Which additional adversities associated with adverse childhood experiences are faced by children in low- and middle-income countries?

Adverse Childhood Experiences (ACEs) encompass potentially traumatic events that occur before the age of 18 and are classified in three domains: household dysfunction, abuse, or neglect. The ACE Study demonstrated a strong dose-response relationship, meaning that individuals with higher ACE scores were at increased risk for various physical and mental health problems, as well as risky behaviors. Since then, numerous studies have replicated and expanded on these findings, solidifying the understanding of ACEs as a critical determinant of lifelong health. ACEs are unfortunately common, with studies revealing a high prevalence globally, particularly in under-resourced communities. In LMICs, research suggests that the prevalence of ACEs may be even higher than in high-income countries, underscoring the urgent need for attention and intervention in these contexts, especially in children and adolescents, since most of the research evaluates adult populations. The types, severity, and the number of ACEs experienced by children and adults in resource-limited contexts may differ from those observed in high-income settings. Additionally, the broader political, economic, and social structures that influence individuals' risks of experiencing ACEs and their ability to recover from them also differ. ACEs are influenced by diverse social, environmental, economic, and cultural factors that affect individuals' health and should be studied with that context in mind. Existing research on ACEs in a global context confirms that ACEs impact health globally and seemingly function as an additional social determinant of health. Historically the research on ACEs and their association with other outcomes in non-Western contexts is sparse. However, a growing interest surged in developing ACE-informed policies among non-Western countries, leading the World Health Organization to sponsor an adaptation of the original ACE grid focused on “the range of adversities prevalent across low-, middle- and high-income countries” called ACEs-IQ. This adapted version includes evaluation of adversities that are more experienced in LMIC settings, according to previous studies. The additional evaluation is about assisting or being a victim of bullying, community violence, or collective violence. Despite these adaptations, research from LMICs in ACEs has included other types of adversities according to the context, such as food insecurity, maternal mental health or age, and socioeconomic constraints, which have proven significant and have not been included in the screening. The aim of this scoping review is to evaluate other adversities that are faced by children from LMICs that are not included in the different screening tools.