Multilevel determinants of early childhood health during the first 1,000 days in Saudi Arabia: a scoping review with implications for nursing practice and policy

Abstract

The first 1,000 days—from conception through 24 months of age—represent a critical and largely irreversible developmental window that shapes child survival, brain architecture, metabolic programming, and lifelong health trajectories. Despite substantial global investment in early childhood development, significant knowledge gaps persist regarding context-specific implementation strategies, particularly in rapidly developing healthcare systems. This scoping review maps determinants of health and development in the first 1,000 days and identifies implications for nursing practice and policy in Saudi Arabia. This scoping review aims to synthesize evidence on determinants of child health during the first 1,000 days, examine nursing roles across ecological levels, and identify Saudi-specific gaps and context-adapted strategies to strengthen early childhood outcomes within the Saudi healthcare system. A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to PRISMA-ScR guidelines. Systematic searches of PubMed, CINAHL, Scopus, Web of Science, and Google Scholar were performed for literature published between January 2015 and March 2025. Studies examining biological, nutritional, environmental, and psychosocial determinants of early childhood development, nursing interventions, and Saudi Arabian healthcare contexts were included. Data were extracted and synthesized thematically. No quality appraisal was conducted, consistent with scoping review methodology. From 1,892 identified records, 74 studies met inclusion criteria. Evidence consistently demonstrates that timely, evidence-based interventions during the first 1,000 days yield substantial developmental benefits including optimized neurocognitive outcomes, reduced morbidity and mortality, and improved metabolic programming. Within Saudi Arabia, critical challenges include: vitamin D deficiency (50–90% prevalence), iron deficiency anemia (25–40% of reproductive-age women), declining exclusive breastfeeding rates (39% at six months), escalating pediatric obesity (10–20%), healthcare access disparities, and nursing workforce limitations in specialized early childhood competencies. This review highlights persistent gaps in integrated maternal and child service delivery, cultural influences on early-life practices, and workforce-related challenges within the Saudi healthcare system. It further underscores the critical role of nursing leadership in translating early-life evidence into practice and proposes context-sensitive strategies to strengthen early childhood outcomes.