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Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
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Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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Westgard CM, Llatance MA, Calderón LF, Rojo GP, Young M, Orrego-Ferreyros LA. The Creation of a Field Manual for Community Health Workers to Teach Child Health and Development During Home Visits: A Case Study of Participatory Content Creation. J Community Health 2023; 48:975-981. [PMID: 37498406 DOI: 10.1007/s10900-023-01260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
Community health workers (CHWs) play a crucial role in improving child health and development in underserved populations. However, CHWs often face challenges in accessing appropriate guidance and materials for their home visits, hindering their ability to deliver accurate and relevant information to families. Extensive searches for existing resources were conducted to search for established field manual guidebooks for CHWs, however, no suitable material was found, highlighting the need for this case study. The exercise aimed to develop a comprehensive field manual guidebook and animated videos to support CHWs in the Amazon of Peru during their home visits. A multidisciplinary team of specialists was assembled to develop the material. The material development process employed a design thinking methodology, incorporating participatory content creation workshops with CHWs and experts in health topics relevant to the Amazon. This approach ensured cultural relevance and sensitivity in conveying information. The team created a list of 38 essential health and early childhood development messages for Amazonian communities. Infographics were designed for each topic, accompanied by easy-to-understand language and images to assist CHWs in conveying information effectively. To provide additional support, seven animated videos were created based on health behavior theory, covering topics such as anemia, healthy diet, diarrhea, breastfeeding, clean water, child-caregiver bond, and early childhood stimulation. The videos were designed for CHWs to share with caregivers during home visits, enhancing information transmission. The resulting guidebook, infographics, and animated videos were presented to CHWs in Loreto, Peru for feedback. Updated versions were printed and distributed to CHWs in seven communities in Loreto.
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Affiliation(s)
- Christopher Michael Westgard
- Department of Research and Implementation, Elementos, Lima, Peru.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Milagros Alvarado Llatance
- Department of Research and Implementation, Elementos, Lima, Peru
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Mayra Young
- Department of Research and Implementation, Elementos, Lima, Peru
| | - Luis Alexander Orrego-Ferreyros
- Department of Research and Implementation, Elementos, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Anago R, Forzy T, Guei S, Pelras C, Ramde S, Tevenart C, Vera Rueda J, Macours K. Piloting, testing and scaling parental training: a multi-partnership approach in Côte d'Ivoire. Front Public Health 2023; 11:1106565. [PMID: 37655283 PMCID: PMC10466389 DOI: 10.3389/fpubh.2023.1106565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Background and objectives Early Childhood Development is high on the policy agenda in Côte d'Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how "MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale," one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of "How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)? Methods Five training approaches to improve caregivers' knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD. Results The evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation. Conclusion The iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis.
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Affiliation(s)
- Romuald Anago
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Sosthene Guei
- Transformer L’éducation Dans Les Communautés de Cacao, Abidjan, Côte d'Ivoire
| | | | - Samuel Ramde
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | | | - Karen Macours
- Paris School of Economics, Paris, France
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), Paris, France
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Buccini G, Kofke L, Case H, Katague M, Pacheco MF, Pérez-Escamilla R. Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001542. [PMID: 37556418 PMCID: PMC10411826 DOI: 10.1371/journal.pgph.0001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Abstract
Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.
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Affiliation(s)
- Gabriela Buccini
- Department of Social and Behavioral Health, University of Nevada Las Vegas School of Public Health, Las Vegas, Nevada, United States of America
| | - Lily Kofke
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Haley Case
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Marina Katague
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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Meghir C, Attanasio O, Jervis P, Day M, Makkar P, Behrman J, Gupta P, Pal R, Phimister A, Vernekar N, Grantham-McGregor S. Early Stimulation and Enhanced Preschool: A Randomized Trial. Pediatrics 2023; 151:191219. [PMID: 37125886 DOI: 10.1542/peds.2023-060221h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To estimate the impacts of 2 interventions, early stimulation (ES) for children aged <3 years and enhanced preschool (EP) for children aged 3+ years, and their interactions. METHODS In Odisha, India, 192 villages were randomly assigned to ES or to no ES. Within each village, about 8 mothers with children initially aged 7 to 16 months were enrolled, receiving ES or no ES accordingly (n = 1449). Subsequently, when children were aged ∼3 years, the villages were rerandomized to either EP at Anganwadi centers or no EP. This yielded 4 groups: (1) ES and EP, (2) only ES, (3) only EP, and (4) no intervention. Trained Anganwadi workers ran the EP. Primary outcomes, measured at baseline and follow-up after ∼1 year, were children's IQ (summarizing cognition, language, and executive functioning) and school readiness (SR). Secondary outcomes were home environments, caregivers' child-development knowledge. and preschool quality. RESULTS Fifteen months after ES ended, onlyES had a sustained benefit on IQ (0.18 SD, P <.04) and on SR (0.13 SD, P <.08). Only EP improved IQ (0.17 SD, P <.04) and SR (0.24 SD, P <.01). Receiving both interventions improved IQ (0.24 SD, P <.01) and SR (0.21 SD, P <.01). No statistically significant interactions between the 2 interventions were observed. CONCLUSIONS Both ES and EP increased IQ and SR. Only ES impacts were sustained for 15 months. Only EP resulted in considerable catch-up for children who did not receive only ES. The absence of significant complementarities should be investigated further because of its profound policy implications.
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Affiliation(s)
- Costas Meghir
- Department of Economics, Yale University, New Haven, Connecticut
- Institute for Fiscal Studies, London, England, United Kingdom
| | - Orazio Attanasio
- Department of Economics, Yale University, New Haven, Connecticut
- Institute for Fiscal Studies, London, England, United Kingdom
| | - Pamela Jervis
- Institute for Fiscal Studies, London, England, United Kingdom
- Universidad de Chile, Santiago, Chile
| | - Monimalika Day
- School of Education Studies, Dr. B. R Ambedkar University, Agra, India
| | | | - Jere Behrman
- Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Prachi Gupta
- School of Education Studies, Dr. B. R Ambedkar University, Agra, India
| | - Rashim Pal
- School of Education Studies, Dr. B. R Ambedkar University, Agra, India
| | - Angus Phimister
- Institute for Fiscal Studies, London, England, United Kingdom
| | - Nisha Vernekar
- Institute for Fiscal Studies, London, England, United Kingdom
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Hossain SJ, Tofail F, Mehrin SF, Hamadani JD. Six-Year Follow-up of Childhood Stimulation on Development of Children With and Without Anemia. Pediatrics 2023; 151:191217. [PMID: 37125884 DOI: 10.1542/peds.2023-060221e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previously, in 30 Bangladeshi villages, 2 groups of children with iron-deficiency anemia (IDA) and nonanemic (NA) iron sufficiency aged 6 to 24 months participated in 2 parallel cluster randomized controlled trials of the effect of psychosocial stimulation on neurodevelopment. The intervention was composed of weekly play sessions at home for 9 months. All children with anemia received iron treatment of 6 months. The intervention improved the mental development of NA but not IDA groups. Six years after end line when the children were aged 8 to 9 years, we aimed to determine if benefits were sustained in the NA group or late-onset benefits emerged in the IDA group. METHODS We relocated 372 (90%) of the initial 412 children from all the clusters (villages), and assessed their IQ with the Wechsler Abbreviated Scale of Intelligence-II, motor development, and school achievement including math, spelling, and reading. Analyses were by intention-to-treat, adjusting for clustering. RESULTS There was a significant interaction between anemia groups (IDA/NA) and intervention on IQ. The intervention benefitted the NA group's Full-Scale IQ (effect size, 0.43 [95% confidence interval, 0.08-0.79]) and Perceptual Reasoning Index (effect size, 0.48 [95% confidence interval, 0.08-0.89]) but did not affect the IDA group's outcomes. No other outcomes were significant. CONCLUSIONS The benefits from early childhood psychosocial stimulation on the NA group's IQ, 6 years after intervention ended, adds to the limited evidence on the sustainability of benefits in low- and middle-income countries. Reasons for lack of effect in children with anemia are unknown.
