Community-based Childcare Centers Research Articles

Impact evaluation of a maternal and child cash transfer intervention, integrated with nutrition, early childhood development, and agriculture messaging (MAZIKO-IE): a study protocol for a cluster-randomised controlled trial

BackgroundChildren in Malawi face high rates of malnutrition and are at risk of not reaching their developmental potential. Community-based childcare centres (CBCCs) can be cost-effective platforms for scaling-up early childhood development (ECD) and nutrition social behaviour change (SBC) interventions. However, evidence also suggests potential synergies from coupling nutrition SBC with cash transfers (CT), given that rural households in Malawi face high levels of poverty and recurring extreme lean season food-security shocks. The Maziko trial is aimed at evaluating the effectiveness and cost-effectiveness of using CBCCs and parenting care groups as platforms to improve maternal diets and child nutrition and development by providing nutrition-sensitive SBC and CT intervention packages in communities already receiving a standard of care Government SBC program.MethodsWe designed a 3-year cluster-randomised controlled trial in two districts of Malawi, including 156 communities randomised to one of four treatment arms: (1) standard of care (SoC) arm: receiving the standard Government SBC program; (2) SBC arm: receiving the SoC intervention with additional nutrition-sensitive SBC activities to improve nutritious food production, diets, and care practices for young children; (3) low CT arm: SoC plus SBC plus a maternal and child cash transfer ~ 17 USD per month; and (4) high CT arm: SoC plus SBC plus a maternal and child CT ~ 43 USD per month. The trial will enrol pregnant women and children < 2 years of age. The primary outcomes are maternal diet assessed using the mean probability of adequacy and child development assessed using the Malawi Developmental Assessment Tool. Intermediate outcomes along the programme impact pathways will also be measured, including maternal mental health, maternal empowerment, child feeding practices, and child nutritional status.DiscussionThis is the first study to examine the impact and synergies of combining ECD SBC with nutrition-sensitive SBC and CTs on maternal and child outcomes during the first 1000 days. The findings from this evaluation will inform national ECD and nutrition programmes.Trial registrationISRCTN ISRCTN53055824. Registered on 7 March 2022.

Examining the child observation in preschool and teacher observation in preschool in community-based child care centers

Previous research indicates that the Child Observation in Preschool (COP) and Teacher Observation in Preschool (TOP), a companion set of observational tools used to assess the quality of preschool classrooms, capture important aspects of the preschool environment that are associated with children's growth (Farran et al., 2017; Nesbitt et al., 2015; Spivak & Farran, 2016). This study is the first to assess the convergent and predictive validity of these tools in community-based child care centers and compare the tools to the Classroom Assessment Scoring System Pre-K (CLASS Pre-K), a widely used classroom observation tool. We collected COP-TOP and CLASS Pre-K data in 138 classrooms in Georgia as part of a validation study of Georgia's Quality Rated and Improvement System. We also collected child assessment data from 583 preschool-aged children in those same classrooms. Over half of the COP-TOP classroom processes were moderately correlated with at least one of the three CLASS Pre-K domains. COP-TOP classroom processes related to time spent in transition, time spent engaging in sequential activities, involvement in learning activities, and opportunities for math learning were associated with children's math skills, preliteracy skills, and socioemotional development at the end of the year, after controlling for their scores at the start of the year and demographic characteristics. All three CLASS Pre-K domains were significantly associated with children's socioemotional development. We discuss the implications of these results for assessing quality in early care and education programs.

Predicting school readiness program implementation in community-based childcare centers.

Targeted curricular interventions can increase preschool program quality and boost children's academic and social-emotional readiness skills, but variable funding and weak organizational infrastructure in many community-based childcare centers may reduce the effective implementation of these programs. This study examined individual teacher and workplace predictors of the REDI program implementation, a targeted school readiness program that was adapted to support delivery in childcare centers. REDI was delivered by 63 teachers in 37 community-based childcare centers with center directors serving as local implementation coaches. Results showed that individual teacher factors (e.g., teaching skills and receptivity to intervention consultation) predicted the quality with which REDI activities and teaching strategies were delivered, and workplace factors were important predictors across multiple implementation indicators. Practice and policy implications for improving intervention implementation and corresponding program quality in childcare centers are highlighted.

Caregivers' Preferences of COVID-19 Vaccination for Children: A Cross-sectional Study From Rural South India.

