Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial.

Peter C Rockers,Davidson H Hamer,Bowen Banda,Günther Fink,Mwaba Moono Chipili,Robert C Hughes,Arianna Zanolini,James K Tumwine

doi:10.1371/journal.pmed.1002555

Abstract

BackgroundEarly childhood interventions have potential to offset the negative impact of early adversity. We evaluated the impact of a community-based parenting group intervention on child development in Zambia.Methods and findingsWe conducted a non-masked cluster-randomized controlled trial in Southern Province, Zambia. Thirty clusters of villages were matched based on population density and distance from the nearest health center, and randomly assigned to intervention (15 clusters, 268 caregiver–child dyads) or control (15 clusters, 258 caregiver–child dyads). Caregivers were eligible if they had a child 6 to 12 months old at baseline. In intervention clusters, caregivers were visited twice per month during the first year of the study by child development agents (CDAs) and were invited to attend fortnightly parenting group meetings. Parenting groups selected “head mothers” from their communities who were trained by CDAs to facilitate meetings and deliver a diverse parenting curriculum. The parenting group intervention, originally designed to run for 1 year, was extended, and households were visited for a follow-up assessment at the end of year 2. The control group did not receive any intervention. Intention-to-treat analysis was performed for primary outcomes measured at the year 2 follow-up: stunting and 5 domains of neurocognitive development measured using the Bayley Scales of Infant and Toddler Development–Third Edition (BSID-III). In order to show Cohen’s d estimates, BSID-III composite scores were converted to z-scores by standardizing within the study population. In all, 195/268 children (73%) in the intervention group and 182/258 children (71%) in the control group were assessed at endline after 2 years. The intervention significantly reduced stunting (56/195 versus 72/182; adjusted odds ratio 0.45, 95% CI 0.22 to 0.92; p = 0.028) and had a significant positive impact on language (β 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (β 0.11, 95% CI −0.06 to 0.29; p = 0.196), motor skills (β −0.01, 95% CI −0.25 to 0.24; p = 0.964), adaptive behavior (β 0.21, 95% CI −0.03 to 0.44; p = 0.088), or social-emotional development (β 0.20, 95% CI −0.04 to 0.44; p = 0.098). Observed impacts may have been due in part to home visits by CDAs during the first year of the intervention.ConclusionsThe results of this trial suggest that parenting groups hold promise for improving child development, particularly physical growth, in low-resource settings like Zambia.Trial registrationClinicalTrials.gov NCT02234726

Highlights

Observed impacts may have been due in part to home visits by child development agent (CDA) during the first year of the intervention. The results of this trial suggest that parenting groups hold promise for improving child development, physical growth, in low-resource settings like Zambia
Children in low- and middle-income countries continue to be exposed to a large number of risk factors affecting healthy development, ranging from exposure to malnutrition and infectious diseases to lack of appropriate stimulation and learning opportunities in their home environment and community [1,2]
32% of Zambian children receive any form of early childhood care and education by age 6 years [5]

Summary

Introduction

Children in low- and middle-income countries continue to be exposed to a large number of risk factors affecting healthy development, ranging from exposure to malnutrition and infectious diseases to lack of appropriate stimulation and learning opportunities in their home environment and community [1,2]. In several settings, coaching caregivers on appropriate play-based activities and providing nutrition counseling have been shown to improve physical growth and neurocognitive development [9,10,11]. Community-based parenting groups have shown promising results in a few settings, and may be an effective and low-cost platform for delivering interventions to improve child health and development [12,13,14,15,16,17]. A set of recent studies in Uganda have provided evidence of the positive potential of community-based parenting interventions for improving child development in sub-Saharan Africa [18,19,20]. We evaluated the impact of a community-based parenting group intervention on child development in Zambia

Methods

Results

Conclusion