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Affiliation(s)
- Sheikh Jamal Hossain
- Maternal and Child Health Division
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fahmida Tofail
- Nutrition and Clinical Science Division, icddr,b, Dhaka, Bangladesh
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Grantham-McGregor SM, Walker SP. Early Childhood Interventions: Issues to Consider in Getting to Scale. Pediatrics 2023; 151:191221. [PMID: 37125888 DOI: 10.1542/peds.2023-060221p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Jervis P, Coore-Hall J, Pitchik HO, Arnold CD, Grantham-McGregor S, Rubio-Codina M, Baker-Henningham H, Fernald LCH, Hamadani J, Smith JA, Trias J, Walker SP. The Reach Up Parenting Program, Child Development, and Maternal Depression: A Meta-analysis. Pediatrics 2023; 151:191225. [PMID: 37125892 DOI: 10.1542/peds.2023-060221d] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence is needed on effective approaches to build parents' ability to promote child development feasible in low- and middle-income countries. Our objective was to synthesize impact of the Reach Up early childhood parenting program in several low- and middle-income countries and examine moderation by family and implementation characteristics. METHODS Systematic search using PubMed and Academic Search Elite/EBSCO Host. Randomized controlled trials of the Reach Up program from 1985 to February 2022 were selected. Data were extracted by 2 independent researchers. Primary outcomes were child cognitive, language, and motor development. Secondary outcomes were home stimulation and maternal depressive symptoms. We synthesized pooled effect sizes using random effect inverse-variance weighting and effect modification by testing pooled subgroup effect estimates using the χ2 test for heterogeneity. RESULTS Average effect size across 18 studies ranged from 0.49 (95% confidence interval [CI] 0.32 to 0.66) for cognition, 0.38 (CI 0.24 to 0.51) for language, 0.27 (CI 0.13 to 0.40) for motor development, 0.37 (CI 0.21 to 0.54) for home stimulation, and -0.09 (CI -0.19 to 0.01) for maternal depressive symptoms. Impacts were larger in studies targeted to undernourished children, with mean enrollment older than age 12 months and intervention duration 6 to 12 months. Quality of evidence assessed with the Cochrane Assessment of Risk of Bias and GRADE system was moderate. Instruments used to assess child development varied. In moderator analyses, some subgroups included few studies. CONCLUSIONS Reach Up benefits child development and home stimulation and is adaptable across cultures and delivery methods. Child and implementation characteristics modified the effects, with implications for scaling.
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Affiliation(s)
- Pamela Jervis
- Universidad de Chile, Santiago, Chile
- Institute for Fiscal Studies, London, United Kingdom
| | - Jacqueline Coore-Hall
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, California
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, California
| | | | | | - Helen Baker-Henningham
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
- School of Human and Behavioural Sciences, Bangor University, Bangor, Wales
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, California
| | - Jena Hamadani
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Joanne A Smith
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Lansford JE, Betancourt TS, Boller K, Popp J, Altafim ERP, Attanasio O, Raghavan C. The Future of Parenting Programs: II Implementation. PARENTING, SCIENCE AND PRACTICE 2022; 22:235-257. [PMID: 36439707 PMCID: PMC9683038 DOI: 10.1080/15295192.2022.2086807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer E Lansford
- Center for Child and Family Policy, Duke University, Box 90545, Durham, NC 27708, USA
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Attanasio O, Baker-Henningham H, Bernal R, Meghir C, Pineda D, Rubio-Codina M. Early Stimulation and Nutrition: The Impacts of a Scalable Intervention. JOURNAL OF THE EUROPEAN ECONOMIC ASSOCIATION 2022; 20:1395-1432. [PMID: 35965610 PMCID: PMC9372035 DOI: 10.1093/jeea/jvac005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Early childhood development is becoming the focus of policy worldwide. However, the evidence on the effectiveness of scalable models is scant, particularly when it comes to infants in developing countries. In this paper, we describe and evaluate with a cluster-Randomized Controlled Trial an intervention designed to improve the quality of child stimulation within the context of an existing parenting program in Colombia, known as FAMI. The intervention improved children's development by 0.16 of a standard deviation (SD) and children's nutritional status, as reflected in a reduction of 5.8 percentage points of children whose height-for-age is below -1 SD.
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Do human capital investments mediate the intergenerational transmission of domestic violence? SSM Popul Health 2022; 17:100985. [PMID: 35024419 PMCID: PMC8733314 DOI: 10.1016/j.ssmph.2021.100985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Domestic violence is a major public health issue worldwide with detrimental consequences not only for its victims but also for the next generations. Despite an extensive literature documenting the persistent intergenerational transmission of domestic violence, few studies explore the mechanisms underlying this transmission. Methods We use data from the Cebu Longitudinal Health and Nutrition Survey implemented between 1984 and 2009 in the Philippines. These longitudinal data allow us to measure how much the association between witnessing parental violence during childhood and the experience of intimate partner violence in young adulthood is explained by different measures of human capital that occur up to young adulthood, including education and health outcomes, cognitive skills, and psychosocial traits. Results We find that these human capital measures explain 22 percent of the transmission of domestic violence. Our results indicate that depression at age 18 and cognitive ability at age 11 are the primary human capital channels. Conclusions Our findings suggest a potential role of interventions targeting these human capital investments in reducing the cycle of violence across generations, as such, it could expand the window of opportunity for effective interventions in developing countries.
