Measures
Child Growth and Development
Physical growth and child development were examined separately as 2 related but independent outcome measures of early child wellbeing. Children’s heights were converted to height-forage z-scores (HAZ) using the World Health Organization 2006 growth standards. 33 We analyzed both the continuous HAZ variable anda binary indicator for stunting (HAZ < –2 SD) as an indicator of growth faltering.
Child development was measured among children aged 36 to 59 months using the caregiver-reported ECDI. 34, 35 The 10 items of the ECDI were established through consultation among child development experts and based on the results of multistage and multicountry pilot tests, measurement analyses, and validation studies. 36 The 10 dichotomous (yes/no) ECDI items pertain to 4 domains of development, literacy–numeracy, physical, socioemotional, and learning, which have been previously validated across a large number of LMICs using confirmatory factor analysis. 37 (Supplemental Table 4 provides details on the ECDI). Several items of the ECDI are directly comparable to items found in wellvalidated ECD measures, such as the Ages and Stages Questionnaire and the Strengths and Difficulties Questionnaire37; furthermore, the ECDI has been used in other recent studies. 37, 38 A composite score