The Association of Early Linear Growth and Hemoglobin Concentration with Later Cognitive, Motor and Social‐emotional Development at Preschool Age in Ghana

It is important to identify the periods during childhood when exposure to environmental risk factors results in long-term neurodevelopmental deficits. Stunting and anemia may be sensitive indicators of exposure to such risks. In a prospective cohort enrolled before birth, we investigated the association of developmental scores at 4-6 years with 1) birth length and linear growth during three postnatal periods and 2) hemoglobin (Hb) concentration at three time points. Children were participants in a follow-up study of a randomized controlled trial of nutritional supplementation in Ghana. At 4-6 years, cognitive, motor, and social-emotional development were assessed using standard tests adapted for this population. We estimated the associations of length-for-age z-score (LAZ) at birth and postnatal linear growth (n=710) and Hb (n=617) with developmental scores in regression models, using multi-stage least squares analysis to calculate uncorrelated residuals for postnatal growth. Cognitive development at 4-6 years was significantly associated with LAZ at birth (β=0.12, 95% CI= 0.05, 0.19), ΔLAZ from 6 to 18 months (β=0.16, 95% CI= 0.04, 0.28), and Hb at 18 months (β=0.13, 95% CI= 0.06, 0.20), but not with ΔLAZ during 0-6 months, ΔLAZ from 18 months to 4-6 years, Hb at 6 months or Hb at 4-6 years. No evidence of associations with motor or social-emotional development were found. These results suggest that in similar contexts, the earlier periods prior to birth and up to 18 months are more sensitive to risk factors for long-term cognitive development associated with LAZ and Hb compared to later childhood. This may inform the optimal timing of interventions targeting improved cognitive development.