Cognitive development, early literacy and numeracy for preschool children who had received basic emergency newborn care intervention: A multi-country cohort study in Bangladesh, Nepal, and Tanzania

Abstract

Background : Newborn care interventions are crucial to reduce neonatal mortality, particularly in low- and middle-income countries (LMICs) where 98% of the world’s 2.3 million annual neonatal deaths occur. Approximately 15-20 million babies require some newborn care, yet data are limited on long-term outcomes. We aimed to compare functional difficulty, cognitive development, and school readiness between children who received basic emergency newborn care (as a marker of underlying risk) and a healthy comparison cohort. Methods : Cohort study in Bangladesh, Nepal, and Tanzania, included 715 children (cases) who received basic emergency newborn care (resuscitation, kangaroo mother care (KMC), or infection treatment) and a comparison cohort of 730 children who did not receive newborn care and had no defined risk factors (i.e., born at term and birthweight >2500g). Children aged 4-6 years were evaluated. Those with functional difficulties were identified using the Washington Group/UNICEF Tool and assessed using PEDI-CAT and PedsQL. Children without functional difficulties were assessed for intelligent quotient (IQ) and school readiness, using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) and Measuring Early Learning Quality & Outcomes (MELQO) assessments, respectively. We compared cases to the comparison group using modified Poisson regression and linear regression. Results : Functional difficulty was 4.8 times higher among cases versus the comparison cohort (adjusted relative risk (aRR) = 4.82, 95% CI: 2.62, 8.92). Among cases, those who received KMC showed the highest proportion of functional difficulties (9.0%). For children without functional difficulty, IQ was 2.22 points lower ( p < 0.001 ), and the total MELQO score was 6.06 points lower ( p < 0.001 ), driven by deficits in early literacy, early maths, and executive function. Conclusions : Receipt of basic emergency newborn care interventions serves as a measurable marker to identify children at higher underlying risk of developmental delays. This approach could inform targeted follow-up and enable earlier intervention in settings where universal developmental surveillance is not feasible.