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Early Childhood Development (ECD) in Ghana: Assessing the Status and Determinants of the Literacy-Numeracy, Physical, Social-Emotional, and Learning Domains

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Title: Early Childhood Development (ECD) in Ghana: Assessing the Status and Determinants of the Literacy-Numeracy, Physical, Social-Emotional, and Learning Domains
Language: English
Authors: Ignitius Ezekiel Lim (ORCID 0000-0002-5927-225X), Ilias Mahmud (ORCID 0000-0003-1330-7813), Md. Uzzal Chowdhury, Adrita Kaiser, Fatema Akter Bonny, Samson Akanbonga, Md. Tanvir Hasan
Source: International Journal of Early Childhood. 2024 56(2):255-276.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 22
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Early Childhood Education
Descriptors: Early Childhood Education, Child Development, Foreign Countries, Literacy, Numeracy, Physical Development, Social Development, Emotional Development, Learning Processes, Sex, Age, Mothers, Educational Background, Family Income, Disabilities, Rural Areas, Family Environment, Child Rearing
Geographic Terms: Ghana
DOI: 10.1007/s13158-023-00349-y
ISSN: 0020-7187
1878-4658
Abstract: Despite initiatives by key actors in the last two decades, Early Childhood Development in Ghana, measured by physical, cognitive, linguistic, and social-emotional development of children up to 8 years of age, remains poor. This study aimed to assess Ghana's Early Childhood Development (ECD) status and determinants by analyzing the Ghana Multiple Indicator Cluster Survey 2017/18 data. Among the 3801 Ghanaian children (35-59 months; 1880 males), 42.7% were developmentally on track in literacy-numeracy, 93.6% in physical, 68.2% in social-emotional, 82.3% in learning, and about 67% in at least 3 of the 4 domains. Multiple logistic regression analyses suggest a positive association between ECD and female sex of children, their age, mothers' attendance in any ECD programs, mothers' educational qualification, and household wealth. On the other hand, evidence of a negative association was observed between ECD and child disability, stunting status of children, maternal disability, the number of days children were left alone for more than an hour, and residence in a rural area. The level of maternal education may be implicated in ECD policies as it affected several ECD domains.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1437878
Database: ERIC
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  Value: <anid>AN0179359479;iec01aug.24;2024Sep03.03:54;v2.2.500</anid> <title id="AN0179359479-1">Early Childhood Development (ECD) in Ghana: Assessing the Status and Determinants of the Literacy–Numeracy, Physical, Social–Emotional, and Learning Domains </title> <p>Despite initiatives by key actors in the last two decades, Early Childhood Development in Ghana, measured by physical, cognitive, linguistic, and social–emotional development of children up to 8 years of age, remains poor. This study aimed to assess Ghana's Early Childhood Development (ECD) status and determinants by analyzing the Ghana Multiple Indicator Cluster Survey 2017/18 data. Among the 3801 Ghanaian children (35–59 months; 1880 males), 42.7% were developmentally on track in literacy–numeracy, 93.6% in physical, 68.2% in social–emotional, 82.3% in learning, and about 67% in at least 3 of the 4 domains. Multiple logistic regression analyses suggest a positive association between ECD and female sex of children, their age, mothers' attendance in any ECD programs, mothers' educational qualification, and household wealth. On the other hand, evidence of a negative association was observed between ECD and child disability, stunting status of children, maternal disability, the number of days children were left alone for more than an hour, and residence in a rural area. The level of maternal education may be implicated in ECD policies as it affected several ECD domains.</p> <p>Résumé: Malgré les initiatives des acteurs clés au cours des deux dernières décennies, l'indice de développement de la petite enfance (DPE), qui mesure le développement physique, cognitif, linguistique et socio-affectif des enfants jusqu'à 8 ans, reste faible au Ghana. Cette étude visait à évaluer le statut et les déterminants du développement de la petite enfance (DPE) au Ghana en analysant les données de l'enquête par grappes à indicateurs multiples 2017/18. Parmi les 3 801 enfants ghanéens (35-59 mois ; 1 880 garçons), 42,7% étaient sur la voie du développement en matière de littératie-numératie, 93,6% en matière physique, 68,2% en matière socio-émotionnelle, 82,3% en matière d'apprentissage, et environ 67% dans au moins 3 des 4 domaines. Les analyses de régression logistique multiple ont montré que l'âge était un facteur significatif commun du DPE et de ses domaines. Le niveau d'éducation de la mère peut être impliqué dans les politiques de DPE car il affecte plusieurs domaines du DPE.mots-clés : Développement de la petite enfance (DPE), indice de développement de la petite enfance (IDPE), alphabétisation-numérotation, physique, social-émotionnel, apprentissage.</p> <p>Resumen: A pesar de las iniciativas de actores clave en las últimas dos décadas, el Índice de Desarrollo Infantil Temprano (ECDI, por sus siglas en inglés), que mide el desarrollo físico, cognitivo, lingüístico y socioemocional de los niños de hasta 8 años de edad, sigue siendo deficiente en Ghana. Este estudio tuvo como objetivo evaluar el estado y los determinantes del Desarrollo de la Primera Infancia (ECD) de Ghana mediante el análisis de los datos de la Encuesta de Indicadores Múltiples por Conglomerados de Ghana 2017/18. Entre los 3.801 niños ghaneses (35-59 meses; 1.880 varones), el 42,7% estaba en vías de desarrollo en alfabetizaciónnumeración, el 93,6% en físico, el 68,2% en socioemocional, el 82,3% en aprendizaje y alrededor del 67% en al menos 3 de los 4 dominios. Los análisis de regresión logística múltiple mostraron que la edad era un factor común significativo del DIT y sus dominios. El nivel de educación materna puede estar implicado en las políticas de ECD, ya que afecta a varios dominios de ECD. Palabras clave: Desarrollo Infantil Temprano (ECD), Índice de Desarrollo Infantil Temprano (ECDI), alfabetización-numeración, físico, socio-emocional, aprendizaje.</p> <p>Keywords: Early Childhood Development (ECD); Early Childhood Development Index (ECDI); Literacy–numeracy; Physical; Social–emotional; Learning</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0179359479-2">Introduction</hd> <p>Early Childhood Development (ECD) refers to the physical, cognitive, linguistic, and social–emotional development of children up to 8 years of age (UNESCO, [<reflink idref="bib27" id="ref1">27</reflink>]). The first few years of life are crucial as it poses a window for rapid brain growth and increased sensitivity to a plethora of factors that may affect development (Black et al., [<reflink idref="bib2" id="ref2">2</reflink>]). The ECD status depends on the progress of a child in the literacy–numeracy, physical, social–emotional, and learning domains (UNICEF, [<reflink idref="bib30" id="ref3">30</reflink>]). Failure of development in any domain may have a lasting negative impact during adulthood. For instance, insufficient early motor and cognitive development have been reported to be associated with poor school performance (Psacharopoulos & Patrinos, [<reflink idref="bib21" id="ref4">21</reflink>]). Factors affecting ECD and its domains can be grouped into individual, parental or caregiving, household, and neighborhood factors. These include age, sex, and nutritional status as individual factors; parental education and engagement in reading, playing, and singing activities as caregiving factors; household wealth and use of iodized salt as household factors; neighborhood safety and socio-economic conditions as neighborhood factors (Aburto et al., [<reflink idref="bib1" id="ref5">1</reflink>]; High & Klass, [<reflink idref="bib14" id="ref6">14</reflink>]; Maggi et al., [<reflink idref="bib17" id="ref7">17</reflink>]; Pearce et al., [<reflink idref="bib20" id="ref8">20</reflink>]). Book reading, storytelling, and singing to children were reported as powerful drivers of cognitive development that also help in speech and language improvement (High & Klass, [<reflink idref="bib14" id="ref9">14</reflink>]; UNICEF, [<reflink idref="bib26" id="ref10">26</reflink>]). In Jamaica and Mexico, stunted children showed reduced activity and physical skills compared to normal children while in Japan, children who were left alone at home for once a week or more became inattentive and developed poor peer relationships (Aburto et al., [<reflink idref="bib1" id="ref11">1</reflink>]; Doi et al., [<reflink idref="bib7" id="ref12">7</reflink>]). Physical punishment was associated with social–emotional problems such as antisocial behaviors among children (Grogan-Kaylor, [<reflink idref="bib12" id="ref13">12</reflink>]). Additionally, the development of children from richer households was better than those from poorer homes (Black et al., [<reflink idref="bib2" id="ref14">2</reflink>]). Iodine deficiency was found to delay physical development, especially during the first 1000 days of life (Pearce et al., [<reflink idref="bib20" id="ref15">20</reflink>]).