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Sylvia S, Luo R, Zhong J, Dill SE, Medina A, Rozelle S. Passive versus active service delivery: Comparing the effects of two parenting interventions on early cognitive development in rural China. WORLD DEVELOPMENT 2022; 149:105686. [PMID: 34980940 PMCID: PMC8566276 DOI: 10.1016/j.worlddev.2021.105686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
We present the results of a cluster-randomized controlled trial that evaluates the effects of a free, center-based parenting intervention on early cognitive development and parenting practices in 100 rural villages in China. We then compare these effects to a previous trial of a home-based intervention conducted in the same region, using the same parenting curriculum and public service system, accounting for potential differences between the studies. We find that the center-based intervention did not have a significant impact on child development outcomes, but did lead to increases in the material investments, time investments, and parenting skills of caregivers. The average impact of the center-based intervention on child skills and investments in children was significantly smaller than the home-visiting intervention. Analysis of the possible mechanisms suggests that the difference in effects was driven primarily by different patterns of selection into program participation.
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Affiliation(s)
- Sean Sylvia
- Gillings School of Global Public Health and Carolina Population Center, 1101-D McGavran-Greenberg Bldg., University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Science, 409 Wangkezhen Bldg., Peking University, No. 5 Yiheyuan, Haidian District, Beijing, China
| | - Jingdong Zhong
- School of Economics, Peking University, No. 5 Yiheyuan, Haidian District, Beijing, China
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, 616 Jane Stanford Way, Stanford University, Stanford, CA, USA
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Little MT, Roelen K, Lange BCL, Steinert JI, Yakubovich AR, Cluver L, Humphreys DK. Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries. PLoS Med 2021; 18:e1003698. [PMID: 34582447 PMCID: PMC8478252 DOI: 10.1371/journal.pmed.1003698] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To strengthen the impact of cash transfers, these interventions have begun to be packaged as cash-plus programmes, combining cash with additional transfers, interventions, or services. The intervention's complementary ("plus") components aim to improve cash transfer effectiveness by targeting mediating outcomes or the availability of supplies or services. This study examined whether cash-plus interventions for infants and children <5 are more effective than cash alone in improving health and well-being. METHODS AND FINDINGS Forty-two databases, donor agencies, grey literature sources, and trial registries were systematically searched, yielding 5,097 unique articles (as of 06 April 2021). Randomised and quasi-experimental studies were eligible for inclusion if the intervention package aimed to improve outcomes for children <5 in low- and middle-income countries (LMICs) and combined a cash transfer with an intervention targeted to Sustainable Development Goal (SDG) 2 (No Hunger), SDG3 (Good Health and Well-being), SDG4 (Education), or SDG16 (Violence Prevention), had at least one group receiving cash-only, examined outcomes related to child-focused SDGs, and was published in English. Risk of bias was appraised using Cochrane Risk of Bias and ROBINS-I Tools. Random effects meta-analyses were conducted for a cash-plus intervention category when there were at least 3 trials with the same outcome. The review was preregistered with PROSPERO (CRD42018108017). Seventeen studies were included in the review and 11 meta-analysed. Most interventions operated during the first 1,000 days of the child's life and were conducted in communities facing high rates of poverty and often, food insecurity. Evidence was found for 10 LMICs, where most researchers used randomised, longitudinal study designs (n = 14). Five intervention categories were identified, combining cash with nutrition behaviour change communication (BCC, n = 7), food transfers (n = 3), primary healthcare (n = 2), psychosocial stimulation (n = 7), and child protection (n = 4) interventions. Comparing cash-plus to cash alone, meta-analysis results suggest Cash + Food Transfers are more effective in improving height-for-age (d = 0.08 SD (0.03, 0.14), p = 0.02) with significantly reduced odds of stunting (OR = 0.82 (0.74, 0.92), p = 0.01), but had no added impact in improving weight-for-height (d = -0.13 (-0.42, 0.16), p = 0.24) or weight-for-age z-scores (d = -0.06 (-0.28, 0.15), p = 0.43). There was no added impact above cash alone from Cash + Nutrition BCC on anthropometrics; Cash + Psychosocial Stimulation on cognitive development; or Cash + Child Protection on parental use of violent discipline or exclusive positive parenting. Narrative synthesis evidence suggests that compared to cash alone, Cash + Primary Healthcare may have greater impacts in reducing mortality and Cash + Food Transfers in preventing acute malnutrition in crisis contexts. The main limitations of this review are the few numbers of studies that compared cash-plus interventions against cash alone and the potentially high heterogeneity between study findings. CONCLUSIONS In this study, we observed that few cash-plus combinations were more effective than cash transfers alone. Cash combined with food transfers and primary healthcare show the greatest signs of added effectiveness. More research is needed on when and how cash-plus combinations are more effective than cash alone, and work in this field must ensure that these interventions improve outcomes among the most vulnerable children.
