Community-based Early Childhood Development Research Articles

Effectiveness and Preferences on Mainstreaming Early Childhood Stimulation Services in Tanzania: A Case Study of Community-based Early Childhood Development Initiative

Early childhood stimulation (ECS) services are globally championed due to their proven ability to help children at risk of developmental delay attain their developmental potential. This study explored the effect of different ways of mainstreaming ECS services on child development. A mixed research approach was employed, involving quantitative and qualitative collection methods. Quantitative data was collected using the adopted ZamCAT tool administered to 334 children sampled from the benefited households. Qualitative data was collected through focus group discussions with the parents (n=4) and in-depth interviews with the key informants (n=14), respectively. The collected quantitative data were coded and analysed using Statistical Package for Social Sciences (25), and the collected qualitative data were analysed through content analysis. The binary logistic regression model was employed where the results showed a significant effect on child development from home visiting (p = 0.01) and Early childhood development centres (p = 0.016) compared to clinic outreaches. Children's nutritional status was also an influencing factor for a child to attain optimal developmental status. Furthermore, both community members and ECS services providers highly preferred ECD centres and home visiting services as opposed to a preference for clinic outreaches. The study concludes that when children are subjected to ECS services, attaining optimal development potential regardless of the household background characteristics is the forecasted result. Therefore, the study underscores the capacitation of communities on ECS practices utilising the available enabling environment and increased budget allocation for developing specific ECD policies and deploying experts.

School Readiness and Community-Based Early Childhood Development (ECD) Centres in Low-Income Communities: Examining The Case of Gugulethu, Western Cape Province, South Africa

A child must be exposed to early learning situations and assisted in developing the skills and ways of functioning to develop, thrive, and be ready for school. It is established that poor school readiness preparation (SRP) negatively impacts subsequent learning outcomes. A qualitative study was conducted in Gugulethu, a poor community in the Western Cape province in South Africa, to determine how Early Childhood Development centres in a poor community prepare children for schooling. The study involved a sample of 12 community-based ECD centres. Interviews and focus group discussions were conducted with direct role-players, including principals, practitioners, and ECD industry key informants. Data was enriched through direct observation of operations at each facility. The study found that all the community-based ECD centres struggle to provide quality SRP. Contributing factors include limited ECD practitioner training, education resources, infrastructure, and facility management. Because these conditions relate to poverty, they affect the SRP of most children in poorer communities, such as Gugulethu, who tend to only have access to under-resourced ECD centres. The study concludes that, given the appalling performance of South Africa’s basic education system, the government has to accept that improving its learning outcomes begins with vastly improving the SRP of children from birth

A community engagement approach for an integrated early childhood development intervention: a case study of an urban informal settlement with Kenyans and embedded refugees

BackgroundCommunity engagement is crucial for the design and implementation of community-based early childhood development (ECD) programmes. This paper aims to share key components and learnings of a community engagement process for an integrated ECD intervention. The lessons shared are drawn from a case study of urban informal settlement with embedded refugees in Nairobi, Kenya.MethodsWe conducted three stakeholder meetings with representatives from the Ministry of Health at County and Sub-County, actors in the ECD sector, and United Nations agency in refugee management, a transect walk across five villages (Ngando, Muslim, Congo, Riruta and Kivumbini); and, six debrief meetings by staff from the implementing organization. The specific steps and key activities undertaken, the challenges faced and benefits accrued from the community engagement process are highlighted drawing from the implementation team’s perspective.ResultsContext relevant, well-planned community engagement approaches can be integrated into the five broad components of stakeholder engagement, formative research, identification of local resources, integration into local lives, and shared control/leadership with the local community. These can yield meaningful stakeholder buy-in, community support and trust, which are crucial for enabling ECD programme sustainability.ConclusionOur experiences underscore that intervention research on ECD programmes in urban informal settlements requires a well-planned and custom-tailored community engagement model that is sensitive to the needs of each sub-group within the community to avoid unintentionally leaving anyone out.

Economic evaluation of an early childhood development center\u2013based agriculture and nutrition intervention in Malawi