</p> <p>Great margins of differences in ECD exist among East Asia–Pacific countries due to culture, parenting, social and economic policies, and availability of quality early education services (Rao et al., [<reflink idref="bib22" id="ref16">22</reflink>]). Maternal conditions such as stress, depression, iron and iodine deficiency, household food insecurity, and incidence of malaria and HIV were reported as factors of poor ECD (Ford et al., [<reflink idref="bib8" id="ref17">8</reflink>]). Evidence also suggests that children with disabilities and those who have experienced emotional or sexual abuse demonstrate poor ECD outcomes (Gershoff et al., [<reflink idref="bib9" id="ref18">9</reflink>]; WHO, [<reflink idref="bib33" id="ref19">33</reflink>]). Contrastingly, better maternal education, appropriate breastfeeding, cognitive stimulation, and family interaction were identified as protective factors shaping development in early life (Walker et al., [<reflink idref="bib31" id="ref20">31</reflink>], [<reflink idref="bib32" id="ref21">32</reflink>]). Similarly, a good standard of preschool education was positively associated with better ECD outcomes (Sylva et al., [<reflink idref="bib25" id="ref22">25</reflink>]).</p> <p>The relevance of ECD has been stressed in the Sustainable Development Goals (SDGs) (UN, [<reflink idref="bib28" id="ref23">28</reflink>]). In target 4.2 of SDG 4, the development and welfare of children, regardless of their gender, are emphasized to safeguard the rights of all children to quality ECD, proper care, and education (UN Statistical Commission, [<reflink idref="bib29" id="ref24">29</reflink>]). However, ECD transcends beyond education, as it bears roots into other SDGs on health, inequality, and poverty. In achieving at least 7 SDGs, ECD must be reinforced with a multi-dimensional approach to tackling its determinants (UN, [<reflink idref="bib28" id="ref25">28</reflink>]; Haq et al., [<reflink idref="bib13" id="ref26">13</reflink>]). It is therefore inevitable that factors affecting ECD are critically investigated to achieve target 4.2 of SDG 4 and design interventions to improve its outcomes.</p> <p>Although the ECD situation has improved in low- and middle-income countries (LMICs), its determinants are less understood and have therefore received little attention (Britto et al., [<reflink idref="bib4" id="ref27">4</reflink>]). Moreover, 250 million (43%) children under 5 years of age in LMICs are at risk of failing to reach their full potential due to extreme poverty, nutritional deficiencies, and inadequate learning opportunities (Grantham-McGregor et al., [<reflink idref="bib11" id="ref28">11</reflink>]; Lu et al., [<reflink idref="bib16" id="ref29">16</reflink>]). Ghana, a lower-middle-income country in West Africa, faces a similar ECD situation to other LMICs. Recent reports show that one-third of the 3–4 years children in Ghana do not meet basic developmental landmarks, such as working independently, adhering to simple instructions, interacting well with others, avoiding distraction and aggression (McCoy et al., [<reflink idref="bib18" id="ref30">18</reflink>]). Additionally, Ghanaian children receive lower stimulation at home, with only a third (33.1%) of them having been read to in the last 3 days compared to an average of 54.1% in all LMICs (McCoy et al., [<reflink idref="bib19" id="ref31">19</reflink>]). While previous editions of the early childhood care and development (ECCD) policy in Ghana heavily relied on cognitive development, the current version now focuses on all developmental domains of children (Boakye et al., [<reflink idref="bib3" id="ref32">3</reflink>]). In 2007, the Ghanaian government launched a free 2-year preschool education for children and later introduced free senior high school to the already existing free basic education system in 2017 (Chanimbe & Dankwah, [<reflink idref="bib5" id="ref33">5</reflink>]). Despite these progresses, the status of ECD in Ghana remains heavily overlooked with limited research examining how a particular factor affects different ECD domains and subsequently assessing which factors are most influential from domain to domain. The objective of this study was to assess the status and determinants of ECD among Ghanaian children aged 35–59 months utilizing data obtained from the most recent nationwide Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. This should provide new and comprehensive insights on ECD and its domains to researchers, policymakers, and other stakeholders in Ghana, specifically guiding them to know the ECD domains that need urgent attention and the factors we need to focus on to improve each domain.</p> <hd id="AN0179359479-3">Materials and Methods</hd> <p></p> <hd id="AN0179359479-4">Study Design, Setting, and Sampling Strategy</hd> <p>We performed secondary analyses on Ghana MICS 2017/18 collected from October 2017 to January 2018 using a multi-stage, stratified cluster sampling. Sampling strata were the urban and rural areas of the 16 regions of Ghana. In the first stage of sampling, a minimum of 60 enumeration areas (EA) were allocated to the smallest regions and a maximum of 86 allocated to the Greater Accra region using systematic size-based probability (Ghana Statistical Service, [<reflink idref="bib10" id="ref34">10</reflink>]). In the second stage of sampling, households listing was done with two strata: households with and without 20–24 years women. Using systematic random sampling, 20 households were sampled in each EA. Parents or caregivers were interviewed to collect socio-demographic characteristics of households and data on their children's development.</p> <hd id="AN0179359479-5">Study Participants and Sample Size</hd> <p>Out of the 13,202 households included in Ghana's MICS 2017/18, data on 3801 children aged 35–59 months were collected (Ghana Statistical Service, [<reflink idref="bib10" id="ref35">10</reflink>]).</p> <hd id="AN0179359479-6">Outcome Measures</hd> <p>The first outcome variable, literacy–numeracy domain, measured the ability to understand simple words and concepts. Children are considered to have progressed well in this domain if they could do at least 2 of these: recognize at least 10 alphabets, read 4 or more simple words, and identify numbers from 1 to 10. The second, physical domain, measured basic motor skills. If a child could use 2 fingers to pick up an object or was not reported to be occasionally too sick to play or both, then he or she was considered to be progressing in this domain. The third, social–emotional domain, measured the ability to understand and manage emotions. Children considered to be thriving in this domain satisfied any of these two: interacted well, played without kicking, biting, or hitting others, and were not easily distracted. Learning was the fourth outcome variable. It measured the ability to comprehend simple instructions. Either following simple directions for an activity or independently performing a task or both indicated development in this domain. ECDI, the main outcome variable, measured physical, cognitive, linguistic, and social–emotional growth across the first few years of life (UNESCO, [<reflink idref="bib27" id="ref36">27</reflink>]). A child was considered on track in ECDI if there were developments in at least 3 of the 4 domains.</p> <hd id="AN0179359479-7">Independent Variables</hd> <p>Three groups of factors were considered based on their epidemiological importance and findings from literature. Individual factors such as age, sex, area, region of residence, attendance of early childhood education program, disability, stunting, wasting, and underweight statuses comprised the first group. The second was parental factors including maternal education, maternal disability status, number of days children were left alone for more than an hour, status of physical punishment, explaining why bad behaviors are wrong, reading books, telling stories, and singing to children. The third was household factors such as household wealth status and usage of iodized salt. Data on neighborhood factors were not available and therefore not incorporated in the analyses.</p> <hd id="AN0179359479-8">Data Analysis</hd> <p>We determined ECD status by estimating the percentage of children developing in the literacy–numeracy, physical, social–emotional, and learning domains. The ECDI was calculated as the percentage of children developing in at least 3 of the 4 domains. Univariate and multiple logistic regressions were used to examine associations between each outcome variable and individual, parental, and household factors. Crude and adjusted odds ratios and their 95% confidence intervals were calculated, and statistical tests with a <emph>p-value</emph> < 0.05 were considered statistically significant. Multicollinearity testing was conducted using Variance Inflation Factors (VIF) set below 5 as the cutoff to exclude any correlation between independent variables. All analyses were performed using the Stata SE version 17.