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Affiliation(s)
- Madison T. Little
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- Green Templeton College, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Keetie Roelen
- Centre for Social Protection, Institute for Development Studies, Brighton, United Kingdom
| | - Brittany C. L. Lange
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- Child Health & Development Institute of Connecticut, Farmington, Connecticut, United States of America
| | - Janina I. Steinert
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- School of Governance, Technical University of Munich, Munich, Germany
| | - Alexa R. Yakubovich
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- MAP Centre for Urban Solutions, Unity Health Toronto & University of Toronto, Toronto, Canada
| | - Lucie Cluver
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - David K. Humphreys
- Department of Social Policy & Intervention, University of Oxford, Oxford, United Kingdom
- Green Templeton College, University of Oxford, Oxford, United Kingdom
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14
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Sherr L, Roberts KJ, Tomlinson M, Skeen S, Mebrahtu H, Gordon S, du Toit S, Haag K, Cluver LD. Food Should not be Forgotten: Impacts of Combined Cash Transfer Receipt and Food Security on Child Education and Cognition in South Africa and Malawi. AIDS Behav 2021; 25:2886-2897. [PMID: 34117591 PMCID: PMC8195450 DOI: 10.1007/s10461-021-03317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
Social protection can take many forms. Both cash transfers and food security may have important contributions to child cognitive development. This study examines the potential impact of combinations of cash transfers and food security status on child cognitive development and educational outcomes. Cross-sectional data for 796 HIV-affected children in the Child Community Care study were utilised for this analysis. Children and caregivers completed interview schedules comprised of standardised items on socio-demographics, household data, cash grant receipt and food security status, school achievement, and cognition. A series of logistic and linear regression models and marginal effects analyses were undertaken to explore the impacts of differing levels of social protection (none; either cash grant receipt or food secure status or, both in combination) on child educational and cognitive outcomes. Although all children lived in poverty-stricken households, 20% (157/796) of children did not live in a household in receipt of a cash grant and did not report food security; 32.4% (258/796) reported either component of social protection and, 47.9% (381/796) received both measures of social protection in combination. Compared to no social protection, being in receipt of either component of social protection was found to be significantly associated with being in the correct class for age, higher scores of non-verbal cognition, and higher working memory scores. Receiving both social protection measures in combination was found to be significantly associated with reduced educational risk scores, improved odds of being in the correct class for age, regular school attendance, missing less than a week of school in the previous two weeks, higher scores on measures of nonverbal cognition, higher working memory scores, and learning new things more easily. Educational and cognitive outcomes for children can be bolstered by social protection measures (cash grant receipt or food security). Benefits are enhanced when social protection is received in combination. Such findings support the notion of synergistic social protection responses for children living in environments impacted by high levels of HIV burden and deprivation.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | | | - Mark Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sarah Skeen
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Helen Mebrahtu
- Institute for Global Health, University College London, London, UK
| | - Sarah Gordon
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Stefani du Toit
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Lucie D. Cluver
- Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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15
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Quality of the home, daycare and neighborhood environment and the cognitive development of economically disadvantaged children in early childhood: A mediation analysis. Infant Behav Dev 2021; 64:101619. [PMID: 34385051 DOI: 10.1016/j.infbeh.2021.101619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/20/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022]
Abstract
The objective of this study was to investigate how socioeconomic factors and the quality of ecological environments affect motor and cognitive development of economically disadvantaged children. This is a cross-sectional, predictive and correlational study using structural equation modeling to analyze data on 147 economic disadvantage children of 24-36 months attending public daycare. The Bayley-III Scales, the Home Observation for Measurement of the Environment Inventory, the Infant/Toddler Environment Rating Scale-Revised Edition, a socioeconomic index and a specifically designed questionnaire on neighborhood quality were applied. The ecological environments did not affect motor development, but 25 % of variations in cognitive development were explained by socioeconomic differences and differences in the quality of the neighborhood, home and daycare. However, only the quality of the home and daycare had a direct impact, with the other factors affecting the outcome indirectly and to a lesser extent. In conclusion, this study investigated the association between the ecological contexts of economically disadvantaged children and their cognitive and motor development. The findings showed that the environmental context had effect on cognitive development. The home was the environment that exerted the most significant direct effect, followed by daycare and, indirectly and to a lesser extent, the neighborhood. Therefore, the coordination of public policies between health, education and social assistance sectors, aiming at the three ecological environments is important in order to promote the cognitive development of economically disadvantaged children.
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16
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Romeo RR, Leonard JA, Scherer E, Robinson S, Takada M, Mackey AP, West MR, Gabrieli JDE. Replication and extension of a family-based training program to improve cognitive abilities in young children. JOURNAL OF RESEARCH ON EDUCATIONAL EFFECTIVENESS 2021; 14:792-811. [PMID: 35321092 PMCID: PMC8939839 DOI: 10.1080/19345747.2021.1931999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 02/12/2021] [Accepted: 04/23/2021] [Indexed: 05/12/2023]
Abstract
Childhood socioeconomic status (SES) is associated with persistent academic achievement gaps, which necessitates evidence-based, scalable interventions to improve children's outcomes. The present study reports results from a replication and extension of a family-based training program previously found to improve cognitive development in lower-SES preschoolers (Neville et al., 2013). One hundred and one primarily low-SES families with 107 children aged 4-7 years were randomly assigned to the intervention or passive control group. Intent-to-treat regression models revealed that children whose families were assigned to the intervention group did not exhibit significant benefit on composite measures of nonverbal IQ, executive functioning, or language skills, though post-hoc analyses suggested marginal improvement on the fluid reasoning subcomponent of nonverbal IQ. Treatment-on-treated models revealed a significant positive effect of intervention attendance on fluid reasoning and a negative effect on vocabulary. We discuss potential causes for the non-replication, including differences in the sample composition, size, and assessment choices. Results suggest the need to more broadly assess scalable interventions with varying populations and ensure appropriate cultural and geographical adaptations to achieve maximum benefits for children from diverse backgrounds.
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Affiliation(s)
- Rachel R Romeo
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Department of Psychology, Harvard University
| | - Julia A Leonard
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Division of Psychology, College of Arts and Sciences, University of Pennsylvania
| | | | - Sydney Robinson
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Children's Hospital of Philadelphia, University of Pennsylvania
| | - Megumi Takada
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Graduate School of Education, Stanford University
| | - Allyson P Mackey
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Division of Psychology, College of Arts and Sciences, University of Pennsylvania
| | | | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
- Graduate School of Education, Harvard University
- Integrated Learning Initiative, Massachusetts Institute of Technology
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17
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Zhang L, Ssewanyana D, Martin MC, Lye S, Moran G, Abubakar A, Marfo K, Marangu J, Proulx K, Malti T. Supporting Child Development Through Parenting Interventions in Low- to Middle-Income Countries: An Updated Systematic Review. Front Public Health 2021; 9:671988. [PMID: 34336768 PMCID: PMC8322584 DOI: 10.3389/fpubh.2021.671988] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions. Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted. Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [-0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes. Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts.
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Affiliation(s)
- Linlin Zhang
- Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Derrick Ssewanyana
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Marie-Claude Martin
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Stephen Lye
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Greg Moran
- Department of Psychology, Western University, London, ON, Canada
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Kofi Marfo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Joyce Marangu
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Kerrie Proulx
- Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Tina Malti
- Centre for Child Development, Mental Health, and Policy, University of Toronto Mississauga, Mississauga, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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18
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Pitchik HO, Tofail F, Rahman M, Akter F, Sultana J, Shoab AK, Huda TMN, Jahir T, Amin MR, Hossain MK, Das JB, Chung EO, Byrd KA, Yeasmin F, Kwong LH, Forsyth JE, Mridha MK, Winch PJ, Luby SP, Fernald LC. A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh. BMJ Glob Health 2021; 6:bmjgh-2020-004307. [PMID: 33727278 PMCID: PMC7970287 DOI: 10.1136/bmjgh-2020-004307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/13/2021] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale. Trial registration number The trial is registered in ISRCTN (ISRCTN16001234).
