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Background: In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan., Methods: We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436)., Findings: LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p<0·0001) as compared with the control condition., Interpretation: LEAPS offers a scalable solution to expand access to high-quality ECCE and promote children's school readiness while providing employment for female youth in rural Pakistan and settings with similarly low ECCE participation., Funding: Dubai Cares; and Saving Brains, Grand Challenges Canada., Translation: For the Urdu translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Research has demonstrated the critical role that early learning experiences play in shaping children's cognitive, social, and emotional development. Nevertheless, tools for assessing children's exposure to early learning experiences remain scarce. This paper describes the initial validation of the Early Learning (EL) tool, which captures the levels of stimulation with playthings and people available to children 0-3-year-old in low-resource, international settings., Methods: We randomly sampled 200 mothers of children under 3-year-old in rural Sindh, Pakistan. We collected data on sociodemographic information, early learning, responsive caregiving, and child development. Psychometric analyses assessing the structural validity with confirmatory factor analysis and item response theory, criterion validity with Pearson correlation coefficients, and predictive validity with Ordinary Least Squares linear regression were conducted., Findings: We found that the EL tool is valid in this setting, capturing two factors of early learning: stimulation with playthings and stimulation with people. Stimulation with playthings and people were strongly and positively correlated with responsive caregiving, maternal education, and wealth, indicating criterion validity. Stimulation with playthings and people were also strongly associated with child development, measured by the Bayleys Scales of Infant Development., Conclusions: The EL tool is a promising instrument for measuring early learning in low- and middle-income countries, and its use can lead to more effective and inclusive monitoring and development of early learning initiatives., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Responsive caregiving is associated with secure attachment and positive child developmental outcomes. However, there is some debate on whether responsive caregiving is a universal construct. Few studies have researched responsive caregiving in diverse cultural settings, particularly in low- and middle-income countries. In this study, we explore if and how responsive caregiving is conceptualized among mothers of children under 3-years-old in rural, Sindh Pakistan. A phenomenological qualitative study was implemented in Naushahro Feroze through in-depth interviews with twenty mothers. Mothers were asked about their aspirations for their children and how they would respond in a variety of different scenarios. Data were analyzed using thematic content analysis with an inductive-deductive coding scheme. There was substantial variation in mothers' described responsive behaviors and beliefs. Almost all mothers described using some form of responsive parenting. Responding to children's demands while the mother was preoccupied, using verbal responses to console children, and if mothers believed that children should be praised, lacked consensus. Most mothers described using breastfeeding for consolation and highlighted the importance of immediately consoling their crying child. The results suggest that there is a need for a more nuanced approach to understand caregiver behaviors across contexts., (© 2024 Michigan Association for Infant Mental Health.)

Adversity within low- and middle-income countries (LMICs) poses severe threats to neurocognitive development, which can be partially mitigated by high-quality early family experiences. Specifically, maternal scaffolding and home stimulation can buffer cognitive development in LMIC, possibly by protecting underlying neural functioning. However, the association between family experiences and neural activity remains largely unexplored in LMIC contexts. This study explored the relation of early family experiences to later cognitive skills and absolute gamma power (21-45 Hz), a neural marker linked to higher-order cognitive skills. Drawing data from the PEDS trial, a longitudinal study in rural Pakistan, we examined maternal scaffolding at 24 months and home stimulation quality at 18 months as predictors of verbal IQ, executive functions, and absolute gamma at 48 months for 105 mother-child dyads (52 girls). Maternal scaffolding interacted with gender to predict absolute gamma power, such that higher maternal scaffolding was related to higher gamma more strongly for girls. Maternal scaffolding also interacted with absolute gamma to predict executive functions, such that higher gamma was related to better executive functions only when maternal scaffolding was average to high. Individual differences in early family experiences may partially buffer the neural underpinnings of cognitive skills from adversity in LMIC., (© 2024 Wiley Periodicals LLC.)