</p> <hd id="AN0179359479-9">Ethical Consideration</hd> <p>This study utilized publicly available secondary data from UNICEF MICS.</p> <hd id="AN0179359479-10">Results</hd> <p></p> <hd id="AN0179359479-11">Socio-Demographic Characteristics</hd> <p>The minimum, maximum, and mean ages of children were 35, 59, and 46.83 (SD = 7.10) months, respectively. More than half of the children were females (51.45%), resided in rural areas (57.52%), attended an early childhood education program (72.30%), and over one-third (35%) were born to mothers with middle-level education. Household wealth status was fairly distributed, with almost a quarter of them from the poorest households (23.30%) (Table 1).</p> <p>Table 1 Descriptive statistics of the individual, parental, and household factors of ECD among 35–59 months children in Ghana</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Variables</p></th><th align="left"><p>Groups</p></th><th align="left"><p>Frequency (%)</p></th></tr></thead><tbody><tr><td align="left" colspan="3"><p><italic>Individual factors</italic></p></td></tr><tr><td align="left" rowspan="3"><p>Age categories (months)</p></td><td align="left"><p>35–42 </p></td><td align="left"><p>1229 (31.80)</p></td></tr><tr><td align="left"><p>43–50 </p></td><td align="left"><p>1235 (33.60)</p></td></tr><tr><td align="left"><p>51–59 </p></td><td align="left"><p>1337 (34.60)</p></td></tr><tr><td align="left" rowspan="2"><p>Sex</p></td><td align="left"><p>Male</p></td><td align="left"><p>1880 (48.55)</p></td></tr><tr><td align="left"><p>Female</p></td><td align="left"><p>1921 (51.45)</p></td></tr><tr><td align="left" rowspan="2"><p>Area of residence</p></td><td align="left"><p>Urban</p></td><td align="left"><p>1514 (42.48)</p></td></tr><tr><td align="left"><p>Rural</p></td><td align="left"><p>2287 (57.52)</p></td></tr><tr><td align="left" rowspan="10"><p>Region of residence</p></td><td align="left"><p>Western</p></td><td align="left"><p>351 (9.92)</p></td></tr><tr><td align="left"><p>Central</p></td><td align="left"><p>370 (10.47)</p></td></tr><tr><td align="left"><p>Greater Accra</p></td><td align="left"><p>325 (9.24)</p></td></tr><tr><td align="left"><p>Volta</p></td><td align="left"><p>331 (8.16)</p></td></tr><tr><td align="left"><p>Eastern</p></td><td align="left"><p>332 (10.51)</p></td></tr><tr><td align="left"><p>Ashanti</p></td><td align="left"><p>483 (23.91)</p></td></tr><tr><td align="left"><p>Brong Ahafo</p></td><td align="left"><p>367 (9.58)</p></td></tr><tr><td align="left"><p>Northern</p></td><td align="left"><p>531 (12.59)</p></td></tr><tr><td align="left"><p>Upper East</p></td><td align="left"><p>330 (3.23)</p></td></tr><tr><td align="left"><p>Upper West</p></td><td align="left"><p>381 (2.39)</p></td></tr><tr><td align="left" rowspan="2"><p>Ever attended early childhood education program</p></td><td align="left"><p>No</p></td><td align="left"><p>1099 (27.65)</p></td></tr><tr><td align="left"><p>Yes</p></td><td align="left"><p>2583 (72.30)</p></td></tr><tr><td align="left" rowspan="2"><p>Any prior disability</p></td><td align="left"><p>No</p></td><td align="left"><p>3472 (90.95) </p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>329 (9.05)</p></td></tr><tr><td align="left" rowspan="2"><p>Presence of stunting (HAZ<-2) </p></td><td align="left"><p>No </p></td><td align="left"><p>3118 (82.12)</p></td></tr><tr><td align="left"><p>Yes</p></td><td align="left"><p>683 (17.88)</p></td></tr><tr><td align="left" rowspan="2"><p>Presence of wasting (WHZ<-2) </p></td><td align="left"><p>No</p></td><td align="left"><p>3662 (97.08)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>139 (2.92)</p></td></tr><tr><td align="left" rowspan="2"><p>Presence of underweight (WAZ<-2) </p></td><td align="left"><p>No</p></td><td align="left"><p>3414 (89.97)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>387 (10.03)</p></td></tr><tr><td align="left" colspan="3"><p><italic>Parental/Caregiving factors</italic></p></td></tr><tr><td align="left" rowspan="5"><p>Level of maternal education </p></td><td align="left"><p>Pre-primary/none </p></td><td align="left"><p>1414 (31.65)</p></td></tr><tr><td align="left"><p>Primary </p></td><td align="left"><p>721 (19.95)</p></td></tr><tr><td align="left"><p>Junior High/Middle </p></td><td align="left"><p>1178 (34.99)</p></td></tr><tr><td align="left"><p>SHS/ Secondary </p></td><td align="left"><p>314 (8.91)</p></td></tr><tr><td align="left"><p>University/Higher </p></td><td align="left"><p>174 (4.51)</p></td></tr><tr><td align="left" rowspan="3"><p>Maternal disability status </p></td><td align="left"><p>No </p></td><td align="left"><p>3064 (82.03)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>279 (6.55)</p></td></tr><tr><td align="left"><p>No information provided</p></td><td align="left"><p>458 (11.41)</p></td></tr><tr><td align="left" rowspan="3"><p>Number of days children were left alone for more than an hour </p></td><td align="left"><p>None (0)</p></td><td align="left"><p>2516 (68.40)</p></td></tr><tr><td align="left"><p>1–4 days</p></td><td align="left"><p>847 (21.40)</p></td></tr><tr><td align="left"><p>5–7 days </p></td><td align="left"><p>383 (8.96)</p></td></tr><tr><td align="left" rowspan="2"><p>Reading books to the child </p></td><td align="left"><p>No </p></td><td align="left"><p>2627 (68.61)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>1174 (31.39) </p></td></tr><tr><td align="left" rowspan="2"><p>Telling stories to the child </p></td><td align="left"><p>No</p></td><td align="left"><p>2598 (68.91)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>1203 (31.09)</p></td></tr><tr><td align="left" rowspan="2"><p>Singing songs to the child </p></td><td align="left"><p>No </p></td><td align="left"><p>1919 (48.79)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>1882 (51.21)</p></td></tr><tr><td align="left" rowspan="2"><p>Physical punishment (spanking, yelling, slapping, shouting, hitting)</p></td><td align="left"><p>No </p></td><td align="left"><p>183 (4.81)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>3618 (95.19)</p></td></tr><tr><td align="left" rowspan="2"><p>Explanation of why bad behavior are wrong </p></td><td align="left"><p>No</p></td><td align="left"><p>910 (22.45)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>2891 (77.55)</p></td></tr><tr><td align="left"><p><italic>Household factors</italic></p></td><td align="left" /><td align="left" /></tr><tr><td align="left" rowspan="2"><p>Usage of iodized salt (≥ 15ppm) </p></td><td align="left"><p>No </p></td><td align="left"><p>2534 (66.34)</p></td></tr><tr><td align="left"><p>Yes </p></td><td align="left"><p>1267 (33.66)</p></td></tr><tr><td align="left" rowspan="5"><p>Wealth index quintile </p></td><td align="left"><p>Poorest</p></td><td align="left"><p>1163 (23.30)</p></td></tr><tr><td align="left"><p>Second</p></td><td align="left"><p>752 (21.16)</p></td></tr><tr><td align="left"><p>Middle </p></td><td align="left"><p>703 (20.24)</p></td></tr><tr><td align="left"><p>Fourth </p></td><td align="left"><p>612 (18.20)</p></td></tr><tr><td align="left"><p>Richest </p></td><td align="left"><p>571 (17.10)</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0179359479-12">Percentage of Children Developmentally on Track in ECDI and its Domains</hd> <p>Among the 3801 children, 42.7% showed development in literacy–numeracy, 93.6% in physical, 68.2% in social–emotional, 82.3% in learning, and 66.8% in at least 3 of the 4 domains (Fig. 1).</p> <p>Graph: Fig. 1 Percentage of Ghanaian children aged 35–59 months who are developmentally on track in ECDI and its four domains</p> <hd id="AN0179359479-13">Effects of Individual, Parental, and Household Factors on ECDI and its Four Domains</hd> <p></p> <hd id="AN0179359479-14">Literacy–Numeracy Domain</hd> <p>In the unadjusted model, children born to mothers with tertiary education were 6.41 times more likely to develop in literacy–numeracy than those born to mothers with no or pre-primary education (COR = 6.41; 95% CI = 3.73–11.02). After controlling for key confounders in the adjusted model, the effect of maternal education attenuated. Now, children born to mothers with tertiary education were 1.25 times more likely to develop in literacy–numeracy than those born to mothers with no or pre-primary education (AOR = 1.25; 95% CI = 0.72–2.18) (Table 2). In the unadjusted model, children who attended an early childhood education program (ECEP) were 7.2 times more likely to excel in literacy–numeracy than those who did not attend (COR = 7.20; 95% CI = 5.21–9.94). There was a 50% decline in odds after controlling for confounders. Now, those who attended an ECEP were 3.57 times more likely to excel in literacy–numeracy compared to those who did not attend (AOR = 3.57; 95% CI = 2.61–4.87). Development in literacy–numeracy significantly increased with household wealth. In the unadjusted model, children from the richest households were 17.13 times more likely to develop in literacy–numeracy than those from the poorest households (COR = 17.13; 95% CI = 11.96–24.52). However, the effect of household wealth decreased after confounders were controlled. The odds for literacy–numeracy progression were now 4.6 times higher for children from richest households than those from poorest households (AOR = 4.60; 95% CI = 2.82–7.50) (Table 2<emph>).