Promoting Family Integrated Early Childhood Development During the First 1000 Days in Urban Slums of Delhi: Feasibility and Early Implementation Experience

The first 1000 days are critical for human development. Children residing in urban slums are at higher risk of suboptimal development. This article reports the feasibility and early implementation experiences of child stimulation directed counselling integrated with nutrition and health services by community functionaries in Delhi slums. This implementation research with cohort study design has two groups. The intervention group includes: pregnant women; infants and children in second year. The comparison group (without intervention) includes: recently delivered women, children aged 13-25 months. The feedback from the community functionaries and parents of children were also obtained. 44 videos with Hindi voiceover, demonstration of tools/toys/props, and 9 calendars depicting age-appropriate child stimulation activities were prepared and packaged with health and nutrition services for delivery by the frontline functionaries. These functionaries are coaching the families on child stimulation using these audio-visual messages using Tablets and demonstration tools/toys/props twice every three months. Monitoring and feedback data on service delivery are being collected. The data from the intervention cohort shall be compared with that from the comparison group to document the impact. From 63 anganwadi centres, 130 pregnant women, 142 infants and 136 children have been recruited for the intervention. 82.9% of the families received the intervention within 2 weeks and average time taken was 15 minutes. The initial feedback from the community functionaries and parents are very encouraging. The integrated child development package is acceptable and feasible for implementation through community functionaries and possible integration into the existing programs at scale.

Promoting family integrated early child development (during first 1000 days) in urban slums of India (fine child 3-3-1000): Study protocol

AIMS

This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000 days for families in Delhi urban slums.

BACKGROUND

The first 1,000 days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development.

DESIGN

This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development.

METHODS

This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13 months and 25 months without intervention to document the impact.

DISCUSSION

The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries.

IMPACT

The first 1,000 days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000 days in three sums of Delhi, India.