Abstract
Supporting caregivers’ mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar–April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children <24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of “unhealthy thoughts” in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting.
Highlights
Around 250 million children under five years of age are at risk of not meeting their optimal developmental potential [1]
Maternal mental health including depressive disorder during pregnancy is associated with the structural changes in the prefrontal cortex as well as the frontal and inferior temporal regions of children’s brains [8,9], and related to poor child development outcomes in low- and middle- income countries worldwide [7]
The present study constitutes a systematic attempt to develop and implement an early child development intervention that includes an emphasis on pregnancy preparedness including regarding early interaction, basic nutritional information, and maternal mental wellbeing
Summary
Around 250 million children under five years of age are at risk of not meeting their optimal developmental potential [1]. Responsive parenting with psychosocial stimulation, and maternal mental health are important influences on early childhood development outcomes [2,4,5]. Poor nutrition and maternal depression affect child development outcomes [6,7]. A meta-analysis showed a significant association between maternal diet during pregnancy and child developmental outcomes, with the strongest impact on socio-emotional and cognitive functioning of children [6]. Maternal mental health including depressive disorder during pregnancy is associated with the structural changes in the prefrontal cortex as well as the frontal and inferior temporal regions of children’s brains [8,9], and related to poor child development outcomes in low- and middle- income countries worldwide [7]
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