Malnutrition is a leading cause of death and disability among children in low-income countries. Nutrition-sensitive interventions show promise in increasing food access and improving diets. There are possible synergies of integrating these programs with other sectors, improving effectiveness by leveraging resources. However, economic evaluations of these multi-sectoral programs are limited. We aimed to estimate the cost efficiency, cost-effectiveness, benefit-cost ratio, and net benefit of using community-based early childhood development (ECD) centers as platforms for an intervention promoting agricultural production and nutrition among households with young children in Malawi. The intervention was costed using bottom-up micro-costing and top-down expenditure analysis with a societal perspective and a 12-month horizon. Effectiveness estimates were derived from a cluster-randomized control trial. Premature deaths and stunting cases averted were estimated using the Lived Saved Tool. We calculated DALYs averted, and the value of three benefits streams resulting from reductions in premature mortality, increases in lifetime productivity and household agricultural productivity. We transferred the US value of a statistical life (VSL) to Malawi using an income elasticity of 1.5, and a 10% discount rate. Probabilistic sensitivity analysis was conducted using a Monte Carlo model. The intervention cost $197,377, reaching 4,806 beneficiaries at $41 per beneficiary, $595 per case of stunting, $18,310 per death, and $516 per DALY averted. Net benefit estimates ranged from $507,589 to $4,678,258, and benefit-cost ratios from 3.57 to 24.70. Sensitivity analyses confirmed a positive return on investment. Implementing agriculture-nutrition interventions through ECD platforms may be an efficient use of resources in Malawi and similar contexts.

Adapt or die in the time of a pandemic: Towards a grounded theory of strategic adjustments by an early childhood development training organisation

The COVID-19 pandemic has led all role players in the Early Childhood Care and Education (ECCE) sector in South Africa, including the particular non-profit organisation (NPO) under investigation, into unchartered territory. The organisation, which is involved in training and mentoring community-based Early Childhood Development centres in marginalised settings, was forced to pivot its service as the country went into lockdown in March 2020. The purpose of this grounded theory study is to discover how employees and associates of this organisation view the adjustments that had to be made during and after lockdown to support principals, staff members and through that the children, their parents and the community during COVID-19 lockdown. Findings indicated that the team was able to rely on existing strengths that intersected on several points to tackle the challenges, namely strong internal and external relationships, sound administrative and business systems and a flexible, risk-taking and social entrepreneurial ethos. This kaleidoscopic combinations of relational, attitudinal and organisational factors, permitted swift adjusting, a strength that may support the sustainability of this NPO and others of its kind, not only during the pandemic but also in its aftermath and with the socio-economic upheaval it has caused particularly among indigent communities.

Correlates of participation in community-based interventions: Evidence from a parenting program in rural China.

A growing body of literature has documented that community-based early childhood development (ECD) interventions can improve child developmental outcomes in vulnerable communities. One critical element of effective community-based programs is consistent program participation. However, little is known about participation in community-based ECD interventions or factors that may affect participation. This paper examines factors linked to program participation within a community-based ECD program serving 819 infants and their caregivers in 50 rural villages in northwestern China. The results find that more than half of families did not regularly attend the ECD program. Both village-level social ties within the program and proximity to the program significantly predict program participation. Increased distance from the program site is linked with decreased individual program participation, while the number of social ties is positively correlated with participation. The average program participation rates among a family's social ties is also positively correlated with individual participation, indicating strong peer effects. Taken together, our findings suggest that attention should be given to promoting social interactions and reducing geographic barriers among households in order to raise participation in community-based ECD programs.

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.

Improving Access and Quality in Early Childhood Development Programs: Experimental Evidence from the Gambia

This paper studies two experiments of early childhood development programs in The Gambia: one increasing access to services, and another improving service quality. In the first experiment, new community-based early childhood development (ECD) centers were introduced to randomly chosen villages that had no pre-existing structured ECD services. In the second experiment, a randomly assigned subset of existing ECD centers received intensive provider training. We find no evidence that either intervention improved average levels of child development. Exploratory analysis suggests that, in fact, the first experiment, which increased access to relatively low quality ECD services, led to declines in child development among children from less disadvantaged households. Evidence supports that these households may have been steered away from better quality early childhood settings in their homes.

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.

Community-based hearing screening for young children using an mHealth service-delivery model

ABSTRACTBackground: Hearing loss is one of the most common developmental disorders identifiable at birth with its prevalence increasing throughout school years. However, early detection programs are mostly unavailable in low- and middle-income countries (LMICs) where more than 80% of children with hearing loss reside.Objective: This study investigated the feasibility of a smartphone-based hearing screening program for preschool children operated by community healthcare workers (CHWs) in community-based early childhood development (ECD) centers.Method: Five CHWs were trained to map ECD centers and conduct smartphone-based hearing screenings within a poor community in South Africa over a 12-month period. The hearScreenTM smartphone application employed automated test protocols operating on low-cost smartphones. A cloud-based data management and referral function allowed for remote monitoring for surveillance and follow up.Results: 6424 children (3–6 years) were screened for hearing loss with an overall referral rate of 24.9%. Only 39.4% of these children attended their follow-up appointment at a local clinic, of whom 40.5% referred on their second screening. Logistic regression analysis indicated that age, gender and environmental noise levels (1 kHz) had a significant effect on referral rates (p < 0.05). The quality index reflecting test operator test quality increased during the first few months of testing.Conclusion: Smartphone-based hearing screening can be used by CHWs to detect unidentified children affected by hearing loss within ECD centers. Active noise monitoring, quality indices of test operators and cloud-based data management and referral features of the hearScreenTM application allows for the asynchronous management of hearing screenings and follow-ups.