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Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Abul Kasham Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tarique Md Nurul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Ruhul Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jyoti Bhushan Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Laura H Kwong
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Peter J Winch
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia Ch Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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19
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Miller AC, Rumaldo N, Soplapuco G, Condeso A, Kammerer B, Lundy S, Faiffer F, Montañez A, Ramos K, Rojas N, Contreras C, Muñoz M, Valdivia H, Vilca D, Córdova N, Hilario P, Vibbert M, Lecca L, Shin S. Success at Scale: Outcomes of Community-Based Neurodevelopment Intervention (CASITA) for Children Ages 6-20 months With Risk of Delay in Lima, Peru. Child Dev 2021; 92:e1275-e1289. [PMID: 34114651 DOI: 10.1111/cdev.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study is a randomized controlled trial of a 12-week community-based group parenting intervention ("CASITA") in Lima, Peru. CASITA improved neurodevelopment in a pilot study of 60 Peruvian children and subsequently scaled to 3,000 households throughout the district. The objective of this study was to assess intervention effectiveness when implemented at scale. A total of 347 children ages 6-20 months (52.7% male, 100% identified as "mestizo") at risk for developmental difficulties were randomized to immediate or delayed CASITA. At 3 months after enrollment, the immediate arm showed significantly higher overall development, based on the Extended Ages and Stages Questionnaire and Home Observation for Measurement of the Environment scores (Cohen's ds = .36 and .31, respectively). Programs demonstrably effective at scale could help address children's development risks worldwide.
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Affiliation(s)
| | | | | | | | | | - Shannon Lundy
- University of California San Francisco Benioff Children's Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonya Shin
- Harvard Medical School.,Brigham and Women's Hospital
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20
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Korevaar E, Kasza J, Taljaard M, Hemming K, Haines T, Turner EL, Thompson JA, Hughes JP, Forbes AB. Intra-cluster correlations from the CLustered OUtcome Dataset bank to inform the design of longitudinal cluster trials. Clin Trials 2021; 18:529-540. [PMID: 34088230 DOI: 10.1177/17407745211020852] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sample size calculations for longitudinal cluster randomised trials, such as crossover and stepped-wedge trials, require estimates of the assumed correlation structure. This includes both within-period intra-cluster correlations, which importantly differ from conventional intra-cluster correlations by their dependence on period, and also cluster autocorrelation coefficients to model correlation decay. There are limited resources to inform these estimates. In this article, we provide a repository of correlation estimates from a bank of real-world clustered datasets. These are provided under several assumed correlation structures, namely exchangeable, block-exchangeable and discrete-time decay correlation structures. METHODS Longitudinal studies with clustered outcomes were collected to form the CLustered OUtcome Dataset bank. Forty-four available continuous outcomes from 29 datasets were obtained and analysed using each correlation structure. Patterns of within-period intra-cluster correlation coefficient and cluster autocorrelation coefficients were explored by study characteristics. RESULTS The median within-period intra-cluster correlation coefficient for the discrete-time decay model was 0.05 (interquartile range: 0.02-0.09) with a median cluster autocorrelation of 0.73 (interquartile range: 0.19-0.91). The within-period intra-cluster correlation coefficients were similar for the exchangeable, block-exchangeable and discrete-time decay correlation structures. Within-period intra-cluster correlation coefficients and cluster autocorrelations were found to vary with the number of participants per cluster-period, the period-length, type of cluster (primary care, secondary care, community or school) and country income status (high-income country or low- and middle-income country). The within-period intra-cluster correlation coefficients tended to decrease with increasing period-length and slightly decrease with increasing cluster-period sizes, while the cluster autocorrelations tended to move closer to 1 with increasing cluster-period size. Using the CLustered OUtcome Dataset bank, an RShiny app has been developed for determining plausible values of correlation coefficients for use in sample size calculations. DISCUSSION This study provides a repository of intra-cluster correlations and cluster autocorrelations for longitudinal cluster trials. This can help inform sample size calculations for future longitudinal cluster randomised trials.
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Affiliation(s)
- Elizabeth Korevaar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Elizabeth L Turner
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Jennifer A Thompson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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21
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Smith JA, Chang SM, Lopez Boo F, Ferro MDLP, Walker SP. Are Benefits From a Parenting Intervention Delivered Through the Health Services Sustainable? Follow-Up of a Randomized Evaluation in Jamaica. Acad Pediatr 2021; 21:638-645. [PMID: 33434700 DOI: 10.1016/j.acap.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE An innovative low-cost parenting intervention, implemented through health services in Jamaica showed benefits to children's cognitive development at 18 months and parent's attitudes concerning childcare. We assessed the impact of the intervention on child and parent outcomes at 6 years of age. METHODS A cluster randomized trial of 2 parenting interventions was conducted through 20 health centers in Jamaica. Interventions were implemented from age 3 to 18 months and each intervention benefited cognitive development at 18 months (effect size 0.34-0.38 standard deviation). Children were reassessed at 6 years (n = 262, 80.1% of those assessed at 18 months) to determine any benefits to cognition, behavior, and parenting behavior. Loss to follow-up was not significantly different by treatment. Inverse probability weighting and Lee bounds were used to adjust for loss to follow-up, and multilevel regression analyses conducted with random effects at the health center level. RESULTS There were no significant benefits to any child outcomes at age 6 years or to parenting behavior. Results are robust using the wild cluster bootstrap procedure and using Lee bounds for attrition. The initial trial benefits were reproduced with the current sample and methods. CONCLUSION Lack of sustained benefits may be related to the initial effect size and low intensity of the intervention that ended very young at age 18 months. It may also be related to lack of initial impact on home environment and fade-out of effects in a country with near universal preschool. The findings have implications for intervention design and targeting.
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Affiliation(s)
- Joanne A Smith
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica.
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
| | - Florencia Lopez Boo
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Maria de la Paz Ferro
- Social Protection and Health Division, Inter-American Development Bank (F Lopez Boo and MdlP Ferro), Washington, DC
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies (JA Smith, SM Chang, and SP Walker), Kingston, Jamaica
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Jeong J, Pitchik HO, Fink G. Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:e004067. [PMID: 33674266 PMCID: PMC7938974 DOI: 10.1136/bmjgh-2020-004067] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Parenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time. METHODS We conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1-3 years after programme completion), medium-term (4-9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children's cognitive and behavioral development by these subgroups of follow-up rounds. RESULTS We identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children's outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time. CONCLUSIONS There have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Switzerland
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Wu T, Niu J, Yin X, Zhao C, Huang X, Wang X. China's antenatal care promoting early childhood development: evidence from a cross-sectional survey. Ann N Y Acad Sci 2021; 1493:90-101. [PMID: 33455003 DOI: 10.1111/nyas.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
The Chinese government has established a three-tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community-based cross-sectional survey was conducted for mothers' ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother-child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44-0.81 for ANC2; and OR = 0.44, 95% CI: 0.34-0.59 for ANC3) and social-emotional developmental delay (OR = 0.68, 95% CI: 0.49-0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled-up early childhood development interventions.
