Early Childhood Development Interventions Research Articles

Caregiving experiences and practices: qualitative formative research towards development of integrated early childhood development interventions targeting Kenyans and refugees in Nairobi’s informal settlements

BackgroundEvidence is needed to understand factors that influence child development and caregiving experiences, especially in marginalized contexts, to inform the development and implementation of early childhood development (ECD) interventions. This study explores caregiving practices for young children in an urban informal settlement with Kenyans and embedded refugees, and identifies factors shaping these caregiving experiences, to inform the design and development of potentially appropriate ECD interventions.MethodsA qualitative formative study, which included 14 focus group discussions (n = 125 participants), and 13 key informant interviews was conducted between August and October 2018. Purposive sampling approaches were used to select a diverse range of respondents including caregivers of children below three years of age and stakeholders of Kenyan nationality and refugees. Data were analysed using a thematic approach and the Nurturing Care Framework was used as an interpretative lens.ResultsThere was a fusion of traditional, religious and modern practices in the care for young children, influenced by the caregivers’ culture, and financial disposition. There were mixed views/practices on nutrition for young children. For example, while there was recognition of the value for breastfeeding, working mothers, especially in the informal economy, found it a difficult practice. Stimulation through play was common, especially for older children, but gaps were identified in aspects such as reading, and storytelling in the home environment. Some barriers identified included the limited availability of a caregiver, insecurity, and confined space in the informal settlement, all of which made it difficult for children to engage in play activities. Physical and psychological forms of discipline were commonly mentioned, although few caregivers practiced and recognized the need for using non-violent approaches. Some overarching challenges for caregivers were unemployment or unstable sources of income, and, particularly for refugee caregivers, their legal status.ConclusionThese findings point to the interplay of various factors affecting optimal caregiving for young children in an urban informal settlement with Kenyans and refugees. Integrated ECD interventions are needed for such a mixed population, especially those that strive to anchor along caregivers’ social support system, co-designed together with community stakeholders, that ideally focus on parent skills training promoting nurturing care and economic empowerment.

In-person versus remote (mHealth) delivery for a responsive parenting intervention in rural Kenya: a cluster randomized controlled trial

BackgroundAn estimated 43% of children under age 5 in low- and middle-income countries (LMICs) experience compromised development due to poverty, poor nutrition, and inadequate psychosocial stimulation. Numerous early childhood development (ECD) parenting interventions have been shown to be effective at improving ECD outcomes, at least in the short-term, but they are (a) still too expensive to implement at scale in low-resource and rural settings, and (b) their early impacts tend to fade over time. New approaches to deliver effective ECD parenting interventions that are low-cost, scalable, and sustainable are sorely needed.MethodsOur study will experimentally test a traditional in-person group-based delivery model for an evidence-based ECD parenting intervention against a hybrid-delivery model that increasingly substitutes in-person meetings with remote (mHealth) delivery via smartphones, featuring audiovisual content and WhatsApp social interactions and learning. We will assess the relative effectiveness and cost of this hybrid-delivery model compared to in-person delivery and will extend the interventions over two years to increase their ability to sustain changes in parenting behaviors and ECD outcomes longer-term. Our evaluation design is a cluster Randomized Controlled Trial (cRCT) across 90 villages and approximately 1200 households. Midline and endline surveys collected 12 and 24 months after the start of the interventions, respectively, will examine short- and sustained two-year intention-to-treat impacts on primary outcomes. We will also examine the mediating pathways using mediation analysis. We hypothesize that a hybrid-delivery ECD intervention will be lower in cost, but remote interactions among participants may be an inferior substitute for in-person visits, leaving open the question of the most cost-effective program.DiscussionOur goal is to determine the best model to maximize the intervention’s reach and sustained impacts to improve child outcomes. By integrating delivery into the ongoing operations of local Community Health Promoters (CHPs) within Kenya’s rural health care system, and utilizing new low-cost technology, our project has the potential to make important contributions towards discovering potentially scalable, sustainable solutions for resource-limited settings.Trial RegistrationNCT06140017 (02/08/2024) AEARCTR0012704.

