{
  "abstract": "Many children in low- and middle-income countries face adversities that put them at risk of not reaching their developmental potential. We investigated risk and protective factors influencing cognitive, language, and motor development at 5 years of age in a South African birth cohort and assessed which early-life factors shaped developmental trajectories between 2-5 years.Methods In the Drakenstein Child Health Study, 728 mother–child dyads were followed from the antenatal period through 5-years. Neurodevelopmental domain outcomes were measured at 5-years using standardized instruments. Random forest models identified key predictors of each domain, these were then examined in multivariable linear regressions. Longitudinal trajectories from 2-5 years were explored with latent class growth analysis; random forest and post-hoc logistic models examined determinants of class membership.Results Higher maternal education was the strongest socioeconomic factor associated with better cognitive scores (β = +5.0, p<0.001; 95%CI: 2.74,7.27) and language outcomes (β = +2.92, p<0.001; 95%CI: 1.49,4.34) with increased birthweight the strongest physical factor associated with higher cognitive scores (β=+2.34, p<0.026; 95%CI: 0.28,4.40) at 5 years. Maternal psychosocial stressors, including depression (β=-0.46; p=0.002; 95%CI:-0.75,-0.17) and physical health, including HIV-exposure (β=–0.51, p<0.001; 95%CI:-0.80,-0.23), were associated with lower expressive language scores. Trajectory analysis revealed 8.8–16% of children demonstrated developmental catch-up between 2-5 years, with female sex and supportive home environment (better parental teamwork, less crowding) predicting membership in this group.Conclusions Alongside factors predicting neurodevelopment variance at age 5-years, trajectory analysis identified developmental catch-up among at-risk children, with maternal and home factors predicting recovery.",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa",
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Kirsten A Donald"
    },
    {
      "affiliations": [
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa",
        "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Simone R Williams"
    },
    {
      "affiliations": [
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa",
        "Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Marilyn T Lake"
    },
    {
      "affiliations": [
        "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa",
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Catherine J Wedderburn"
    },
    {
      "affiliations": [
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa",
        "Ascent lab, Department of Psychology, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Susan Malcolm-Smith"
    },
    {
      "affiliations": [
        "Mrc Statistics & Epidemiology group, London School of Hygiene & Tropical Medicine, London, United Kingdom"
      ],
      "name": "Andrea M Rehman"
    },
    {
      "affiliations": [
        "Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa",
        "Samrc Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Nadia Hoffman"
    },
    {
      "affiliations": [
        "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa",
        "Samrc Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Tiffany Burd"
    },
    {
      "affiliations": [
        "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa",
        "Samrc Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Heather J Zar"
    },
    {
      "affiliations": [
        "Neuroscience Institute, University of Cape Town, Cape Town, South Africa",
        "Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa",
        "Samrc Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Dan J Stein"
    }
  ],
  "title": "214 Determinants of neurodevelopment and preschool trajectories in a South African birth cohort",
  "uid": "2f9056a5-0a48-5de6-83a3-60e8acaef3d1"
}