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Affiliation(s)
- Tianchen Wu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Jieqiong Niu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Xiaohan Yin
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Chunxia Zhao
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaona Huang
- Section of Health, Nutrition, and Water, Environment and Sanitation, The United Nations Children's Fund in China Office, Beijing, China
| | - Xiaoli Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.,Key Laboratory of Reproductive Health, National Health Commission, Beijing, China
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Luoto JE, Lopez Garcia I, Aboud FE, Singla DR, Fernald LCH, Pitchik HO, Saya UY, Otieno R, Alu E. Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial. LANCET GLOBAL HEALTH 2020; 9:e309-e319. [PMID: 33341153 PMCID: PMC8054650 DOI: 10.1016/s2214-109x(20)30469-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 01/24/2023]
Abstract
Background Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya’s network of community health volunteers. Methods We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558. Findings Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Interpretation Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability.
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Affiliation(s)
| | | | - Frances E Aboud
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Daisy R Singla
- Department of Psychiatry, Sinai Health and University of Toronto, Toronto, ON, Canada
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Edith Alu
- Safe Water and AIDS Project, Kisumu, Kenya
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Andrew A, Cattan S, Costa Dias M, Farquharson C, Kraftman L, Krutikova S, Phimister A, Sevilla A. Inequalities in Children's Experiences of Home Learning during the COVID-19 Lockdown in England. FISCAL STUDIES 2020; 41:653-683. [PMID: 33362314 PMCID: PMC7753283 DOI: 10.1111/1475-5890.12240] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This paper combines novel data on the time use, home-learning practices and economic circumstances of families with children during the COVID-19 lockdown with pre-lockdown data from the UK Time Use Survey to characterise the time use of children and how it changed during lockdown, and to gauge the extent to which changes in time use and learning practices during this period are likely to reinforce the already large gaps in educational attainment between children from poorer and better-off families. We find considerable heterogeneity in children's learning experiences - amount of time spent learning, activities undertaken during this time and availability of resources to support learning. Concerningly, but perhaps unsurprisingly, this heterogeneity is strongly associated with family income and in some instances more so than before lockdown. Furthermore, our analysis suggests that any impacts of inequalities in time spent learning between poorer and richer children are likely to be compounded by inequalities not only in learning resources available at home, but also in those provided by schools.
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Affiliation(s)
- Alison Andrew
- Institute for Fiscal Studies; University College London
| | | | - Monica Costa Dias
- University of Bristol; Institute for Fiscal Studies; University of Porto
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26
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Andrew A, Cattan S, Costa Dias M, Farquharson C, Kraftman L, Krutikova S, Phimister A, Sevilla A. Inequalities in Children's Experiences of Home Learning during the COVID-19 Lockdown in England. FISCAL STUDIES 2020. [PMID: 33362314 DOI: 10.2139/ssrn.3654937] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper combines novel data on the time use, home-learning practices and economic circumstances of families with children during the COVID-19 lockdown with pre-lockdown data from the UK Time Use Survey to characterise the time use of children and how it changed during lockdown, and to gauge the extent to which changes in time use and learning practices during this period are likely to reinforce the already large gaps in educational attainment between children from poorer and better-off families. We find considerable heterogeneity in children's learning experiences - amount of time spent learning, activities undertaken during this time and availability of resources to support learning. Concerningly, but perhaps unsurprisingly, this heterogeneity is strongly associated with family income and in some instances more so than before lockdown. Furthermore, our analysis suggests that any impacts of inequalities in time spent learning between poorer and richer children are likely to be compounded by inequalities not only in learning resources available at home, but also in those provided by schools.
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Affiliation(s)
- Alison Andrew
- Institute for Fiscal Studies; University College London
| | | | - Monica Costa Dias
- University of Bristol; Institute for Fiscal Studies; University of Porto
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27
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Andrew A, Cattan S, Costa Dias M, Farquharson C, Kraftman L, Krutikova S, Phimister A, Sevilla A. Inequalities in Children's Experiences of Home Learning during the COVID-19 Lockdown in England. FISCAL STUDIES 2020. [PMID: 33362314 DOI: 10.1920/bn.ifs.2020.bn0290] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper combines novel data on the time use, home-learning practices and economic circumstances of families with children during the COVID-19 lockdown with pre-lockdown data from the UK Time Use Survey to characterise the time use of children and how it changed during lockdown, and to gauge the extent to which changes in time use and learning practices during this period are likely to reinforce the already large gaps in educational attainment between children from poorer and better-off families. We find considerable heterogeneity in children's learning experiences - amount of time spent learning, activities undertaken during this time and availability of resources to support learning. Concerningly, but perhaps unsurprisingly, this heterogeneity is strongly associated with family income and in some instances more so than before lockdown. Furthermore, our analysis suggests that any impacts of inequalities in time spent learning between poorer and richer children are likely to be compounded by inequalities not only in learning resources available at home, but also in those provided by schools.
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Affiliation(s)
- Alison Andrew
- Institute for Fiscal Studies; University College London
| | | | - Monica Costa Dias
- University of Bristol; Institute for Fiscal Studies; University of Porto
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28
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Andrew A, Attanasio O, Augsburg B, Day M, Grantham‐McGregor S, Meghir C, Mehrin F, Pahwa S, Rubio‐Codina M. Effects of a scalable home-visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial. J Child Psychol Psychiatry 2020; 61:644-652. [PMID: 31797385 PMCID: PMC7242140 DOI: 10.1111/jcpp.13171] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND An estimated 63.4 million Indian children under 5 years are at risk of poor development. Home visits that use a structured curriculum to help caregivers enhance the quality of the home stimulation environment improve developmental outcomes. However, achieving effectiveness in poor urban contexts through scalable models remains challenging. METHODS Using a cluster randomised controlled trial, we evaluated a psychosocial stimulation intervention, comprising weekly home visits for 18 months, in urban slums of Cuttack, Odisha, India. The intervention is complementary to existing early childhood services in India and was run and managed through a local branch of a national NGO. The study ran from August 2013 to July 2015. We enrolled 421 children aged 10-20 months from 54 slums. Slums were randomised to intervention or control. Primary outcomes were children's cognitive, receptive language, expressive language and fine motor development assessed using the Bayley-III. Prespecified intent-to-treat analysis investigated impacts and heterogeneity by gender. TRIAL REGISTRATIONS ISRCTN89476603, AEARCTR-0000169. RESULTS Endline data for 378 (89.8%) children were analysed. Attrition was balanced between groups. We found improvements of 0.349 of a standard deviation (SD; p = .005, stepdown p = .017) to cognition while impacts on receptive language, expressive language and fine motor development were, respectively, 0.224 SD (p = .099, stepdown p = .184), 0.192 SD (p = .085, stepdown p = .184) and 0.111 (p = .385, stepdown p = .385). A child development factor improved by 0.301 SD (p = .032). Benefits were larger for boys. The quality of the home stimulation environment also improved. CONCLUSIONS This study shows that a potentially scalable home-visiting intervention is effective in poor urban areas.