</emph></p> <p>Table 2 Logistic regression analyses examining the effects of individual, parental, and household level factors on literacy-numeracy, physical, social-emotional, learning, and ECDI among children aged 35–59 months in Ghana</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2"><p>Background characteristics</p></th><th align="left" colspan="3"><p>Literacy-numeracy</p></th><th align="left" colspan="3"><p>Physical</p></th><th align="left" colspan="2"><p>Social-emotional</p></th><th align="left" colspan="2"><p>Learning</p></th><th align="left" colspan="2"><p> ECDI</p></th></tr><tr><th align="left"><p>COR (95% CI)</p></th><th align="left" colspan="2"><p>AOR (95% CI) </p></th><th align="left" colspan="2"><p>COR (95% CI)</p></th><th align="left"><p>AOR (95% CI) </p></th><th align="left"><p>COR (95% CI)</p></th><th align="left"><p>AOR (95% CI) </p></th><th align="left"><p>COR (95% CI)</p></th><th align="left"><p>AOR (95% CI) </p></th><th align="left"><p>COR (95% CI)</p></th><th align="left"><p>AOR (95% CI) </p></th></tr></thead><tbody><tr><td align="left" colspan="13"><p><italic>Individual factors</italic></p></td></tr><tr><td align="left" colspan="13"><p>Sex </p></td></tr><tr><td align="left"><p> Male</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Female</p></td><td align="left"><p>1.15 (0.93–1.42)</p></td><td align="left" colspan="2"><p>1.20 (0.94–1.53)</p></td><td align="left" colspan="2"><p>1.00 (0.70–1.43)</p></td><td align="left"><p>0.95 (0.66–1.37)</p></td><td align="left"><p>1.54 (1.26–1.88)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.58 (1.30–1.94)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.45 (1.13–1.87)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.52 (1.18–1.97)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.40 (1.15–1.70)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.47 (1.21–1.79)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p>Area of residence</p></td></tr><tr><td align="left"><p> Urban</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Rural</p></td><td align="left"><p>0.29 (0.23–0.38)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.64 (0.46–0.90)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.52 (0.35–0.77)<sup>**</sup></p></td><td align="left"><p>0.78 (0.48–1.25)</p></td><td align="left"><p>0.82 (0.65–1.03)</p></td><td align="left"><p>0.85 (0.65–1.11)</p></td><td align="left"><p>0.60 (0.46–0.78)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.79 (0.55–1.14)</p></td><td align="left"><p>0.42 (0.33–0.52)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.66 (0.50–0.87)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p>Region</p></td></tr><tr><td align="left"><p> Greater Accra</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Central</p></td><td align="left"><p>0.47 (0.30–0.74)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.92 (0.56–1.50)</p></td><td align="left" colspan="2"><p>0.21 (0.08–0.58)<sup>**</sup></p></td><td align="left"><p>0.35 (0.12–1.01)</p></td><td align="left"><p>1.11 (0.72–1.71)</p></td><td align="left"><p>1.26 (0.78–2.03)</p></td><td align="left"><p>0.63 (0.37–1.07)</p></td><td align="left"><p>0.91 (0.49–1.66)</p></td><td align="left"><p>0.47 (0.30–0.74)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.82 (0.47–1.43)</p></td></tr><tr><td align="left"><p> Western</p></td><td align="left"><p>0.48 (0.31–0.75)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.92 (0.57–1.49)</p></td><td align="left" colspan="2"><p>0.20 (0.08–0.55)<sup>**</sup></p></td><td align="left"><p>0.31 (0.10–0.91)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.04 (0.66–1.64)</p></td><td align="left"><p>1.07 (0.64–1.79)</p></td><td align="left"><p>0.38 (0.23–0.63)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.48 (0.25–0.89)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.40 (0.26–0.64)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.63 (0.36–1.09)</p></td></tr><tr><td align="left"><p> Eastern</p></td><td align="left"><p>0.28 (0.17–0.45)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.43 (0.27–0.69)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.44 (0.14–1.40)</p></td><td align="left"><p>0.62 (0.18–2.17)</p></td><td align="left"><p>0.73 (0.46–1.18)</p></td><td align="left"><p>0.87 (0.54–1.41)</p></td><td align="left"><p>1.31 (0.71–2.42)</p></td><td align="left"><p>2.05 (1.02–4.14)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.50 (0.31–0.83)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.84 (0.48–1.48)</p></td></tr><tr><td align="left"><p> Volta</p></td><td align="left"><p>0.14 (0.07–0.27)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.45 (0.26–0.79)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.23 (0.09–0.62)<sup>**</sup></p></td><td align="left"><p>0.46 (0.16–1.32)</p></td><td align="left"><p>1.55 (0.90–2.66)</p></td><td align="left"><p>2.02 (1.10–3.70)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.94 (0.58–1.52)</p></td><td align="left"><p>1.77 (1.02–3.09)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.46 (0.29–0.72)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.22 (0.67–2.25)</p></td></tr><tr><td align="left"><p> Ashanti</p></td><td align="left"><p>0.85 (0.53–1.37)</p></td><td align="left" colspan="2"><p>1.80 (1.02–3.18)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.53 (0.19–1.49)</p></td><td align="left"><p>0.80 (0.28–2.33)</p></td><td align="left"><p>1.24 (0.79–1.94)</p></td><td align="left"><p>1.39 (0.88–2.20)</p></td><td align="left"><p>0.94 (0.55–1.61)</p></td><td align="left"><p>1.19 (0.70–2.11)</p></td><td align="left"><p>0.90 (0.58–1.42)</p></td><td align="left"><p>1.47 (0.85–2.54)</p></td></tr><tr><td align="left"><p> Brong Ahafo</p></td><td align="left"><p>0.53 (0.33–0.87)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.35 (0.82–2.22)</p></td><td align="left" colspan="2"><p>0.21 (0.07–0.58)<sup>**</sup></p></td><td align="left"><p>0.33 (0.11–0.98)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.49 (0.93–2.37)</p></td><td align="left"><p>1.61 (0.97–2.69)</p></td><td align="left"><p>1.05 (0.58–1.90)</p></td><td align="left"><p>1.63 (0.83–3.20)</p></td><td align="left"><p>0.78 (0.48–1.26)</p></td><td align="left"><p>1.45 (0.83–2.54)</p></td></tr><tr><td align="left"><p> Northern</p></td><td align="left"><p>0.11 (0.07–0.17)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.46 (0.27–0.77)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.36 (0.13–1.01)</p></td><td align="left"><p>0.67 (0.22–2.07)</p></td><td align="left"><p>0.97 (0.64–1.45)</p></td><td align="left"><p>1.31 (0.81–2.13)</p></td><td align="left"><p>0.57 (0.35–0.93)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.22 (0.65–2.30)</p></td><td align="left"><p>0.31 (0.21–0.48)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.81 (0.46–1.42)</p></td></tr><tr><td align="left"><p> Upper East</p></td><td align="left"><p>0.12 (0.07–0.20)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.35 (0.20–0.63)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.80 (0.25–2.54)</p></td><td align="left"><p>1.47 (0.43–5.05)</p></td><td align="left"><p>0.92 (0.58–1.45)</p></td><td align="left"><p>1.27 (0.71–2.11)</p></td><td align="left"><p>0.39 (0.23–0.66)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.60 (0.31–1.15)</p></td><td align="left"><p>0.28 (0.18–0.43)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.57 (0.31–1.04)</p></td></tr><tr><td align="left"><p> Upper West</p></td><td align="left"><p>0.10 (0.07–0.16)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.33 (0.20–0.55)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.52 (0.41–5.64)</p></td><td align="left"><p>2.89 (0.73–11.45)</p></td><td align="left"><p>1.46 (0.94–2.27)</p></td><td align="left"><p>1.75 (1.07–2.86)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.35 (0.22–0.55)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.63 (0.35–1.13)</p></td><td align="left"><p>0.33 (0.22–0.51)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.78 (0.44–1.40)</p></td></tr><tr><td align="left" colspan="13"><p> Age</p></td></tr><tr><td align="left"><p> 35–42 months</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> 43–50 months</p></td><td align="left"><p>1.73 (1.36–2.19)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.72 (1.24–2.38)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.17 (0.75–1.84)</p></td><td align="left"><p>1.47 (0.91–2.35)</p></td><td align="left"><p>1.20 (0.94–1.53)</p></td><td align="left"><p>1.38 (1.08–1.77)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.97 (1.50–2.59)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.36 (1.00–1.86)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.86 (1.47–2.35)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.57 (1.20–2.06)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left"><p> 51–59 months</p></td><td align="left"><p>2.71 (2.16–3.41)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>2.95 (2.15–4.05)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.37 (0.87–2.14)</p></td><td align="left"><p>1.80 (1.13–2.88)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.29 (1.04–1.60)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.55 (1.23–1.94)<sup><bold>**</bold></sup></p></td><td align="left"><p>3.09 (2.31–4.15)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.14 (1.56–2.93)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.94 (2.38–3.64)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.56 (2.00–3.27)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Ever attended early childhood program </p></td></tr><tr><td align="left"><p> No</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Yes </p></td><td align="left"><p>7.20 (5.21–9.94)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>3.57 (2.61–4.87)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.19 (0.84–1.67)</p></td><td align="left"><p>0.71 (0.47–1.06)</p></td><td align="left"><p>1.16 (0.94–1.43)</p></td><td align="left"><p>1.10 (0.88–1.39)</p></td><td align="left"><p>1.85 (1.45–2.36)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.35 (1.03–1.77)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.51 (2.10–3.01)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.54 (1.25–1.91)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Any disability </p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> No</p></td><td align="left"><p>1.11 (0.80–1.53)</p></td><td align="left" colspan="2"><p>1.13 (0.79–1.62)</p></td><td align="left" colspan="2"><p>2.20 (1.39–3.48)<sup>**</sup></p></td><td align="left"><p>1.89 (1.17–3.05)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.30 (0.95–1.79)</p></td><td align="left"><p>1.32 (0.96–1.82)</p></td><td align="left"><p>1.35 (0.96–1.88)</p></td><td align="left"><p>1.29 (0.87–1.90)</p></td><td align="left"><p>1.71 (1.23–2.36)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.75 (1.22–2.51)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Presence of stunting (low height for age) </p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> No</p></td><td align="left"><p>2.57 (1.95–3.39)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.53 (1.11–2.11)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.99 (1.33–2.99)<sup>**</sup></p></td><td align="left"><p>1.92 (1.19–3.11)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.03 (0.82–1.30)</p></td><td align="left"><p>0.95 (0.72–1.24)</p></td><td align="left"><p>1.60 (1.18–2.16)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.32 (0.93–1.89)</p></td><td align="left"><p>1.74 (1.37–2.23)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.33 (1.01–1.75)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Presence of underweight (low weight for age) </p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> No</p></td><td align="left"><p>1.93 (1.34–2.78)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.35 (0.76–2.39)</p></td><td align="left" colspan="2"><p>1.42 (0.82–2.45)</p></td><td align="left"><p>1.01 (0.55–1.86)</p></td><td align="left"><p>1.08 (0.82–1.42)</p></td><td align="left"><p>1.08 (0.79–1.47)</p></td><td align="left"><p>1.47 (1.05–2.06)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.26 (0.85–1.87)</p></td><td align="left"><p>1.37 (1.03–1.83)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.08 (0.78–1.50)</p></td></tr><tr><td align="left" colspan="13"><p><italic>Parental/Caregiving factors</italic></p></td></tr><tr><td align="left" colspan="13"><p> Maternal education</p></td></tr><tr><td align="left"><p> Pre–primary/none</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p>Primary</p></td><td align="left"><p>1.29 (0.86–1.95)</p></td><td align="left" colspan="2"><p>1.34 (0.88–2.04)</p></td><td align="left" colspan="2"><p>1.05 (0.66–1.68)</p></td><td align="left"><p>0.94 (0.58–1.51)</p></td><td align="left"><p>0.95 (0.71–1.26)</p></td><td align="left"><p>1.11 (0.82–1.51)</p></td><td align="left"><p>1.24 (0.89–1.73)</p></td><td align="left"><p>0.83 (0.57–1.20)</p></td><td align="left"><p>1.11 (0.82–1.51)</p></td><td align="left"><p>1.10 (0.79–1.53)</p></td></tr><tr><td align="left"><p> Middle school</p></td><td align="left"><p>3.21 (2.11–4.87)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.86 (1.35–2.57)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.14 (0.76–1.72)</p></td><td align="left"><p>1.08 (0.66–1.76)</p></td><td align="left"><p>0.91 (0.70–1.18)</p></td><td align="left"><p>0.95 (0.71–1.27)</p></td><td align="left"><p>1.50 (1.12–2.00)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.12 (0.74–1.69)</p></td><td align="left"><p>1.66 (1.26–2.18)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.21 (0.89–1.66)</p></td></tr><tr><td align="left"><p> Secondary school</p></td><td align="left"><p>5.83 (3.51–9.66)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>2.29 (1.43–3.69)<sup>**</sup></p></td><td align="left" colspan="2"><p>2.73 (1.26–5.91)<sup>**</sup></p></td><td align="left"><p>2.10 (0.89–4.96)</p></td><td align="left"><p>1.25 (0.84–1.85)</p></td><td align="left"><p>1.20 (0.79–1.82)</p></td><td align="left"><p>1.66 (1.07–2.56)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.26 (0.70–2.27)</p></td><td align="left"><p>3.19 (2.09–4.85)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.07 (1.20–3.54)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left"><p> Higher</p></td><td align="left"><p>6.41 (3.73–11.02)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.25 (0.72–2.18)</p></td><td align="left" colspan="2"><p>6.96 (1.30–37.30)<sup>**</sup></p></td><td align="left"><p>3.39 (0.57–20.23)</p></td><td align="left"><p>1.67 (0.96–2.91)</p></td><td align="left"><p>1.62 (0.86–3.02)</p></td><td align="left"><p>2.27 (1.26–4.11)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.13 (0.51–2.48)</p></td><td align="left"><p>4.58 (2.73–7.69)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.72 (0.90–3.26)</p></td></tr><tr><td align="left" colspan="13"><p> Maternal disability status </p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> No </p></td><td align="left"><p>1.59 (1.11–2.29)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.20 (0.81–1.77)</p></td><td align="left" colspan="2"><p>1.89 (1.13–3.17)<sup>**</sup></p></td><td align="left"><p>1.69 (0.99–2.88)</p></td><td align="left"><p>1.25 (0.83–1.88)</p></td><td align="left"><p>1.26 (0.81–1.96)</p></td><td align="left"><p>1.74 (1.20–2.53)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.39 (0.85–2.26)</p></td><td align="left"><p>2.27 (1.59–3.25)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.93 (1.28–2.91)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Number of days children were left alone for more than an hour </p></td></tr><tr><td align="left"><p> None(0)</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> 1–4 days </p></td><td align="left"><p>0.70 (0.55–0.89)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.81 (0.61–1.09)</p></td><td align="left" colspan="2"><p>1.06 (0.67–1.66)</p></td><td align="left"><p>1.10 (0.70–1.72)</p></td><td align="left"><p>0.77 (0.60–0.99)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.80 (0.63–1.02)</p></td><td align="left"><p>0.61 (0.47–0.79)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.63 (0.46–0.85)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.65 (0.52–0.82)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.73 (0.57–0.93)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left"><p> 5–7 days </p></td><td align="left"><p>0.57 (0.40–0.81)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.16 (0.77–1.74)</p></td><td align="left" colspan="2"><p>2.28 (1.23–4.25)<sup>**</sup></p></td><td align="left"><p>2.40 (1.23–4.71)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.63 (0.45–0.87)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.62 (0.44–0.87)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.58 (0.41–0.83)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.66 (0.42–1.03)</p></td><td align="left"><p>0.60 (0.44–0.81)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.82 (0.57–1.18)</p></td></tr><tr><td align="left" colspan="13"><p> Reading books to the child </p></td></tr><tr><td align="left"><p> No</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Yes </p></td><td align="left"><p>3.15 (2.52–3.93)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.56 (1.19–2.05)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.11 (0.75–1.63)</p></td><td align="left"><p>0.61 (0.37–1.00)</p></td><td align="left"><p>1.05 (0.86–1.28)</p></td><td align="left"><p>1.06 (0.83–1.34)</p></td><td align="left"><p>1.48 (1.13–1.94)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.20 (0.87–1.67)</p></td><td