Effect of parenting centers on caregiver mental health ——Evidence from a large scale randomized controlled trial in rural China

In the context of economic development, the escalating prevalence of depression, anxiety and stress poses substantial challenges, not only impacting individuals' physical and mental well-being but also exerting a profound influence on future human capital. This study conducts an exploratory analysis of the effects of a center-based early childhood development intervention on the mental health of the caregivers, utilizing data from a cluster randomized controlled trial involving 1652 caregivers in rural China. Over the course of two years, caregivers and children in 50 villages received individualized parenting training, one-on-one parenting classes, and access to open play spaces in village parenting centers. Our findings reveal sustained and significant intervention effects on caregivers' anxiety and stress symptoms. The primary mechanisms driving these effects include increased parenting time investment, alterations in parenting styles, and changes in the level of trust in others. Furthermore, our research demonstrates that the positive treatment effects on mental health outcomes are more pronounced among caregivers of children who initially lower development skills. The intervention exhibits a stronger impact on caregivers with lower educational attainment, particularly when the caregivers are grandmothers. These results underscore the importance of governmental attention to mental health issues in rural China, suggesting avenues for intervention through the provision of parenting knowledge and spaces facilitating caregiver-child interactions. This research contributes valuable insights into addressing mental health challenges in rural settings, promoting effective strategies for future policy implementation.

In-person versus remote (mHealth) delivery for a responsive parenting intervention in rural Kenya: A cluster randomized controlled trial.

An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) experience compromised development due to poverty, poor nutrition, and inadequate psychosocial stimulation. Numerous early childhood development (ECD) parenting interventions have been shown to be effective at improving ECD outcomes, at least in the short-term, but they are a) still too expensive to implement at scale in low-resource and rural settings, and b) their early impacts tend to fade over time. New approaches to deliver effective ECD parenting interventions that are low-cost, scalable, and sustainable are sorely needed. Our study will experimentally test a traditional in-person group-based delivery model for an evidence-based ECD parenting intervention against a hybrid-delivery model that increasingly substitutes in-person meetings for a remote (mHealth) delivery via smartphones, featuring audiovisual content and WhatsApp social interactions and learning. We will assess the relative effectiveness and cost of this hybrid-delivery model against purely in-person delivery and will extend the interventions over two years to increase their ability to sustain changes in parenting behaviors and ECD outcomes longer-term. Our evaluation design is a cluster Randomized Controlled Trial (cRCT) across 90 villages and approximately 1200 households. Midline and endline surveys collected 12 and 24 months after the start of the interventions, respectively, will examine short- and sustained two-year intention-to-treat impacts on primary outcomes. We will also examine the mediating pathways using Mediation Analysis. We hypothesize that a hybrid-delivery ECD intervention will be lower cost, but remote interactions among participants may be an inferior substitute for in-person visits, leaving open the question of the most cost-effective program. Our goal is to determine the best model to maximize the intervention's reach and sustained impacts to improve child outcomes. By integrating delivery into the ongoing operations of local Community Health Promoters (CHPs) within Kenya's rural health care system, and utilizing new low-cost technology, our project has the potential to make important contributions towards discovering potentially scalable, sustainable solutions for resource-limited settings. NCT06140017 (02/08/2024) AEARCTR0012704.

Losing the race before its start: inequities in early childhood development interventions in China

ABSTRACT Extensive research demonstrates the far-reaching impacts of early childhood development (ECD) interventions, including both pre-primary education (PPE) and in-home nurturing. At the same time, a limited understanding of inequalities in ECD exposure across groups of children in many countries poses a fundamental challenge to effective policymaking. This research investigates key factors driving unequal access to PPE and positive parenting for children in China using data from the nationally representative China Family Panel Studies 2010–2018. The research finds substantial and persistent disparities by children’s ethnicity, migration status, household wealth, and mother’s education. While mother’s education dominates variation in both PPE participation and parenting practices, household wealth and ethnicity strongly influence PPE participation but exert less influence than migration status on positive parenting. The research contributes to a deeper understanding of the factors driving inequality in ECD in China, with important implications for targeted policies and programmes in China and beyond.

With instead of about: Toward an anthropology that is critically integrated into Global Early Childhood Development interventions

AbstractThis comment posits questions and opens debates around the recent article by Scheidecker et al. based in the author's experience in anthropological research and applied work in child development in the Global South. The article advocates for a critical review of how anthropologists in the Global South carry out and disseminate their research, in order to broaden audiences beyond the academy. Finally, it is argued that for anthropological evidence to hold a place at the table on Global Early Childhood Development (ECD), anthropologists must engage in practices, methodologies, and forms of collaboration that make our findings and perspectives hearable. For this to happen, anthropologists should take an active part in institutions and fields of work they tend to avoid. Only in this way can we positively impact children and families by incorporating the inherent diversity of ECD beyond the parameters and values of normalcy that predominate in the so‐called minority world.