Objective:This study aimed to document caregivers’ perceptions and preferences regarding coronavirus disease-19 (COVID-19) vaccination among children.Methods:This cross-sectional study analyzed 272 caregivers with 347 children (aged 1-18 years) attending a subdistrict rural hospital in February-March 2022.Results:Vaccine acceptance was high (93.4%). Although fear of side effects was the most common reason not to vaccinate, a higher proportion of caregivers willing to vaccinate children had consulted healthcare personnel to clarify queries related to side effects. Familiar vaccination sites, where children had previously received routine immunization (RI), such as government hospitals, and Anganwadis (community-based childcare centers) where vaccines were available free of cost on all working days, were the most preferred for COVID-19 vaccination, followed by schools. Only 5.5% of the caregivers preferred private hospitals. Vaccination at home was desired for chronically ill and out-of-school children. RI as per age was associated with the willingness to vaccinate. In addition to protection from COVID-19, other benefits identified by willing parents were being able to attend schools, recreation, and travel.Conclusions:Out-of-school children, children left or missed out in RI, and children with chronic illness can be at risk of being left out for COVID-19 vaccination and can be included by expanding vaccination services house-to-house as in adults. Media engagement and communication must be interactive to address issues, such as fear of side effects, and promote additional benefits of vaccination.

Implementing a School Readiness Intervention in Community-Based Childcare Centers: Director and Teacher Perceptions

ABSTRACT In the U.S., one-third of preschool children attend programs run by childcare centers. Childcare centers are generally isolated and under-resourced businesses, often challenged by high rates of teacher turnover and inconsistent financial support. Correspondingly, childcare centers often struggle to provide high-quality educational experiences for preschool children. This study introduced an evidence-based curriculum (REDI) to improve the educational experiences of preschool children in childcare centers and used a novel professional development (PD) model in which center directors were trained to serve as local coaches. Open-ended interviews with 45 teachers and 31 center directors evaluated the acceptability, feasibility, and effectiveness of the REDI intervention and coaching model. Participants also described their workplace and rated their intentions regarding future program use. Participants described multiple challenges in the workplace but generally positive perceptions of the REDI intervention. Perceptions regarding the feasibility of the coaching model were mixed. Workplace descriptions were associated with intervention experiences which, in turn, predicted intentions for future program use. Findings validate the importance of addressing the unique workplace challenges faced by childcare staff when designing classroom interventions and PD supports. Attending to program acceptability, feasibility, and perceived effectiveness in these settings may be critical to support sustained use.

A Community-Based Early Childhood Development Center Platform Promoting Diversified Diets and Food Production Increases the Mean Probability of Adequacy of Intake of Preschoolers in Malawi: A Cluster Randomized Trial

Young children in Malawi consume low-quality diets lacking micronutrients critical for their development. To evaluate the impact of an agriculture and nutrition behavior change communication (BCC) intervention implemented through community-based childcare centers on the nutrient adequacy of diets of children living in food-insecure settings in Malawi. A cluster randomized trial was undertaken in 60 community-based childcare centers, including 1248 children aged 3-6 y. Nutrient intakes were estimated using interactive, multipass 24-h recall. Dietary adequacy was estimated through the probability of adequacy (PA) and mean probability of adequacy (MPA) of 11 micronutrients. Impacts were assessed by difference-in-difference (DID) estimates, adjusted for geographic clustering and child age and sex. Intervention groups were similar for most baseline characteristics. Loss to follow-up was low (7% over a 12-mo period) and participation in the intervention was high (>90% enrollment and 80% attendance during the 5 d before the survey). Positive impacts were found for the PA of several individual micronutrient intakes: vitamin A [DID: 9 percentage points (pp), SE 3 pp], vitamin C (14 pp, SE 3 pp), riboflavin (11 pp, SE 3 pp), zinc (8 pp, SE 3 pp), and for the MPA for the 11 nutrients considered (5 pp, SE 1 pp). These impacts were driven by effects on younger children (aged 3-4 y). Using a preschool platform to implement a nutrition-sensitive BCC intervention is an effective strategy to improve the adequacy of micronutrient intake of preschool children in food-insecure settings. The trial was registered at ISCRCTN as ISCRCTN96497560.