Background: High-quality early childhood care and education (ECCE) programs can positively impact children's development. However, as an unintended consequence, ECCE attendance may also affect children's nutritional status., Objective: We evaluated the effect of a center-based ECCE intervention on child nutritional outcomes in rural Pakistan., Methods: This study utilized data from a stepped-wedge cluster randomized controlled trial of a center-based ECCE program that trained female youth to run high-quality preschools for children aged 3.5-5.5 y (Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) program) in rural Sindh, Pakistan. The program did not include any school meals. A total of 99 village clusters were randomized to receive the LEAPS intervention in 3 steps, and repeated cross-sectional surveys were conducted to assess the impact on children (age: 4.5-5.5 y) at 4- time points. ITT analyses with multilevel mixed-effect models were used to estimate the effect of the intervention on child anthropometric outcomes., Results: The analysis included 3858 children with anthropometric data from 4 cross-sectional survey rounds. The LEAPS intervention was found to have a positive effect on child height-for-age z score (mean difference: 0.13 z-scores; 95% confidence interval [CI]: 0.02, 0.24). However, there was a negative effect on weight-based anthropometric indicators, -0.29 weight-for-height z score (WHZ) (95% CI: -0.42, -0.15), -0.13 BMI z score (BMIZ) (95% CI: -0.23, -0.03), and -0.16 mid-upper arm circumference-for-age z score MUACZ (95% CI: -0.25, -0.05). An exploratory analysis suggested that the magnitude of the negative effect of LEAPS on WHZ, BMIZ, and weight-for-age z score (WAZ) was greater in the survey round during the COVID-19 lockdown., Discussion: The LEAPS intervention positively affected child linear growth but had negative effects on multiple weight-based anthropometric measures. ECCE programs in low- and middle-income country settings should evaluate the integration of nutrition-specific interventions (eg school lunch, counseling on healthy diets) and infection control strategies to promote children's healthy growth and development., Clinical Trial Registry: clinicaltrials.gov, NCT03764436, https://clinicaltrials.gov/ct2/show/NCT03764436., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Research on the sustainable development goals (SDGs) has brought attention to the significance of small and medium enterprises (SMEs) due to their substantial contributions to economic growth. However, SMEs still need to develop integrated frameworks to assess the implications of sustainable operations while managing scarce resources. In this study, we investigate how top managers of SMEs utilize leadership competencies to balance and allocate resources for SDGs in a turbulent environment. To test the model, the analysis was conducted on 254 SMEs operating in an emerging market. The findings indicate that resource commitment plays a partially mediating role between leadership competencies and SDGs, while environmental uncertainty does not moderate the relationship between leadership competencies and resource commitment. These insights suggest that SMEs with competent leaders commit resources to SDGs regardless of environmental conditions. This research recommends that SMEs focus on cultivating competent leaders to navigate resource constraints and contribute to the SDGs in a turbulent environment. Further implications are discussed., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Drawing on the social exchange theory, this research advances the understanding of leadership and task performance in the hospitality industry in China by exploring the impact of inclusive leadership on the task performance of subordinates working in dyadic forms. The current literature is scarce on the role of leadership in increasing the task performance of employees working in teams in dyadic forms. Multi-level sample of 410 leaders-subordinates in the hospitality industry was used to derive the research findings using PLS-SEM. The results indicated a positive influence of inclusive leadership on the task performance of subordinates. Psychological empowerment mediated this direct relationship. In addition, trust in leaders strengthened the direct link of inclusive leadership with task performance and psychological empowerment. The findings demonstrate that leaders in the hospitality industry should adopt an inclusive leadership style as it contributes to employee task performance, which improves the industry's performance., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