Early Childhood Development Programs in Nepal: Opportunities and Challenges

This article presents a comprehensive examination of the contemporary landscape of Early Childhood Development (ECD) initiatives in Nepal, focusing on both their quality and accessibility. Through a meticulous analysis of secondary data, this study scrutinizes the current state of Early Childhood Education and Development (ECED) centers, the pivotal roles of educators, and the efficacy and caliber of ECD programs, thereby elucidating the prevailing opportunities and obstacles. A high-quality ECD program is fundamental in extending developmental prospects to all children, including those facing adversities, by furnishing them with requisite care, support, and safeguarding. Realizing this necessitates concerted efforts from diverse stakeholders, entailing heightened investments in ECD and the advocacy of its developmental imperatives. Paramount among these stakeholders is the family, serving as the primary gateway to ECD interventions, underscoring the imperative for tailored interventions within familial contexts. Moreover, communities wield significant potential in augmenting ECD initiatives. Thus, a decentralized approach to ECD delivery across all strata of governance emerges as imperative. The realization of quality ECD hinges upon the convergence of multifaceted inputs, harmonized across various domains. By fostering synergy among these inputs, ECD programs can achieve their utmost efficacy and impact, thereby fostering holistic child development.

Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework

ABSTRACT There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021–2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

"The Early Years are Like a Foundation for the Future" Perspectives, Facilitators, and Challenges of Anganwadi Workers in Supporting Early Child Development Interventions in Hyderabad, India: Qualitative Findings from a Scalable Program Incorporating Early Child Development Interventions.

Integrated Child Development Services (ICDS) scheme, a large public health program, addresses the needs of young children with Anganwadi Workers (AWWs) as frontline agents of delivery. A scalable program incorporating early child development interventions (ASPIRE) has been developed to complement the program and address some of its gaps. This paper describes formative work done with AWWs, as part of ASPIRE to assess their understanding of early childhood development (ECD) and acceptability of a novel ECD intervention using digital technology. Six focus group discussions (FGDs) were conducted with 31 AWWs, using a semi-structured guide. Framework analysis of their responses from FGDs led to the identification of three themes: (1) time use, (2) understanding of ECD, and (3) delivering messages using videos. The findings suggest that AWWs tight schedules often leave them feeling overburdened with work. They are aware of factors that can aid as well as hinder child growth and development, but their understanding of play is limited to games played by older children. They expressed acceptability in using a video intervention, specifying features that would increase relevance for families. Integration of novel ECD interventions delivered by frontline workers needs to take into account their existing work schedules and associated challenges. Training on ECD interventions will need to broaden AWWs understanding of the critical foundational experiences which responsive caregiving and early child stimulation can provide.

Cost-effectiveness of a radio intervention to stimulate early childhood development: protocol for an economic evaluation of the SUNRISE trial in Burkina Faso

IntroductionApproximately 250 million children under 5 years of age are at risk of poor development in low-income and middle-income countries. However, existing early childhood development (ECD) interventions can be expensive,...

Willingness-to-pay for early childhood development: A field experiment in Western China

Given the size of the problem and the scientific evidence that timely intervention can improve long-term outcomes, an important question is how to best scale-up early childhood development (ECD) interventions in low- and middle-income countries (LMICs). A key component of the solution is financing. However, there has been little research on the question of whether cost-sharing models can equitably and sustainably finance ECD programs at scale in LMICs. We built parenting centers in two rural communities of Western China to teach caregivers how to stimulate child development through fun and interactive activities. We used the Becker-Degroot-Marschak (BDM) mechanism to elicit the household willingness-to-pay (WTP) for a one-month pass to the parenting centers. The results of the BDM suggest that a cost-sharing model would not be suitable for China's rural population at least in the short-run. Demand was found to be highly elastic. In addition, we found limited evidence of selection effects. We also found no evidence of sunk-cost effects.

CHAMPP4KIDS: Mixed methods study protocol to evaluate acceptability and feasibility of Parenting for Lifelong Health materials in a Canadian context.

Parents and caregivers play a key role in children's healthy development and well-being. Traditional parenting interventions promote positive parenting practices and are key to preventing child maltreatment. However, numerous barriers can limit access to programs, barriers which were further exacerbated by the COVID-19 pandemic. The Parenting for Lifelong Health group developed mass media and public health communication materials to promote positive caregiving behaviours on a population level. The Champions of Positive Parenting 4 Kids (CHAMPP4KIDS) study will examine the acceptability and feasibility of these materials for service providers and caregivers of children aged 2-6 years in Ontario, Canada. This study will use a convergent mixed-methods design. Consenting service providers (n = 200) and caregivers (n = 100) will complete a quantitative survey to rate, rank and give feedback on Parenting for Lifelong Health tip sheets and social media ads. Caregivers will also complete self-report scales measuring depression and anxiety. We will hold focus group discussions with a sub-sample of surveyed providers (n = 40) and caregivers (n = 25). An adapted Trials of Improved Practices methodology will explore caregiver perspectives after implementing the tip sheets. Primary quantitative outcomes will be descriptive statistics of rankings, Likert Scale scores and descriptive analysis of caregiver depression and anxiety. Qualitative data will be analyzed using Rapid Qualitative Inquiry and triangulated through a convergent coding matrix. The Parenting for Lifelong Health COVID-19 parenting materials offer succinct, engaging parenting information in a mass media format that addresses some challenges associated with accessing in-person programming. The CHAMPP4KIDS study will provide mixed methods insights on the materials' acceptability and feasibility from different groups in a Canadian context, with a focus on marginalized families. The use of Trials of Improved Practices methodology could prove a useful tool for participant-led adaptation of existing parenting, early childhood development and other health intervention materials.