Using a Community-Based Early Childhood Development Center as a Platform to Promote Production and Consumption Diversity Increases Children's Dietary Intake and Reduces Stunting in Malawi: A Cluster-Randomized Trial

ABSTRACTBackgroundChildren in Malawi face nutritional risks related to low-quality diets and chronic malnutrition.ObjectiveThis study evaluated the impact of a 1-y early childhood development (ECD) center–based agriculture and nutrition intervention aimed at improving household production diversity, maternal knowledge on child nutrition and feeding practices, and children's diets and anthropometric measures.MethodsA longitudinal cluster-randomized controlled trial was implemented in 60 community-based childcare centers (CBCCs), covering 1248 preschool children (aged 36–72 mo) and 304 younger siblings (aged 6–24 mo). CBCCs were randomly assigned to 1) a control group providing the Save the Children's ECD program or 2) a treatment group providing a standard ECD program with additional activities to improve nutritious food production and behavior change communication to improve diets and care practices for young children. Primary outcomes were household production and production diversity, preschooler enrollment and attendance, and dietary intake measured by quantitative 24-h recall and minimum diet diversity for younger siblings. Secondary outcomes included anthropometric measures for preschoolers and younger siblings, child development scores for preschoolers, and women's asset ownership and time use (the latter 2 are not discussed in this article). We used difference-in-difference (DID) estimates to assess impacts.ResultsCompared with the control group, preschool children in the intervention group had greater increases in nutrient intakes and in dietary diversity. No impacts on anthropometric measures were seen in preschoolers. Younger siblings in the intervention group had greater increases in height-for-age z scores than did children in the control group (DID: 0.44; P < 0.05) and greater reductions in the prevalence of stunting (DID: –17 percentage points; P < 0.05). The plausibility of the impact on growth in younger siblings was supported by effects along program impact pathways, including production of nutritious foods, caregiver knowledge, and dietary diversity.ConclusionImplementing an integrated agriculture and nutrition intervention through an ECD platform benefited children's diets and reduced stunting among younger siblings of targeted preschoolers. This trial was registered on the ISRCTN registry as ISCRCTN96497560.

Supporting Children with Disabilities in Low- and Middle- Income Countries: Promoting Inclusive Practice within Community-Based Childcare Centres in Malawi through a Bioecological Systems Perspective

Given the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle-income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer ‘caregiver’ in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.

The Use of Infant Confinement Equipment in Community-Based Child Care Centers: An Analysis of Centers Participating in a Statewide Quality Rating and Improvement System.

Objectives Although infants increasingly spend time in community-based child care centers, little attention has been paid to their physical activity experiences while in group care. In particular, the use of devices to restrict infant mobility, such as bouncy seats, high chairs, cribs, and stationary activity centers, has received little attention in the physical activity literature. The current study examines the presence and use of these confinement devices in infant classrooms. Methods A secondary analysis of observational data in child care centers participating in Delaware's Quality Rating and Improvement System was conducted. Quality assessment observations were coded for the use of confinement devices and the actual amount of time the confinement device was employed per child. The sample consisted of 38 infant classrooms serving a total of 162 infants in the statewide system. Results Findings suggest a high level of utilization of confinement devices in infant child care classrooms with each classroom averaging three pieces of equipment used during the observations and 22% of observed children being confined 30min or longer during the observation period. Conclusions for Practice The reliance on confinement devices in group child care is a potential concern in the quest to prevent childhood obesity by ensuring adequate physical activity and mobility for infants in group care settings. More research is needed to understand the implications of the use of confinement devices on physical activity in group care settings.

Classroom quality and children’s academic skills in child care centers: Understanding the role of teacher qualifications

This study examines the associations of teachers’ levels of education and professional training with observed classroom quality and children’s school readiness in community-based child care centers. Prior research provides mixed evidence about whether teachers’ education predicts early childhood education (ECE) classroom quality and children’s outcomes. Data are drawn from a Midwestern study of community child care centers (typically private pay non-profit or for-profit child care centers that are not directly funded by government programs) and the children ages 3–5 in their care (N=189 centers and 661 children). This study takes advantage of a very detailed set of teacher training measures that includes information on education degrees, ECE credit-based training, and placement on the state’s 17-level professional career ladder (the Registry). Using these measures, the current study is able to examine whether variations in degrees and ECE credit-based training for teachers predict observed classroom quality and children’s school readiness skills. Analyses control for a rich set of variables, including children’s demographic information and fall assessment scores, teachers’ work-related characteristics (e.g., motivation for ECE work), and classrooms and programs’ features. Results from regression models suggest few associations between teachers’ education level, ECE credits, or level on the professional career ladder and observed classroom quality. The key exception is that teachers who do not have any postsecondary education and training in ECE are in classrooms of significantly lower quality compared with teachers who have a college degree. Results from hierarchical linear models indicate that teachers’ education does not predict children’s early academic skills.

Improving child nutrition and development through community-based childcare centres in Malawi \u2013 The NEEP-IE study: study protocol for a randomised controlled trial

BackgroundThe Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial.MethodsSixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children’s Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children’s ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders.DiscussionAssessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.Trial registrationISRCTN registry, ID: ISRCTN96497560. Registered on 21 September 2016.

