Objectives: To examine associations between child care center attendance and child health, growth, and development in low-income and middle-income countries.
Methods: Searches were conducted in the following databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and ERIC. Inclusionary criteria were comparison of child care center participation with a nonparticipation group, aged 0-3 years, publication 2000-2018, and an English translation. Exclusionary criteria were specialized groups, co-intervention, or studies focused exclusively on children over 3 years of age. Eleven studies met criteria: 7 from South America (Brazil), 2 from Africa (Nigeria), and 2 from Asia (Turkey and Nepal).
Results: Child care centers, often implemented to enable mothers to work, included private, nongovernmental, and public programs. Children of older, better-educated mothers tended to enroll in private centers, and children from low-income communities and backgrounds in public centers. Child care center participation was associated with discontinued breastfeeding and increased infections. In some cases, longer duration of child care attendance was associated with improved immunity and normal growth, especially for the youngest children. Child development findings were mixed. Policies guiding the programs varied across the countries where studies were conducted; most countries were underdeveloped.
Conclusions: Many LMIC are increasing their attention and support for early child care programs, often in support of maternal employment. By providing child care centers that are accessible, available, and affordable; that ensure safe and hygienic environments; and that include opportunities for age-appropriate activities and interactions with consistent and responsive caregivers, countries can promote young children's health, growth, and development. Policies, programs, and investments that support high-quality child care can not only support mothers in the work force, but also enhance the country's future by ensuring that young children receive the care and support needed to advance their development.
Funding Sources: RTI International.Partial funding from the National Institutes of Health - National Institute of Diabetes and Digestive and Kidney Diseases.