Early childhood development and nutritional status in urban Ethiopia.

Early childhood development (ECD) is crucial for better health and well-being throughout life, but few studies have examined how ECD relates to child malnutrition. This is mainly due to lack of reliable and disaggregated data on ECD. We estimated the prevalence of ECD delays (communication, fine motor, gross motor, problem-solving and personal-social) and examined how different ECD domains were associated with child nutritional status in urban Ethiopia. Using a community-based cross-sectional survey design, 627 mother-child (12-36 months old) pairs were included in the study. The ECD was assessed using the Age and Stage Questionnaire (ASQ-3), and the nutritional status was assessed using anthropometric measurements. The association between the ECD domains and nutritional status was analysed using ordinal logistic regression, adjusting for confounding variables. Delays in ECD domains were common, especially in fine motor domain (41.9%); and more than half of the children were stunted (52.8%). Stunting and underweight were associated with ECD delays, while wasting was not. Accordingly, stunted children were more likely to have worst ECD delays in fine motor (odds ratios [OR] = 1.54; 95% confidence interval [CI]: 1.11; 2.15), gross motor (OR = 1.47; 95% CI: 1.05; 2.04) and problem-solving (OR = 1.41; 95% CI: 1.02; 1.96) domains compared to non-stunted children. Similarly, underweight children were more likely to have worse ECD delays in gross motor (OR = 1.91; 95% CI: 1.20; 3.04) and fine motor (OR = 1.90; 95% CI: 1.15; 3.15) domains compared to normal children. Coordinated and targeted ECD interventions, such as nurturing care, should be promoted and implemented widely to improve ECD outcomes and child nutrition.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

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.

Cluster randomized controlled trial of a phone-based caregiver support and parenting program for Syrian and Jordanian families with young children

For refugee caregivers who may live in remote areas or be a highly mobile population, creating parenting programs that fit their needs and accommodate their mobility can be highly beneficial. In this article, we evaluate a 6-month, audio-only early childhood development (ECD) intervention delivered via phone (3 calls per month) to caregivers of Syrian and Jordanian backgrounds in Jordan. A sample of stipended community health volunteers (CHVs; N = 99) and their caseloads of caregivers (n = 2,298) was randomized to calls with health and nutritional content (control group) or calls with health, nutritional, and added parenting and caregiver-focused content (including content adapted from the Reach Up and Learn model). Hypothesized outcomes included reduced caregiver depressive and anxiety symptoms, parenting stress, and harsh discipline; increased parent-child learning activities and parenting self-efficacy. Exploratory outcomes (all caregiver-reported) included child development; and caregiver engagement in activities related to health and child learning following the calls. Exposure to the treatment condition resulted in a statistically significant reduction in caregivers’ depressive symptoms (d=-0.11). No other statistically significant impacts were found. Implications of these findings for caregiver interventions are discussed.

Family responsive care mediating the home visiting effects on left-behind children's early development in rural China.

The early development of left-behind children requires great concern and improvement. Yet, current interventions for left-behind children are mainly focussed on children older than 3. This study aims to assess the effectiveness of a home visiting programme on family responsive care and early development of rural left-behind children and examine whether family responsive care mediates the effects of intervention on child development. A quasi-experimental study design was utilized in this study. A stratified clustered sampling was employed to choose villages in programme towns into intervention group. A control village was matched with every intervention village. All of the left-behind children and their caregivers meeting the inclusion criteria in the chosen villages were enrolled in the survey. The outcomes included child development, caregiver's early stimulation, parent-child communication, and learning materials. Baseline assessments were conducted in 2018, and endline assessments were conducted in 2020. In the endline survey, we enrolled 608 children with 258 in the intervention group and 350 in the control group. Left-behind children in the intervention group were less likely to have development delay compared with the control group (odds ratio [OR] = 0.59, 95% confidence interval [CI]: 0.36, 0.96). Migrant parents of children in the intervention group showed higher proportion of expressing emotional support to their children when communicating (OR = 1.69, 95% CI: 1.05, 2.72). Children who received home visits more than once per 2months had lower level of suspected development delay than children in the control group (OR = 0.34, 95% CI: 0.18, 0.68). Caregiver's early stimulation and migrant parents' emotional support to left-behind children mediated the intervention dose and left-behind children's development. Caregiver's early stimulation mediates the intervention and child's development. The findings suggest a promising future for scaling similar early childhood development interventions for left-behind children in rural settings.