The present study examines the link between children's number of older siblings and their cognitive development, as measured by executive function (EFs) skills and verbal skills (VIQ) in a sample of 1,302 4-year-old children (54% boys) living in rural Pakistan. Specifically, we investigate whether the links between the number of older siblings and preschoolers' EFs and VIQ are moderated by preschoolers' quality of home stimulation and gender. Multivariate regressions revealed that the number of older siblings was positively associated with EFs for boys in homes with both higher and lower levels of stimulation, and for girls in homes with lower levels of stimulation ( p < .05). However, the number of older siblings was negatively associated with EFs for girls from homes with higher levels of stimulation ( p = .03). Further, the number of older siblings was positively associated with VIQ in homes with lower stimulation ( p < .05), but not for higher stimulation homes. Gender was not a statistically significant moderator of the association between the number of older siblings and VIQ. Findings suggest that living with more older siblings may promote emerging EFs and VIQ among boys and girls with fewer opportunities for cognitive stimulation. However, more older siblings may hinder EF development for girls in the context of adequate home stimulation, perhaps due to inequitable allocation of resources among boys and girls in more affluent, larger families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Performance-based measures of children's executive functions (EFs) do not capture children's application of these skills during everyday emotionally-laden and socially-mediated interactions. The current study demonstrates the value of using assessor report of self-regulation behaviors (inhibitory control and positive affect/engagement) in addition to EF tasks when studying early childhood experiences and development in a rural lower-middle-income country setting. In a sample of 1302 disadvantaged 4-year-olds living in rural Pakistan, we found that directly assessed EFs were significantly related to assessor observations of children's inhibitory control and positive affect/engagement during a structured assessment protocol. However, EFs and two types of self-regulation behaviors demonstrated unique associations with children's (1) contextual experiences, as indexed by family socio-economic resources, participation in parenting interventions, and children's physical growth; and (2) age-salient developmental outcomes, as indexed by direct assessment of pre-academic skills and maternal report of prosocial behaviors and behavior problems. First, family wealth uniquely predicted only observed positive affect/engagement, whereas maternal education uniquely predicted only EFs. Second, children's antecedent linear growth was a significant predictor of both EFs and positive affect/engagement, but exposure to an enhanced nutrition intervention during the first 2 years of life and preschoolers' hair cortisol concentration were associated only with observed self-regulation behaviors. Finally, both EFs and observed positive affect/engagement uniquely predicted children's pre-academic skills. In contrast, only assessors' ratings of positive affect/engagement uniquely predicted maternal report of prosocial behaviors and only assessors' ratings of inhibitory control uniquely predicted maternal report of behavioral problems., (© 2022 John Wiley & Sons Ltd.)

This study examined whether child diet and mother-child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0-24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother-child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother-child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother-child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Service recovery performance (SRP) is very important for the takaful insurance industry for maintaining and attracting new clients, which in turn serves as a competitive advantage for the survival and continued future of the businesses. If the insurance sector could not maintain SRP, then the competitive advantage of the organizations could be decayed. Therefore, under the theoretical foundation of equity theory and resource-based theory, this research has investigated the link between human resources management practices (HRMP) (such as human capital, training, job description, teamwork, empowerment, and rewards) and SRP directly and indirectly through the employee commitment. By using a convenient sampling technique data was collected from the employees working in the Takaful industry in Pakistan to empirically test the proposed hypotheses and validate the findings. Using cross research design and quantitative research approach. The Structural Equation Modeling (SEM) had presented the positive relationship between HRM practices and SRP. On the other hand, employee commitment had also mediated this relationship. As employee commitment is significantly mediated among most of the HRMP, this aspect is therefore considered to be a big contribution of the study in the context of Pakistan. Based on these findings, the current study has several important implications the practitioners and readers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mao, Siyal, Javed Ahmed, Ahmad, Xin and Qasim.)

The current study aims to investigate the moderating effect of green brand knowledge (GBK) on the relationship of green brand positioning (GBP), attitude towards the green brand (ATGB), environmental concern (EC) and green purchase intention (GPI) in Pakistan. For this purpose, the data was collected from the individuals who were buying organic food by using purposive sampling, using cross-sectional research design and quantitative research approach. The Partial Least Square (PLS)-Structural Equation Modeling (SEM) technique results had shown that all the direct-effect relationships, namely, GBP, ATGB, EC variables have a positive and significant relationship with the GPI. While indirect-effect relationships have shown that the relationships of ATGB, EC and GPI are significantly moderated by GBK, which indicated that the effect of GBP, and EC toward GPI would be stronger when individuals have strong knowledge about green brands. In contrast, GBK is not significantly moderating the relationship between GBP and GPI. The empirical findings of this study fill a gap in the existing body of literature regarding the effects of GPI, ATGB and EC on green brands, as well as the moderating effect of GBK. As a result, this study provides insight into the topic, which has not been thoroughly investigated in earlier studies. Therefore, we consider that understanding this moderating effect is a positive contribution to the existing body of knowledge, which could help researchers explore this relationship in the future. This study could also help the owners and managers to know about the importance of these exogenous, and moderate variables to increase their customer's green purchase intentions.