align="left"><p>1.87 (1.52–2.31)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.15 (0.87–1.51)</p></td></tr><tr><td align="left" colspan="13"><p> Telling stories to the child </p></td></tr><tr><td align="left"><p> No</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Yes </p></td><td align="left"><p>2.28 (1.83–2.85)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.33 (0.99–1.80)</p></td><td align="left" colspan="2"><p>1.82 (1.15–2.88)<sup>**</sup></p></td><td align="left"><p>1.42 (0.78–2.58)</p></td><td align="left"><p>0.93 (0.75–1.15)</p></td><td align="left"><p>0.99 (0.76–1.27)</p></td><td align="left"><p>1.31 (0.99–1.72)</p></td><td align="left"><p>0.90 (0.64–1.25)</p></td><td align="left"><p>1.68 (1.35–2.08)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.19 (0.87–1.61)</p></td></tr><tr><td align="left" colspan="13"><p> Singing songs to the child </p></td></tr><tr><td align="left"><p> No</p></td><td align="left"><p>Ref</p></td><td align="left" /><td align="left" colspan="2" /><td align="left" colspan="2" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Yes</p></td><td align="left"><p>1.91 (1.58–2.31)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.13 (0.89–1.43)</p></td><td align="left" colspan="2"><p>1.71 (1.20–2.44)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.52 (1.02–2.26)<sup>**</sup></p></td><td align="left"><p>0.86 (0.72–1.03)</p></td><td align="left"><p>0.84 (0.68–1.05)</p></td><td align="left"><p>1.21 (0.96–1.52)</p></td><td align="left"><p>1.02 (0.78–1.34)</p></td><td align="left"><p>1.36 (1.13–1.64)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.96 (0.75–1.23)</p></td></tr><tr><td align="left" colspan="13"><p> Physical punishment (spanking, yelling, slapping, shouting, hitting)</p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> No </p></td><td align="left"><p>0.60 (0.38–0.95)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.63 (0.36–1.11)</p></td><td align="left" colspan="2"><p>0.48 (0.25–0.92)<sup>**</sup></p></td><td align="left" colspan="2"><p>0.53 (0.27–1.07)</p></td><td align="left"><p>1.70 (1.07–2.69)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.64 (1.01–2.65)<sup><bold>**</bold></sup></p></td><td align="left"><p>0.76 (0.44–1.29)</p></td><td align="left"><p>0.79 (0.42–1.47)</p></td><td align="left"><p>0.95 (0.64–1.41)</p></td><td align="left"><p>1.09 (0.69–1.71)</p></td></tr><tr><td align="left" colspan="13"><p> Explanation of why bad behaviors are wrong </p></td></tr><tr><td align="left"><p> No</p></td><td align="left"><p>Ref</p></td><td align="left" /><td align="left" colspan="2" /><td align="left" colspan="2" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Yes </p></td><td align="left"><p>1.74 (1.38–2.19)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.36 (1.03–1.79)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.45 (0.99–2.13)</p></td><td align="left" colspan="2"><p>1.16 (0.77–1.75)</p></td><td align="left"><p>1.13 (0.88–1.44)</p></td><td align="left"><p>1.11 (0.86–1.45)</p></td><td align="left"><p>1.53 (1.21–1.92)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.27 (0.96–1.68)</p></td><td align="left"><p>1.64 (1.31–2.05)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.32 (1.03–1.69)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p><italic>Household factors</italic></p></td></tr><tr><td align="left" colspan="13"><p> Wealth index </p></td></tr><tr><td align="left"><p> Poorest</p></td><td align="left"><p>Ref</p></td><td align="left" /><td align="left" colspan="2" /><td align="left" colspan="2" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Second</p></td><td align="left"><p>2.55 (1.68–3.87)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.59 (1.06–2.37)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>0.86 (0.53–1.40)</p></td><td align="left" colspan="2"><p>0.95 (0.57–1.56)</p></td><td align="left"><p>1.22 (0.89–1.67)</p></td><td align="left"><p>1.15 (0.80–1.63)</p></td><td align="left"><p>1.26 (0.92–1.71)</p></td><td align="left"><p>1.22 (0.86–1.72)</p></td><td align="left"><p>1.37 (1.04–1.82)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.12 (0.85–1.50)</p></td></tr><tr><td align="left"><p> Middle</p></td><td align="left"><p>4.37 (3.12–6.12)<sup><bold>**</bold></sup></p></td><td align="left"><p>2.51 (1.70–3.73)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.52 (0.84–2.74)</p></td><td align="left" colspan="2"><p>1.80 (0.95–3.41)</p></td><td align="left"><p>1.02 (0.76–1.37)</p></td><td align="left"><p>0.97 (0.68–1.38)</p></td><td align="left"><p>1.23 (0.88–1.72)</p></td><td align="left"><p>0.90 (0.59–1.37)</p></td><td align="left"><p>1.57 (1.20–2.04)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.07 (0.79–1.45)</p></td></tr><tr><td align="left"><p> Fourth</p></td><td align="left"><p>7.60 (5.36–10.77)<sup><bold>**</bold></sup></p></td><td align="left"><p>3.03 (2.01–4.57)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>1.74 (0.98–3.09)</p></td><td align="left" colspan="2"><p>1.69 (0.89–3.19)</p></td><td align="left"><p>1.21 (0.88–1.66)</p></td><td align="left"><p>1.11 (0.73–1.67)</p></td><td align="left"><p>1.57 (1.09–2.26)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.16 (0.69–1.95)</p></td><td align="left"><p>2.44 (1.83–3.25)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.41 (0.94–2.11)</p></td></tr><tr><td align="left"><p> Richest</p></td><td align="left"><p>17.13 (11.96–24.52)<sup><bold>**</bold></sup></p></td><td align="left"><p>4.60 (2.82–7.50)<sup><bold>**</bold></sup></p></td><td align="left" colspan="2"><p>2.81 (1.48–5.36)<sup>**</sup></p></td><td align="left" colspan="2"><p>1.89 (0.85–4.23)</p></td><td align="left"><p>1.26 (0.91–1.74)</p></td><td align="left"><p>1.02 (0.65–1.59)</p></td><td align="left"><p>2.41 (1.60–3.62)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.28 (0.65–2.53)</p></td><td align="left"><p>5.07 (3.63–7.07)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.91 (1.15–3.20)<sup><bold>**</bold></sup></p></td></tr><tr><td align="left" colspan="13"><p> Usage of iodized salt (≥ 15ppm) </p></td></tr><tr><td align="left"><p> No</p></td><td align="left" colspan="12"><p>Ref</p></td></tr><tr><td align="left"><p> Yes</p></td><td align="left"><p>1.97 (1.59–2.44)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.00 (0.76–1.31)</p></td><td align="left" colspan="2"><p>1.02 (0.69–1.50)</p></td><td align="left" colspan="2"><p>1.02 (0.63–1.65)</p></td><td align="left"><p>1.31 (1.03–1.67)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.25 (0.96–1.63)</p></td><td align="left"><p>1.02 (0.78–1.34)</p></td><td align="left"><p>0.99 (0.71–1.39)</p></td><td align="left"><p>1.52 (1.21–1.90)<sup><bold>**</bold></sup></p></td><td align="left"><p>1.15 (0.89–1.48)</p></td></tr></tbody></table> </ephtml> </p> <p>**Statistically significant (<emph>p</emph> value less than 0.05); <emph>COR</emph> crude odds ratio; <emph>AOR</emph> adjusted odds ratio; <emph>ECDI</emph> Early Childhood Development Index</p> <hd id="AN0179359479-15">Physical Domain</hd> <p>In the unadjusted model, children without disabilities were 2.2 times more likely to develop physically compared to those with disabilities (COR = 2.20; 95% CI = 1.39–3.48). However, in the adjusted model, children without disabilities were 1.89 times more likely to develop in this domain than children with disabilities (AOR = 1.89; 95% CI = 1.17–3.05). Similarly, non-stunted children were 1.99 times more likely to develop physically than stunted children in the unadjusted model (COR = 1.99; 95% CI = 1.33–2.99). After controlling for confounders, the effect of stunting lessened. Now, non-stunted children were 1.92 times more likely to develop physically than stunted children (AOR = 1.92; 95% CI = 1.19–3.11) (Table 2).</p> <hd id="AN0179359479-16">Social–Emotional Domain</hd> <p>In the unadjusted model, female children were 1.54 times more likely to develop social–emotionally than male children (COR = 1.54; 95% CI = 1.26–1.88). After controlling for confounders, female children were now 1.58 times more likely to develop social–emotionally than male children (AOR = 1.58; 95% CI = 1.30–1.94). Social–emotional development increased with age. The unadjusted model showed that 51–59 months children were 1.29 times more likely to develop social–emotionally than 35–42 months children (COR = 1.29; 95% CI = 1.04–1.60). In the adjusted model, a 20% increment in the odds was observed. 51–59 months children were now 1.55 times more likely to develop social–emotionally than 35–42 months children (AOR = 1.55; 95% CI = 1.23–1.94). Compared to children never left alone, those left alone for more than an hour for 5–7 days had 37% and 38% lower odds of social–emotional development in the unadjusted and adjusted models, respectively (COR = 0.63; 95% CI = 0.45–0.87; AOR = 0.62; 95% CI = 0.44–0.87). In the unadjusted model, children who were not physically punished were 1.7 times more likely to develop social–emotionally than those physically punished (COR = 1.70; 95% CI = 1.07–2.69). The effect of physical punishment declined after controling for confounders in the adjusted model. Now, children who were not physically punished were 1.64 times more likely to develop social–emotionally than those physically punished (AOR = 1.64; 95% CI = 1.01–2.65) (Table 2).