International Journal of Public Health

, Volume 59, Issue 5, pp 779–788 | Cite as

A community-based study of early childhood sensory stimulation in home environment associated with growth and psychomotor development in Pakistan

  • Bilal Iqbal AvanEmail author
  • Syed Ahsan Raza
  • Betty R. Kirkwood
Original Article



Sensory stimulation (SS) is a non-nutritional modifiable risk factor for early childhood development. We assessed SS in home environment and examined its influence on physical growth and psychomotor development (PD).


A cross-sectional study was conducted in 26 communities in Pakistan among children aged <3 (n = 1,219). They were assessed at home visits using (1) Bayley’s Infant Developmental Scale for PD, (2) home observation for measurement of the environment inventory for SS, (3) anthropometry and (4) socio-economic questionnaire.


In rural homes, SS provided was lower as compared to urban counterparts (Adj mean diff: 4.47, 95 % CI 3.78, 5.16) and showed an association with stunting (Adj mean diff: −1.30, 95 % CI −1.93, −0.66), and underweight (Adj mean diff: −1.04, 95 % CI −1.71, −0.38) not explained by type of neighbourhood or socio-economic status. SS was associated with PD more than combined contribution of socio-economic status and rural–urban factors (Adj mean diff: 0.47, 95 % CI 0.30, 0.63).


SS in rural homes may be a significant factor influencing the child development. There is a need to corroborate these results by additional research for integration in health policy initiatives.


Sensory stimulation Psychomotor development Physical growth Anthropometry Socio-economic status Rural–urban neighbourhood Developing countries 



We would like to thank Dr Jose-Carlos Martines for helpful comments on this manuscript. The project was funded by International Maternal and Child Health Research and Training programme (IMCHRT) that supported the project under the Fogarty Fellowship of the National Institutes of Health, Fogarty International Centre in US and by the University Research Council of the Aga Khan University, Karachi, Pakistan. Further support was also provided by the Department of Child and Adolescent Health and Development, World Health Organization.


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Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  • Bilal Iqbal Avan
    • 1
    Email author
  • Syed Ahsan Raza
    • 2
  • Betty R. Kirkwood
    • 3
  1. 1.Informed Decisions for Actions in Maternal and Newborn Health (IDEAS), Department of Disease Control, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Department of Social and Preventive Medicine, Faculty of MedicineUniversity of MontrealMontrealCanada
  3. 3.Nutrition and Public Health Intervention Research Unit, Department of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK

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