Background: The Sustainable Development Goals (SDGs) highlight the importance of investments in early childhood care and education (ECCE) and youth development. Given Pakistan's large young population, and gender and urban-rural inequalities in access to education, training, and employment, such investments offer opportunities. LEAPS is a youth-led ECCE program that trains female youth, 18-24 years, as Community Youth Leaders (CYLs) to deliver high-quality ECCE for children, 3.5-5.5 years, in rural Sindh, Pakistan., Methods: We use a stepped wedge cluster-randomized trial to evaluate implementation of LEAPS. Ninety-nine clusters will be randomized to receive the intervention in one of three 7-month steps (33 clusters/step). The primary outcome is children's school readiness (indexed by the total score on the International Development and Early Learning Assessment (IDELA)). Secondary child outcomes are children's IDELA domain scores and executive functions. Data are collected in cross-sectional surveys of 1089 children (11 children/cluster from 99 clusters) aged 4.5-5.5 years at four timepoints (baseline and at the end of each step). Additionally, we will enroll three non-randomized youth participant open cohorts, one per step (33 CYLs: 66 comparison youth per cohort; 99:198 in total). Youth cohorts will be assessed at enrollment and every 7 months thereafter to measure secondary outcomes of youth personal and professional development, depressive symptoms, and executive functions. A non-randomized school cohort of 330 LEAPS students (10 students/cluster from 33 clusters) will also be enrolled and assessed during Step 1 after intervention rollout and at endline. The quality of the learning environment will be assessed in each LEAPS ECCE center and in a comparison center at two timepoints midway following rollout and at endline. A concurrent mixed-methods implementation evaluation will assess program fidelity and quality, and the extent to which a technical support strategy is successful in strengthening systems for program expansion. A cost evaluation will assess cost per beneficiary. Data collection for implementation and cost evaluations will occur in Step 3., Discussion: Youth-led models for ECCE offer a promising approach to support young children and youth. This study will contribute to the evidence as a means to promote sustainable human development across multiple SDG targets., Trial Registration: ClinicalTrials.gov NCT03764436 . Registered on December 5, 2018., (© 2021. The Author(s).)

Fine motor skills enable children to make precise and coordinated movements with their hands and support their ability to engage in everyday activities and learning experiences. In a longitudinal study of 1,058 4-year-old children in rural Pakistan (n = 488 girls), we examined how prior and concurrent levels of home stimulation relate to change in fine motor skills from ages 2 to 4 while controlling for family wealth, maternal education, number of siblings at birth, prior and concurrent measures of children's physical growth and food insecurity, and prior motor skills at age 2. Moreover, we tested whether the association between early home stimulation and subsequent fine motor skills was mediated by physical growth, food insecurity, motor skills at age 2, and concurrent home stimulation. Results revealed that home stimulation at 18 months was positively associated with change in fine motor skills from ages 2 to 4, over and above family socioeconomic resources. This association was mediated by physical growth, food insecurity and motor skills at age 2. In contrast to home stimulation at 18 months, home stimulation at age 4 was positively associated with concurrent motor skills at age 4 when controlling for all antecedent family factors, as well as prior and concurrent measures of physical growth and food insecurity, and prior motor skills at age 2. Findings suggest that the preschool period may be an important window of time when physically and cognitively stimulating experiences at home uniquely relate to variability in fine motor development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Plastic bottles are generally recycled by remolding them into numerous products. In this study, waste from plastic bottles was used to fabricate recycled polyethylene terephthalate (r-PET) nanofibers via the electrospinning technique, and high-performance conductive polyethylene terephthalate nanofibers (r-PET nanofibers) were prepared followed by copper deposition using the electroless deposition (ELD) method. Firstly, the electrospun r-PET nanofibers were chemically modified with silane molecules and polymerized with 2-(methacryloyloxy) ethyl trimethylammonium chloride (METAC) solution. Finally, the copper deposition was achieved on the surface of chemically modified r-PET nanofibers by simple chemical/ion attraction. The water contact angle of r-PET nanofibers, chemically modified r-PET nanofibers, and copper deposited nanofibers were 140°, 80°, and 138°, respectively. The r-PET nanofibers retained their fibrous morphology after copper deposition, and EDX results confirmed the presence of copper on the surface of r-PET nanofibers. XPS was performed to analyze chemical changes before and after copper deposition on r-PET nanofibers. The successful deposition of copper one r-PET nanofibers showed an excellent electrical resistance of 0.1 ohms/cm and good mechanical strength according to ASTM D-638.

