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.
Highlights
In low- and middle-income countries (LMICs), over 250 million children under age five are not achieving their developmental potential due to adverse living environments, such as chronic poverty, poor nutrition and sanitation, violence, and inadequate learning opportunities [1]
Twenty-one studies were identified from a total of 81,210 records from the database search and previous reviews based on the eligibility criteria
Common reasons for exclusion include the use of a non-RCT design, study conducted outside a low-and-middle-income country context, a single focus on nutrition supplementation or education, the enrollment of predominantly children over 24 months, and the absence of child developmental outcomes
Summary
In low- and middle-income countries (LMICs), over 250 million children under age five are not achieving their developmental potential due to adverse living environments, such as chronic poverty, poor nutrition and sanitation, violence, and inadequate learning opportunities [1]. There has been a push for the improved focus and need for investment in the first 1,000 days of life (which equates to the period from pregnancy to 2 years) [8] During this period, children are highly susceptible to environmental influences such as responsive parenting and cognitive stimulation. Exposure to risk factors during this time can pose long-term and sometimes difficultto-reverse detrimental impacts on children’s developmental, educational, and health outcomes and productivity, incurring costs to society [9]. This can be a window for children to benefit from a nurturing caregiving home environment and thrive despite the adverse larger social environment [10]. 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
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