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Affiliation(s)
- Alison Andrew
- Institute for Fiscal StudiesLondonUK,Department of EconomicsUniversity College LondonLondonUK
| | - Orazio Attanasio
- Institute for Fiscal StudiesLondonUK,Department of EconomicsUniversity College LondonLondonUK
| | | | - Monimalika Day
- Center for Early Childhood Education and DevelopmentAmbedkar UniversityDelhiIndia
| | | | - Costas Meghir
- Institute for Fiscal StudiesLondonUK,Department of EconomicsYale UniversityNew HavenCTUSA
| | - Fardina Mehrin
- International Centre for Diarrhoeal Disease ResearchDhakaBangladesh
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Effects of nutritional supplementation and home visiting on growth and development in young children in Madagascar: a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2020; 7:e1257-e1268. [PMID: 31402006 DOI: 10.1016/s2214-109x(19)30317-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/21/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence from efficacy trials suggests that lipid-based nutrient supplementation (LNS) and home visits can be effective approaches to preventing chronic malnutrition and promoting child development in low-income settings. We tested the integration of these approaches within an existing, large-scale, community-based nutrition programme in Madagascar. METHODS We randomly allocated 125 programme sites to five intervention groups: standard-of-care programme with monthly growth monitoring and nutrition education (T0); T0 plus home visits for intensive nutrition counselling through an added community worker (T1); T1 plus LNS for children aged 6-18 months (T2); T2 plus LNS for pregnant or lactating women (T3); or T1 plus fortnightly home visits to promote and encourage early stimulation (T4). Pregnant women (second or third trimester) and infants younger than 12 months were enrolled in the trial. Primary outcomes were child growth (length-for-age and weight-for-length Z scores) and development at age 18-30 months. Analyses were by intention to treat. The trial was registered with the ISRCTN registry, number ISRCTN14393738. FINDINGS The study enrolled 3738 mothers: 1248 pregnant women (250 women in each of the T0, T1, T2, and T4 intervention groups and 248 in the T3 intervention group) and 2490 children aged 0-11 months (497 children in T0, 500 in T1, 494 in T2, 499 in T3, and 500 in T4) at baseline who were assessed at 1-year and 2-year intervals. There were no main effects of any of the intervention groups on any measure of anthropometry or any of the child development outcomes in the full sample. However, compared with children in the T0 intervention group, the youngest children (<6 months at baseline) in the T2 and T3 intervention groups who were fully exposed to the child LNS dose had higher length-for-age Z scores (a significant effect of 0·210 SD [95% CI -0·004 to 0·424] for T2 and a borderline effect of 0·216 SD [0·043 to 0·389] for T3) and lower stunting prevalence (-9·0% [95% CI -16·7 to -1·2] for T2 and -8·2% [-15·6 to -0·7] for T3); supplementing mothers conferred no additional benefit. INTERPRETATION LNS for children for a duration of 12 months only benefited growth when it began at an early age, suggesting the need to supplement infants at age 6 months in a very low-income context. The lack of effect of the early stimulation messages and home visits might be due to little take-up of behaviour-change messages and delivery challenges facing community health workers. FUNDING Eunice Kennedy Shriver National Institutes of Child Health and Human Development, Strategic Impact Evaluation Fund, World Bank Innovation Grant, Early Learning Partnership Grant, World Bank Research Budget, Japan Nutrition Trust Fund, Power of Nutrition, and the National Nutrition Office of Madagascar.
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30
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Kohli-Lynch M, Ponce Hardy V, Bernal Salazar R, Bhopal SS, Brentani A, Cavallera V, Goh E, Hamadani JD, Hughes R, Manji K, Milner KM, Radner J, Sharma S, Silver KL, Lawn JE, Tann CJ. Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation. BMJ Open 2020; 10:e032134. [PMID: 32341042 PMCID: PMC7204990 DOI: 10.1136/bmjopen-2019-032134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. SETTING We evaluated 32 RCEL projects across 17 LMICs on four continents. PARTICIPANTS Overall, 2165 workers delivered ECD interventions to 25 909 families. INTERVENTION Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. PRIMARY AND SECONDARY OUTCOMES We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. RESULTS Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. CONCLUSIONS This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.
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Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Raquel Bernal Salazar
- Economics Department, Universidad de Los Andes, Bogota, Colombia
- Centro de Estudios de Desarrollo Economico (CEDE), Universidad de Los Andes, Bogota, Colombia
| | - Sunil S Bhopal
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle upon Tyne, UK
| | - Alexandra Brentani
- Departamento do Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard Van Leer Foundation, The Hague, Netherlands
| | - Jena D Hamadani
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Rob Hughes
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, United Kingdom
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Social Aspects of Health across the Life Course, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Weber AM, Rubio-Codina M, Walker SP, van Buuren S, Eekhout I, Grantham-McGregor SM, Araujo MC, Chang SM, Fernald LCH, Hamadani JD, Hanlon C, Karam SM, Lozoff B, Ratsifandrihamanana L, Richter L, Black MM. The D-score: a metric for interpreting the early development of infants and toddlers across global settings. BMJ Glob Health 2019; 4:e001724. [PMID: 31803508 PMCID: PMC6882553 DOI: 10.1136/bmjgh-2019-001724] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Early childhood development can be described by an underlying latent construct. Global comparisons of children's development are hindered by the lack of a validated metric that is comparable across cultures and contexts, especially for children under age 3 years. We constructed and validated a new metric, the Developmental Score (D-score), using existing data from 16 longitudinal studies. METHODS Studies had item-level developmental assessment data for children 0-48 months and longitudinal outcomes at ages >4-18 years, including measures of IQ and receptive vocabulary. Existing data from 11 low-income, middle-income and high-income countries were merged for >36 000 children. Item mapping produced 95 'equate groups' of same-skill items across 12 different assessment instruments. A statistical model was built using the Rasch model with item difficulties constrained to be equal in a subset of equate groups, linking instruments to a common scale, the D-score, a continuous metric with interval-scale properties. D-score-for-age z-scores (DAZ) were evaluated for discriminant, concurrent and predictive validity to outcomes in middle childhood to adolescence. RESULTS Concurrent validity of DAZ with original instruments was strong (average r=0.71), with few exceptions. In approximately 70% of data rounds collected across studies, DAZ discriminated between children above/below cut-points for low birth weight (<2500 g) and stunting (-2 SD below median height-for-age). DAZ increased significantly with maternal education in 55% of data rounds. Predictive correlations of DAZ with outcomes obtained 2-16 years later were generally between 0.20 and 0.40. Correlations equalled or exceeded those obtained with original instruments despite using an average of 55% fewer items to estimate the D-score. CONCLUSION The D-score metric enables quantitative comparisons of early childhood development across ages and sets the stage for creating simple, low-cost, global-use instruments to facilitate valid cross-national comparisons of early childhood development.