Many young children in low- and middle-income countries (LMICs) face heightened risk for experiencing environmental adversity, which is linked with poorer developmental outcomes. Children's stress physiology can shed light on why children are differentially susceptible to adversity. However, no known studies have examined whether links between adversity and children's development are moderated by children's stress physiology in LMICs. The present study revealed significant interactive effects of hair cortisol concentrations, an index of chronic physiological stress regulation, and family wealth on preschoolers' cognitive skills in rural Pakistan. In a sample of 535 4-year-old children (n = 342 girls), we found significant associations between family wealth and direct assessments of verbal intelligence, pre-academic skills, and executive functions only in girls with lower hair cortisol concentrations. Specifically, girls with lower cortisol concentrations displayed greater cognitive skills if they came from relatively wealthier families, but lower cognitive skills if they came from very poor families. There were no significant associations among boys. Results provide evidence of biological sensitivity to context among young girls in a LMIC, perhaps reflecting, in part, sex differences in daily experiences of environmental adversity., (© 2020 Wiley Periodicals, Inc.)

Parental stimulation and responsiveness are associated with improved early child development outcomes. However, the majority of studies have relied on maternal-reported measures of only mothers' parenting practices. The purpose of this study was to assess the agreement between fathers' and mothers' reports of their own and their partner's engagement in stimulation and assess the degree to which parents' reported stimulation correlated with their observed responsive caregiving behaviors. Data were collected from 33 couples (33 fathers and 32 mothers) who had a child under 5 years of age in rural Pakistan. Paternal and maternal stimulation were measured based on reports of their own and their partner's practices in play and learning activities with the child. Paternal and maternal responsiveness were observed in a subsample of 18 families. Moderate agreement was found between paternal and maternal reports of their own and their partner's practices. Moderate associations were also found between self-reported measures of stimulation and observed responsive caregiving for both fathers and mothers. The strengths of agreement and associations were greater among couples who had higher quality coparenting relationships. Findings highlight the feasibility, reliability, and promise of assessing fathers' parenting in a low-resource setting, using similar methods as for mothers' parenting, to triangulate measures between reported and observed parenting and gain a deeper understanding of fathers' and mothers' unique caregiving contributions.

After publication of the original article [1], the authors wanted to make an amendment in the Acknowledgments section as Muneera Rasheed requested to be removed. This correction article shows the original and revised version of the "Acknowledgments". The original article was not updated.

Background: Parents are the primary providers of nurturing care for young children's healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers' parenting roles with regards to their young children's early health and development in rural Pakistan., Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). Data were analyzed using thematic content analysis., Results: Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers' coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community., Conclusions: Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers' direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.

Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at-scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed-methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale-up., (© 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.)