</p> <hd id="AN0179359479-17">Learning Domain</hd> <p>In the unadjusted model, 51–59 months children were 3.09 times more likely to develop in learning compared to 35–42 months children (COR = 3.09; 95% CI = 2.31–4.15). After adjusting for confounders, 51–59 months children were 2.14 times more likely to learn well than 35–42 months children (AOR = 2.14; 95% CI = 1.56–2.93). In the unadjusted model, children left alone for more than an hour for 5–7 days had 42% lower odds of development in learning than those never left alone (COR = 0.58; 95% CI = 0.41–0.83). In the adjusted model, children left alone for more than an hour for 5–7 days were 34% less likely to learn well than those never left alone (AOR = 0.66; 95% CI = 0.42–1.03). The odds of development in learning increased with maternal education. In the unadjusted model, children born to mothers with tertiary education were 2.27 times more likely to be on track in learning than those born to mothers with no or pre-primary education (COR = 2.27; 95% CI = 1.26–4.11) (Table 2). However, after adjusting for confounders, no significant association between maternal education and learning was found.</p> <hd id="AN0179359479-18">Early Childhood Development Index (ECDI)</hd> <p>In the unadjusted model, 51–59 months children were 2.94 times more likely to have a better ECDI than 35–42 months children (COR = 2.94; 95% CI = 2.38–3.64). After adjusting for confounders, 51–59 months children were now 2.56 times more likely to have a better ECDI than 35–42 months children (AOR = 2.56; 95% CI = 2.00–3.27). ECDI was positively associated with maternal education. In the unadjusted model, children born to mothers with tertiary education were 4.58 times more likely to have a greater ECDI than those born to mothers with no or pre-primary education (COR = 4.58; 95% CI = 2.73–7.69). But in the adjusted model, except for children born to mothers with secondary education, no other educational level showed a significant relationship with ECDI. Also, ECDI increased with household wealth. In the unadjusted model, children from the richest households were 5.07 times more likely (COR = 5.07; 95% CI = 3.63–7.07) to have a better ECDI than those from the poorest households. In the adjusted model, children from the richest households were 1.91 times more likely to have a better ECDI than those from the poorest households (AOR = 1.91; 95% CI = 1.15–3.20) (Table 2).</p> <hd id="AN0179359479-19">Discussion</hd> <p>A theoretical framework was developed to serve as a guide in data interpretation and discussion (Fig. 2). Each paragraph of the discussion was dedicated to an ECD domain. Results were discussed in two dimensions. Within a particular domain, factors influential to it were first discussed, followed by the effect of a particular factor across different domains. To make reading easier, [<emph>across</emph>] was employed whenever we were assessing the effect of a particular factor across different ECD domains. All other discussions were factors affecting a particular domain.</p> <p>Graph: Fig. 2 Theoretical framework for data interpretation and discussion</p> <p>Disparities were reported in the percentages for ECDI and its domains for different determinants. As such, effective multi-sectoral interventions such as nurturing care for young children should be scaled up for childhood development.</p> <p>Book reading was found to be an important factor that greatly influenced literacy–numeracy skills. Those whose parents or caregivers read to them were better positioned to develop in the literacy–numeracy domain compared to those who were not read any books. Book reading has been shown to be a powerful driver of mental growth in young children which also helps in improving speech, language, and literacy capacity (High et al., [<reflink idref="bib14" id="ref37">14</reflink>]; UNICEF, [<reflink idref="bib26" id="ref38">26</reflink>]). Similarly, household wealth status was found to be a key factor significantly affecting literacy–numeracy. The provision of books and playthings in rich families is common compared to those living in poorer families, and these resources have been shown to augment literacy skills (High et al., [<reflink idref="bib14" id="ref39">14</reflink>]). Another factor that significantly increased literacy–numeracy was the attendance of an early childhood education program. It influenced literacy–numeracy the most in comparison to the other domains [<emph>across</emph>] and has been shown to aid in the proper development of children (UNICEF, [<reflink idref="bib26" id="ref40">26</reflink>]). Costa Rica, a benchmark country for ECD, has made it compulsory for children to attend preschool with compensation packages to encourage enrollment (Hunter, [<reflink idref="bib15" id="ref41">15</reflink>]; San Francisco et al., [<reflink idref="bib24" id="ref42">24</reflink>]). Although the current education policy of Ghana provides children with two years of free and compulsory preschool education, there are still no stringent measures to monitor enrollment and punish defaulters. We found maternal education as a crucial factor affecting literacy–numeracy. Among ECDI and its four domains [<emph>across</emph>], it affected literacy–numeracy the most. Concurrent with previous studies done in Bangladesh, Ghana, and Costa Rica, mothers with higher education were better positioned to positively influence the literacy–numeracy skills of their children than those with lower education (Haq et al., [<reflink idref="bib13" id="ref43">13</reflink>]). Therefore, it can be postulated that formal education of mothers may positively contribute toward improving the literacy–numeracy skills of children.</p> <p>In the physical domain, disability and stunting were the most influential factors as they significantly reduced physical development. This is consistent with previous studies in Jamaica and Mexico, where stunted children showed reduced activity and physical skills (Aburto et al., [<reflink idref="bib1" id="ref44">1</reflink>]). We suggest special attention be given to children with disabilities and nutritional supplementation programs modeled into communities to reduce the impact of stunting to improve physical development.</p> <p>Sex was found as a crucial factor greatly affecting social–emotional development. We found that female children developed better social–emotionally than males, a finding which could be due to the inherent aggressive, resilient, possessive, and emotionally sensitive nature of the latter (Sambu & Mhongo, [<reflink idref="bib23" id="ref45">23</reflink>]). Two factors that significantly decreased social–emotional development were the number of days children were left alone for more than an hour and physical punishment. The physical punishment was found to result in aggressive, social, and emotional problems such as antisocial behaviors (Grogan-Kaylor, [<reflink idref="bib12" id="ref46">12</reflink>]). In Japan, children left alone at home for once a week or more became inattentive with poor peer relationships and academic scores (Doi et al., [<reflink idref="bib7" id="ref47">7</reflink>]). We suggest children should not be left alone or at least they should be left in the care of relatives or trusted friends in the absence of parents. We also encourage a dialogue approach of explaining to children why their bad behaviors were wrong rather than physical punishment.</p> <p>The odds of learning increased with age, probably due to the enhanced ability to comprehend information as one matures. This finding is consistent with a 2021 multi-country study conducted in Bangladesh, Ghana, and Costa Rica (Haq et al., [<reflink idref="bib13" id="ref48">13</reflink>]). Maternal education significantly affected the learning domain, although this was only true for the unadjusted model, where children born to mothers with higher education were developing better in learning than those born to mothers with lower education. This agrees with previous studies conducted in Bangladesh, Ghana, and Costa Rica (Haq et al., [<reflink idref="bib13" id="ref49">13</reflink>]). We suggest some form of formal education for mothers to identify the learning needs of their children and to provide early learning opportunities for them.</p> <p>In ECD, maternal education was found to be an important factor that had the greatest influence. The overall development in early childhood increased with maternal education. Similar findings were reported in a 2021 multi-country study conducted in Bangladesh, Costa Rica, and Ghana (Haq et al., [<reflink idref="bib13" id="ref50">13</reflink>]). Mothers with higher education were reported to provide a more conducive environment than those with lower education, irrespective of their family resources (Cui et al., [<reflink idref="bib6" id="ref51">6</reflink>]). It can be seen how vast and wide the effect of maternal education on ECD and its domains. We strongly advocate for women's completion of primary and continuity to secondary schooling and beyond.