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Affiliation(s)
- Ann M Weber
- School of Community Health Sciences, University of Nevada Reno, Reno, Nevada, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
- Methodology & Statistics, Utrecht University, Utrecht, Netherlands
| | - Iris Eekhout
- Netherlands Organization for Applied Scientific Research TNO, Leiden, Netherlands
| | | | | | - Susan M Chang
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Lia CH Fernald
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | | | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Simone M Karam
- Department of Pediatrics, Federal University of Rio Grande, Rio Grande, Brazil
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Linda Richter
- Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- International Education, RTI International, Research Triangle Park, North Carolina, USA
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32
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Black MM, Yimgang DP, Hurley KM, Harding KB, Fernandez-Rao S, Balakrishna N, Radhakrishna KV, Reinhart GA, Nair KM. Mechanisms linking height to early child development among infants and preschoolers in rural India. Dev Sci 2019; 22:e12806. [PMID: 30715779 PMCID: PMC7428854 DOI: 10.1111/desc.12806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 01/16/2023]
Abstract
Stunting has been negatively associated with children's development. We examined the range of height by testing hypotheses: (a) height is positively associated with children's development, with associations moderated by inflammation and (b) home environments characterized by nurturance and early learning opportunities is positively associated with children's development over time and attenuate associations with height. Data included 513 infants (mean age 8.6 months) and 316 preschoolers (mean age 36.6 months) in rural India from a randomized controlled trial of multiple micronutrient powders (MNPs). Measures included height (height-for-age z-scores based on WHO standards), inflammation (C-reactive protein concentration >5 mg/L), nurturance (HOME Inventory), child development (Mullens Scales of Early Learning), and inhibitory control (preschoolers). Linear mixed effects models accounting for repeated measures, clustering, and confounders were used to assess associations between height and child development over time (infants: enrollment, 6 and 12 months; preschoolers: enrollment and 8 months). Moderating effects of inflammation and nurturance were tested with interaction terms. Among infants and preschoolers, height and nurturance were positively associated with all domains of child development over time, with the exception of inhibitory control. Among preschoolers, in the presence of inflammation, height was not associated with child development. Among infants, but not preschoolers, a nurturant home environment attenuated significant associations between height with fine motor and receptive language development. The mechanisms associated with children's development over time are multifactorial and include direct and indirect associations among nutrition, health, and the home environment, as supported by the Nurturing Care Framework.
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Affiliation(s)
- Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
- RTI International, Research Triangle Park, NC
| | - Doris P Yimgang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Kristen M Hurley
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Laajaj R, Macours K, Pinzon Hernandez DA, Arias O, Gosling SD, Potter J, Rubio-Codina M, Vakis R. Challenges to capture the big five personality traits in non-WEIRD populations. SCIENCE ADVANCES 2019; 5:eaaw5226. [PMID: 31309152 PMCID: PMC6620089 DOI: 10.1126/sciadv.aaw5226] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/05/2019] [Indexed: 05/30/2023]
Abstract
Can personality traits be measured and interpreted reliably across the world? While the use of Big Five personality measures is increasingly common across social sciences, their validity outside of western, educated, industrialized, rich, and democratic (WEIRD) populations is unclear. Adopting a comprehensive psychometric approach to analyze 29 face-to-face surveys from 94,751 respondents in 23 low- and middle-income countries, we show that commonly used personality questions generally fail to measure the intended personality traits and show low validity. These findings contrast with the much higher validity of these measures attained in internet surveys of 198,356 self-selected respondents from the same countries. We discuss how systematic response patterns, enumerator interactions, and low education levels can collectively distort personality measures when assessed in large-scale surveys. Our results highlight the risk of misinterpreting Big Five survey data and provide a warning against naïve interpretations of personality traits without evidence of their validity.
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Affiliation(s)
| | - Karen Macours
- Paris School of Economics, Paris, France
- INRA, Paris, France
| | | | | | - Samuel D. Gosling
- University of Texas at Austin, Austin, TX, USA
- University of Melbourne, Parkville, Victoria, Australia
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Luoto JE, Lopez Garcia I, Aboud FE, Fernald LCH, Singla DR. Testing means to scale early childhood development interventions in rural Kenya: the Msingi Bora cluster randomized controlled trial study design and protocol. BMC Public Health 2019; 19:259. [PMID: 30832624 PMCID: PMC6399811 DOI: 10.1186/s12889-019-6584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Forty-three percent of children under five in low and middle-income countries (LMICs) experience compromised cognitive and psychosocial development. Early childhood development (ECD) interventions that promote parent-child psychosocial stimulation and nutrition activities can help remediate early disadvantages in child development and health outcomes, but are difficult to scale. Key questions are: 1) how to maximize the reach and cost-effectiveness of ECD interventions; 2) what pathways connect interventions to parental behavioral changes and child outcomes; and 3) how to sustain impacts long-term. METHODS Msingi Bora ("good foundation" in Swahili) is a multi-arm cluster randomized controlled trial across 60 villages and 1200 households in rural Western Kenya that tests different, potentially cost-effective and scalable models to deliver an ECD intervention in biweekly sessions lasting 7 months. The curriculum integrates child psychosocial stimulation with hygiene and nutrition education. The multi-arm study will test the cost-effectiveness of two models of delivery: a group-based model versus a mixed model combining group sessions with personalized home visits. Households in a third study arm will serve as a control group. Each arm will have 20 villages and 400 households with a child aged 6-24 months at baseline. Primary outcomes are child cognitive and socioemotional development and home stimulation practices. In a 2 × 2 design among the 40 treatment villages, we will also test the role of including fathers in the intervention. We will estimate intention-to-treat and local average treatment effects, and examine mediating pathways using Mediation Analysis. One treatment arm will receive quarterly booster visits for 6 months following the end of the sessions. A follow-up survey 2 years after the end of the main intervention period will examine sustainability of outcomes and any spillover impacts onto younger siblings. Study protocols have been approved by the Maseno Ethics Review Committee (MUERC) in Kenya (00539/18) and by RAND's institutional review board. This study is funded by the National Institute for Child Health and Human Development (R01HD090045). DISCUSSION Results can provide policymakers with rigorous evidence of how best to design ECD interventions in low-resource rural settings. TRIAL REGISTRATION Clinical Trial NCT03548558 registered June 7, 2018 at clinicaltrials.gov; AEA-RCT registry AEARCTR-0002913.
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Affiliation(s)
| | | | | | | | - Daisy R. Singla
- Department of Psychiatry, Sinai Health System and University of Toronto, Toronto, Canada
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Abstract
In a Perspective, Mark Tomlinson discusses research on early interventions to support child development in developing countries.
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Affiliation(s)
- Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
- Centre of Excellence in Human Development, University Witwatersrand, Johannesburg, South Africa
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