main limitations of this study included the cross-sectional nature of the datasets and the use of the ECDI, which lacks sensitivity to measure ECD outcomes.ConclusionsIn this study, we observed that improved housing was associated with on-track cognitive development and with on-track social-emotional development in girls. These findings suggest that housing improvement in SSA may be associated not only with benefits for children's physical health but also with broader aspects of healthy child development.