Household Food Insecurity, Growth and Development of Preschool Children: Evidence From Rural Pakistan.

Household food insecurity (HFI) remains a challenge globally and is recognized as a risk factor for poor child nutritional outcomes for infants and young children. However, few studies have evaluated the associations of HFI with the growth and development of preschool children. This study assessed the association of HFI with growth and development outcomes among preschool-aged children in rural Pakistan and explored potential differences in the magnitude of the associations by child gender and early childhood care and education (ECCE) intervention. Anthropometric and child development data from 2795 children aged 4.5-5.5 years enroled in a cluster-randomized stepped-wedge trial of the Youth Leaders for Early Childhood Assuring Children are Prepared for School intervention were collected across four districts in rural Sindh. HFI was assessed using the Household Food Insecurity Access Scale, and child development was measured by the International Development and Early Learning Assessment (IDELA) and a battery of executive functions tasks. Multilevel mixed-effects models were utilized to investigate the associations between HFI and height-for-age (HAZ), weight-for-age (WAZ), BMI-for-age z scores and child development scores. Increasing levels of HFI were associated with lower child WAZ, lower total IDELA scores and lower emergent literacy scores (p values for trend < 0.05). No significant association was observed between HFI and executive functioning. Gender and ECCE intervention status did not modify the relationship between HFI and child growth and development outcomes (p > 0.05). Future research should investigate the synergistic potential of nutrition and ECCE programmes to improve outcomes for children and families in rural Pakistan and similar resource-scarce settings. The trial is registered with ClinicalTrials.gov (NCT03764436).