Monitoring and evaluation of an early childhood development programme

The article aims to discuss preliminary findings from a participatory monitoring and evaluation (M&amp;E) framework, used in a community-based early childhood development (ECD) programme in KwaZulu-Natal South Africa, and their implications for leadership and management. The purposes of the M&amp;E were for LETCEE, the implementing organization, to enhance its own learning and M&amp;E systems, and to gather data for use by the funding body to advocate for alternative ECD programmes. A participatory M&amp;E framework was used, adopting a case study design, to collect both qualitative and quantitative data from multiple sources. Thematic analysis and statistical analysis were employed for qualitative and quantitative data, respectively. Emerging issues from data analysis included: use of data beyond accountability to funders; new learnings for all those involved with M&amp;E; and informing decision-making and planning. The implications of these findings are discussed for the organization’s leadership and management.

Informal community-based early childhood development as a focus for urban public theology in South Africa

This article highlights important dimensions of public theology and shows how the identified dimensions are relevant to the specific situation of informal early childhood development (ECD) facilities in a South African urban setting. The article considers the contributions and challenges of informal community-based ECD on the basis of research conducted in the Rustenburg/Phokeng area of the North West province of South Africa. It critically discusses the sociocultural discourses and legislation regulating ECD centres, by focusing on the constraints put on informal ECD service providers. It concludes by considering ways in which urban public theology should act to serve, strengthen and advocate this vitally important, yet informal, sector.

Youth Narratives on Community Experiences and Sense of Community and Their Relation to Participation in an Early Childhood Development Program

This comparative study examined how participation in an early childhood development (ECD) program, Better Beginnings, Better Futures, for children (ages 4-8) relates to sense of community (SOC) in later adolescence (ages 18-19). Youths’ stories ( N = 96) about community experiences, collected by semistructured, open-ended interviews, were quantitatively coded for several narrative dimensions (specificity, positivity, prosocial content, and meaning-making) and for elements of SOC (membership, influence, needs fulfillment, and shared emotional connection). Findings show a significant positive relationship between all narrative dimensions and the total SOC score. Better Beginnings youths’ stories ( n = 64) were significantly higher on specificity and shared emotional connection than comparison youth ( n = 32). Findings have implications for community-based ECD programs to impact later adolescence SOC and for using narratives to study these effects.

Exploring Outcomes through Narrative: The Long‐term Impacts of Better Beginnings, Better Futures on the Turning Point Stories of Youth at Ages 18–19

This study examined the long-term effects of the Better Beginnings, Better Futures project, a community-based early childhood development program, on 18-19year-old youths' narratives about turning points in their lives. The sample consisted of youth who participated in Better Beginnings from ages 4-8 (n=62) and youth from a comparison community who did not participate in Better Beginnings (n=34). Controlling for covariates, significant differences favoring youth from the Better Beginnings sites were found on several dimensions of the turning point stories: ending resolution, personal growth, meaning-making, coherence, and affect transformation. Effect sizes ranged from .45 to .76 for these outcome dimensions, indicating moderate to large effects. Also, turning point story dimensions were found to be significantly correlated with two standardized measures of well-being: youths' self-esteem and community involvement. Youths' self-esteem was directly related to story ending resolution, personal growth, and meaning making, and youths' community involvement was directly related to story specificity, meaning making, and coherence. Family functioning was also examined in relation to these narrative dimensions but was not found to be significantly related to them. The findings suggest the utility of a narrative approach for the evaluation of the long-term outcomes of early childhood development programs.

Promoting Program Success and Fulfilling Accountability Requirements in a Statewide Community-Based Initiative

Large community initiatives are a growing phenomenon both in the U.S. and worldwide. These initiatives address a wide variety of issues, including early childhood development, by integrating institutions such as schools, health agencies, and faith-based institutions that focus on separate but related aspects of community concern. A major challenge facing these initiatives is the competing demands of developing organizational capacity to promote effective programming while simultaneously delivering demonstrable results and accountability. Empowerment evaluation (Fetterman, Kaftarian, & Wandersman, 1996) is an approach to evaluation and organizational capacity building that equips participants at all levels of an organization to pursue programming quality and results. This article describes and presents lessons learned from the development and implementation of a system of tools and processes, grounded in the principles of empowerment evaluation, designed to promote quality in the planning, implementation, and evaluation of a statewide school readiness initiative. While these lessons are specifically applicable to community-based early childhood development initiatives, they are broadly applicable to initiatives fostering systems change through community development.