</p> <hd id="AN0179359479-20">Strengths and Limitations</hd> <p>This study utilized data from a nationally representative survey that followed standard methodology to generate reliable data. One of the limitations of this study was its cross-sectional study design, which was not suitable for identifying the cause-and-effect relationship between ECD, its domains, and selected individual, parental, and household factors. Another limitation was the unavailability of neighborhood factors for 35–59 months children in the UNICEF MICS dataset for Ghana 2017/18. Finally, ECDI may have not been contextualized in the primary data to fit various socio-cultural context across different regions in Ghana. Future studies should consider all age groups in the spectrum of ECD, preferably from 0 to 8 years.</p> <hd id="AN0179359479-21">Conclusion</hd> <p>This study provided scientific evidence on the status and drivers of ECD in Ghana. We found maternal education, the number of days children were left alone for more than an hour, disability, and stunting as factors of greatest concern to ECD and its domains. Barriers to entry and continued use of health and nutrition services should be alleviated to reach all children. Educating mothers is strongly needed to enhance the development of children, and with social and child support services, to protect the most vulnerable children. We have a great opportunity to invest in the early years of children to maximize gains and achieve the SDGs. As such, all sectors must be aligned with this common goal of providing nurturing care to young children.</p> <hd id="AN0179359479-22">Acknowledgements</hd> <p>The authors are grateful to James P Grant School of Public Health, BRAC University, for their support and to the UNICEF MICS team for their permission to use the Ghana MICS dataset 2017/18 for analyses and publication. The data to reproduce our analyses are publicly available upon request from the UNICEF MICS website https://mics.unicef.org/surveys. Our analyses were not preregistered, and the code needed to replicate it will be made available upon request from the corresponding author.</p> <hd id="AN0179359479-23">Declarations</hd> <p></p> <hd id="AN0179359479-24">Conflict of interests</hd> <p>We did not receive any funding and have no conflict of interest to disclose.</p> <hd id="AN0179359479-25">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0179359479-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref5" type="bt">1</bibl> <bibtext> Aburto NJ, Ramirez-Zea M, Neufeld LM, Flores-Ayala R. Some indicators of nutritional status are associated with activity and exploration in infants at risk for vitamin and mineral deficiencies. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Early Childhood Development (ECD) in Ghana: Assessing the Status and Determinants of the Literacy-Numeracy, Physical, Social-Emotional, and Learning Domains
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ignitius+Ezekiel+Lim%22">Ignitius Ezekiel Lim</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-5927-225X">0000-0002-5927-225X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ilias+Mahmud%22">Ilias Mahmud</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-1330-7813">0000-0003-1330-7813</externalLink>)<br /><searchLink fieldCode="AR" term="%22Md%2E+Uzzal+Chowdhury%22">Md. Uzzal Chowdhury</searchLink><br /><searchLink fieldCode="AR" term="%22Adrita+Kaiser%22">Adrita Kaiser</searchLink><br /><searchLink fieldCode="AR" term="%22Fatema+Akter+Bonny%22">Fatema Akter Bonny</searchLink><br /><searchLink fieldCode="AR" term="%22Samson+Akanbonga%22">Samson Akanbonga</searchLink><br /><searchLink fieldCode="AR" term="%22Md%2E+Tanvir+Hasan%22">Md. Tanvir Hasan</searchLink>
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22International+Journal+of+Early+Childhood%22"><i>International Journal of Early Childhood</i></searchLink>. 2024 56(2):255-276.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 22
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Literacy%22">Literacy</searchLink><br /><searchLink fieldCode="DE" term="%22Numeracy%22">Numeracy</searchLink><br /><searchLink fieldCode="DE" term="%22Physical+Development%22">Physical Development</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Development%22">Social Development</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Development%22">Emotional Development</searchLink><br /><searchLink fieldCode="DE" term="%22Learning+Processes%22">Learning Processes</searchLink><br /><searchLink fieldCode="DE" term="%22Sex%22">Sex</searchLink><br /><searchLink fieldCode="DE" term="%22Age%22">Age</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Background%22">Educational Background</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Income%22">Family Income</searchLink><br /><searchLink fieldCode="DE" term="%22Disabilities%22">Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Rural+Areas%22">Rural Areas</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Rearing%22">Child Rearing</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Ghana%22">Ghana</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s13158-023-00349-y
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0020-7187<br />1878-4658
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Despite initiatives by key actors in the last two decades, Early Childhood Development in Ghana, measured by physical, cognitive, linguistic, and social-emotional development of children up to 8 years of age, remains poor. This study aimed to assess Ghana's Early Childhood Development (ECD) status and determinants by analyzing the Ghana Multiple Indicator Cluster Survey 2017/18 data. Among the 3801 Ghanaian children (35-59 months; 1880 males), 42.7% were developmentally on track in literacy-numeracy, 93.6% in physical, 68.2% in social-emotional, 82.3% in learning, and about 67% in at least 3 of the 4 domains. Multiple logistic regression analyses suggest a positive association between ECD and female sex of children, their age, mothers' attendance in any ECD programs, mothers' educational qualification, and household wealth. On the other hand, evidence of a negative association was observed between ECD and child disability, stunting status of children, maternal disability, the number of days children were left alone for more than an hour, and residence in a rural area. The level of maternal education may be implicated in ECD policies as it affected several ECD domains.
– Name: AbstractInfo
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1437878
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1437878
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1007/s13158-023-00349-y
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 22
        StartPage: 255
    Subjects:
      – SubjectFull: Early Childhood Education
        Type: general
      – SubjectFull: Child Development
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Literacy
        Type: general
      – SubjectFull: Numeracy
        Type: general
      – SubjectFull: Physical Development
        Type: general
      – SubjectFull: Social Development
        Type: general
      – SubjectFull: Emotional Development
        Type: general
      – SubjectFull: Learning Processes
        Type: general
      – SubjectFull: Sex
        Type: general
      – SubjectFull: Age
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Educational Background
        Type: general
      – SubjectFull: Family Income
        Type: general
      – SubjectFull: Disabilities
        Type: general
      – SubjectFull: Rural Areas
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Child Rearing
        Type: general
      – SubjectFull: Ghana
        Type: general
    Titles:
      – TitleFull: Early Childhood Development (ECD) in Ghana: Assessing the Status and Determinants of the Literacy-Numeracy, Physical, Social-Emotional, and Learning Domains
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ignitius Ezekiel Lim
      – PersonEntity:
          Name:
            NameFull: Ilias Mahmud
      – PersonEntity:
          Name:
            NameFull: Md. Uzzal Chowdhury
      – PersonEntity:
          Name:
            NameFull: Adrita Kaiser
      – PersonEntity:
          Name:
            NameFull: Fatema Akter Bonny
      – PersonEntity:
          Name:
            NameFull: Samson Akanbonga
      – PersonEntity:
          Name:
            NameFull: Md. Tanvir Hasan
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 08
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0020-7187
            – Type: issn-electronic
              Value: 1878-4658
          Numbering:
            – Type: volume
              Value: 56
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: International Journal of Early Childhood
              Type: main
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