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SO006

Early-life environmental factors and emotional and behavioural problems between ages 5 and 16 in South African children and adolescents: a birth cohort study

EARLY LIFE ENVIRONMENTAL FACTORS AND EMOTIONAL-BEHAVIOURAL PROBLEMS IN SOUTH AFRICAN CHILDREN AND ADOLESCENTS AT AGE 5-16 YEARS: A BIRTH COHORT STUDY

Maternal mental health problems and infections during pregnancy were associated with both externalising and internalising problems, whereas substance use during pregnancy predicted only externalising problems.

The study aimed to examine prospective associations between early-life environmental factors and emotional and behavioural problems in children and adolescents in South Africa, a low- and middle-income country. Data were drawn from the Safe Passage Study, a community-based birth cohort comprising 5,889 mother–infant pairs. Prenatal, perinatal and postnatal factors were collected through questionnaires and from clinical and medical records. In the Biomarkers of Neurodevelopmental Outcomes follow-up study, 1,284 caregiver–child pairs were reassessed when the children were aged 5 to 16 years. Externalising and internalising problems were measured using the caregiver-completed Strengths and Difficulties Questionnaire, and associations were tested using regression models adjusted for the child's sex and age at assessment. Maternal mental health problems during pregnancy (depression, anxiety and self-harm) and infections were associated with increased problems in both domains. Maternal substance use during pregnancy (tobacco, alcohol and recreational drugs), asthma, higher paternal educational attainment and infant exposure to second-hand smoke were associated only with externalising problems, whereas a placenta that was large for gestational age was associated only with internalising problems. Fetal, birth-related and other placental factors showed modest associations. The authors note that these associations should be investigated further using causal models and in terms of the cumulative effects of multiple environmental factors.

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