Early childhood development: the role of community based childcare centres in Malawi.

BackgroundSomatic changes including growth and development of the brain of a human being occur very early in life. Programmes that enhance early childhood development (ECD) therefore should be part of the national agenda. Cognizant of this fact, the Malawi Government together with development partners facilitated the establishment of community-based child care centres (CBCCs) which are owned and managed by community members. This study was aimed at understanding how CBCCs operated and their core functions.MethodsUsing information from databases kept by the District Social Welfare Officers from all the 28 districts in Malawi, coupled with snowballing, all functioning CBCCs were enumerated. A questionnaire was administered to the head of the CBCC or a care giver. Highly trained Research Assistants also carried our observations of the structures around the centres and the activities that actually happened. Data was analysed using a Statistical Package for Social Sciences.ResultsCommunities provide structures, support for care givers, food, utensils, labour and play materials for the children in CBCCs. The first ECD centre was established in 1966 but the real surge in establishing these happened towards the end of the 1990s and by 2007 there were 5,665 CBCCs in Malawi caring for 407,468 children aged between 3 and 5 years. CBCCs were established to provide pre-primary school learning, and in some cases provide special care to orphans and other vulnerable.ConclusionsDespite the fact that most CBCC premises and structures fell short of the standards laid down by the CBCC profile, the activities and services provided were mostly to the book. Children were provided with nutritious foods and subjected to play that stimulated their cognitive and mental development. Despite the fact that some members of the community do not realize the value of the CBCCs, the existence of these institutions is an opportunity for the community to take care of their children communally, a task that has become imperative as a result of the upsurge in the number of orphans as a result of the HIV and AIDS epidemic. The study recommends that Malawi should take investments in ECD programmes as a priority.

From Early Childhood Development Policy to Sustainability: The Fragility of Community-Based Childcare Services in Malawi

Over the past 20 years, more than 6,000 community-based childcare centers (CBCCs) have been created in mostly rural areas of Malawi. Although the original purpose of these CBCCs was to meet the care needs of orphans and vulnerable children affected by the HIV/AIDS pandemic, the services have since expanded their mandate to provide early development and learning opportunities as well as part-time childcare for working parents. The Malawi national policy is to expand this network of CBCCs to improve early childhood development outcomes, however, sustainability of these services has been an ongoing challenge. This article discusses the roots and extent of this sustainability challenge, drawing on lessons learned from recent fieldwork conducted as part of a baseline study.

Accounting for movement between childcare classrooms: Does it change teacher effects interpretations?

Child care studies that have examined links between teachers' qualifications and children's outcomes often ignore teachers' and children's transitions between classrooms at a center throughout the day and only take into account head teacher qualifications. The objective of this investigation was to examine these traditional assumptions and to compare inferences made from these traditional models to methods accounting for transitions between classrooms and multiple teachers in a classroom. The study examined the receptive language, letter–word identification, and passage comprehension skills of 307 children enrolled in 49 community-based child care centers serving primarily low-income families in Colorado. Results suggest that nearly one-third of children and over 80% of teachers moved daily between classrooms. Findings also reveal that failure to account for daily transitions between classrooms can affect interpretations of the relationship between teacher qualifications and child outcomes, with the model accounting for movement providing significant improvements in model fit and inference.

Professional Development Opportunities for Early Childhood Educators in Community-Based Child Care Centers

In this study, the staff development opportunities among early childhood educators in community-based, nonprofit child care centers were investigated. The trends for professional development and implications for future staff development were determined from data gathered from surveys completed by 12 lead teachers, 5 paraprofessionals, and 5 administrators from 5 community-based child care centers in New Jersey. The results indicated that the teachers preferred enhanced or advanced professional development on subjects in which they already possessed an adequate level of knowledge and experience. In addition, teachers and administrators stated they preferred workshops as the professional development format. The findings were consistent with typical formal professional development, but contrary to the research that promotes effective learning and efficient staff professional development.

Quality of Early Childhood Programs in Inclusive and Noninclusive Settings

This study assessed factors that contributed to global program quality in early childhood settings. The sample consisted of 180 community-based child care centers from 12 geographically and economically diverse regions in North Carolina. The Early Childhood Environment Rating Scale (ECERS) total mean score was used as the primary measure of global program quality. The study found that 62 (34%) of the early childhood programs reported enrolling at least one child with disabilities. The study also found that inclusive early childhood programs scored significantly higher on the ECERS overall than did noninclusive programs. Results of an Analysis of Covariance (ANCOVA) indicated three other predictors of global program quality: teacher education, professional experience, and teacher self-ratings of knowledge and skill.