Children in low- and middle-income countries are at high risk of cognitive deficits due to environmental deprivation that compromises brain development. Despite the high prevalence of unrealized cognitive potential, very little is known about neural correlates of cognition in this population. We assessed resting EEG power and cognitive ability in 105 highly disadvantaged 48-month-old children in rural Pakistan. An increase in EEG power in gamma frequency bands (21-30Hz and 31-45Hz) was associated with better executive function. For girls, EEG gamma power also related to higher verbal IQ. This study identifies EEG gamma power as a neural marker of cognitive function in disadvantaged children in low- and middle-income countries. Elevated gamma power may be a particularly important protective factor for girls, who may experience greater deprivation due to gender inequality., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The current study focuses on maternal cognitive capacities as determinants of parenting in a highly disadvantaged global context, where children's experiences at home are often the 1st and only opportunity for learning and intellectual growth. In a large sample of 1,291 biological mothers of preschool-aged children in rural Pakistan, we examined the unique association of maternal working memory skills (independent of related cognitive capacities) with cognitively stimulating parenting behaviors. Path analysis revealed that directly assessed working memory, short-term memory, and verbal intelligence independently predicted greater levels of observed maternal scaffolding behaviors. Mothers from poorer families demonstrated lower levels of working memory, short-term memory, and verbal intelligence. However, mothers' participation in an early childhood parenting intervention that ended 2 years prior to this study contributed to greater levels of working memory skills and verbal intelligence. Further, all 3 domains of maternal cognitive capacity mediated the effect of family economic resources on maternal scaffolding, and verbal intelligence also mediated the effect of early parenting intervention exposure on maternal scaffolding. The study demonstrates the unique relevance of maternal working memory for scaffolding behaviors that required continuously monitoring the child's engagement, providing assistance, and minimizing external distractions. These results highlight the importance of directly targeting maternal cognitive capacities in poor women with little or no formal education, using a 2-generation intervention approach that includes activities known to promote parental executive functioning and literacy. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: A previous study in Pakistan assessed the effectiveness of delivering responsive stimulation and enhanced nutrition interventions to young children. Responsive stimulation significantly improved children's cognitive, language, and motor development at 2 years of age. Both interventions significantly improved parenting skills, with responsive stimulation showing larger effects. In this follow-up study, we investigated whether interventions had benefits on children's healthy development and care at 4 years of age., Methods: We implemented a follow-up study of the initial, community-based cluster-randomised effectiveness trial, which was conducted through the Lady Health Worker programme in Sindh, Pakistan. We re-enrolled 1302 mother-child dyads (87% of the 1489 dyads in the original enrolment) for assessment when the child was 4 years of age. The children were originally randomised in the following groups: nutrition education and multiple micronutrient powders (enhanced nutrition; n=311), responsive stimulation (n=345), combined responsive stimulation and enhanced nutrition (n=315), and routine health and nutrition services (control; n=331). The data collection team were masked to the allocated intervention. The original enrolment period included children born in the study area between April 1, 2009, and March 31, 2010, if they were up to 2·5 months old without signs of severe impairments. The primary endpoints for children were development and growth at 4 years of age. Interventions were given in monthly group sessions and in home visits. The primary endpoint for mothers was wellbeing and caregiving knowledge, practices, and skills when the child was 4 years of age. Analysis was by intention to treat. The original trial is registered with ClinicalTrials.gov, number NCT00715936., Findings: 1302 mother-child dyads were re-enrolled between Jan 1, 2013, and March 31, 2013, all of whom were followed up at 4 years of age. Children who received responsive stimulation (with or without enhanced nutrition) had significantly higher cognition, language, and motor skills at 4 years of age than children who did not receive responsive stimulation. For children who received responsive stimulation plus enhanced nutrition, effect sizes (Cohen's d) were 0·1 for IQ (mean difference from control 1·2, 95% CI -0·3 to 2·7), 0·3 for executive functioning (0·18, -0·07 to 0·29), 0·5 for pre-academic skills (7·53, 5·14 to 9·92) and 0·2 for pro-social behaviours (0·08, 0·03 to 0·13). For children who received responsive stimulation alone, effect sizes were 0·1 for IQ (mean difference with controls 1·7, -0·3 to 3·7), 0·3 for executive functioning (0·17, 0·07 to 0·27), 0·2 for pre-academic skills (3·86, 1·41 to 6·31), and 0·2 for pro-social behaviours (0·07, 0·02 to 0·12). Enhanced nutrition improved child motor development, with effect size of 0·2 for responsive stimulation plus enhanced nutrition (0·56, -0·03 to 1·15), and for enhanced nutrition alone (0·82, 0·18 to 1·46). Mothers who received responsive stimulation (with or without enhanced nutrition) had significantly better responsive caregiving behaviours at 4 years of child age than those who did not receive intervention. Effect size was 0·3 for responsive stimulation plus enhanced nutrition (1·95, 0·75 to 3·15) and 0·2 for responsive stimulation (2·01, 0·74 to 3·28). The caregiving environment had a medium effect size of 0·3 for all interventions (responsive stimulation plus enhanced nutrition 2·99, 1·50 to 4·48; responsive stimulation alone 2·82, 1·21 to 4·43; enhanced nutrition 3·52, 1·70 to 5·34)., Interpretation: Responsive stimulation delivered in a community health service can improve child development and care, 2 years after the end of intervention. Future analyses of these data are needed to identify which children and families benefit more or less over time., Funding: Grand Challenges Canada., (Copyright © 2016 Yousafzai et al. Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.)