Digital Support Systems to Improve Child Health and Development in Peru: Protocol for a Randomized Controlled Trial.

Children living in low and middle-income countries (LMICs) are at greater risk for experiencing adversities that can undermine their health and early development. Recently launched digital early childhood development (ECD) programs attempt to support families with young children in their home environments using digital technologies. However, relatively little is known regarding the effectiveness of these new technologies. The goal of this study is to rigorously assess the reach, effectiveness, and cost-effectiveness of a newly developed digital ECD platform called Afini. The Afini platform was designed to support parents of young children in low-resource settings to improve ECD and interact with caregivers through messenger services and a chatbot. This is a 3-arm cluster randomized controlled trial. In total, 2471 caregivers and their 3- to 9-month-old children were enrolled in the study across 164 study clusters in the San Marcos, Cajabamba, and Cajamarca provinces of Peru. Clusters of participants were randomly assigned to 1 of 3 groups: a control group (72 community clusters and 980 caregiver-child dyads), a home visit intervention group (20 community clusters and 316 caregiver-child dyads), and an Afini intervention group (72 community clusters and 1175 caregiver-child dyads). Families in the control group receive no focused ECD intervention. The home visit group is receiving biweekly home visits by a trained field staff following the national ECD program (Programa Nacional Cuna Más) curriculum and training guidelines. Caregivers in the Afini group are receiving ECD activities and advice through the digital platform. The primary study outcome is children's overall development at the age of 2.5 years, using the internationally validated long form of the Global Scales for Early Development. Secondary outcomes include caregiver engagement; caregiver mental health; screen time; as well as caregiver reports of children's motor, cognitive, language, and socioemotional development measured through locally piloted and validated tools. Enrollment started in September 2021 and ended in March 2023. Endline assessments will take place between August 2023 and September 2024. This study is, to our knowledge, the first to rigorously assess the effectiveness and cost-effectiveness of digital ECD technologies in LMICs. Given the large number of children in LMICs currently receiving only limited external support, the evaluated platform has the potential to improve the short- and long-term well-being of millions of children and their parents globally. ClinicalTrials.gov NCT05202106; https://clinicaltrials.gov/ct2/show/NCT05202106. DERR1-10.2196/50371.

Maternal barriers to stimulating early childhood development on Tidore Island

Background The first 5 years of life provide a foundation for neuroplastic development, which establishes the capacity to accomplish complicated tasks in later life. However, this period is vulnerable to multiple stressors and adversities that prevent children from achieving age-related developmental milestones. Mothers as primary caregivers may find it challenging to engage her child in stimulating activities.&#x0D; Objectives To understand maternal barriers to stimulating early childhood development and potential interventions that can be developed.&#x0D; Methods This explorative, qualitative study was conducted in 13 different service coverage areas of the Soasio Community Health Center (Puskesmas), Tidore Islands, North Maluku, Indonesia. A total of 30 mothers participated in structured interview sessions. The analysis was conducted inductively, by generating some key issues from the interview.&#x0D; Results Eight maternal barriers to engaging in child stimulation activities were found: (1) family members, (2) gender-related interaction, (3) partial understanding of child health-related information, (4) prioritizing one developmental achievement over others, (5) timidity in decision making, (6) delaying stimulation due to overreliance on the role of school, (7) responsive feeding, and (8) media. Maternal motivation, societal awareness of child development, and support of maternal and family mental health are needed to improve maternal engagement in child stimulation.&#x0D; Conclusions Family, community, and life experiences may become maternal barriers to stimulating childhood development. Providing better social support, information access, and woman empowerment in decision-making will help mothers to be more engaged in child development stimulation activities.

Measuring the cost-effectiveness of a home-visiting intervention to promote early child development among rural families linked to the Rwandan social protection system.

Early childhood development (ECD) programmes are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. This study estimates the cost and cost-effectiveness of the Sugira Muryango (SM) trial, a home-visiting intervention to improve ECD outcomes through positive parent-child relationships. Cost-effectiveness analysis of ECD interventions is challenging given their potential to have multiple benefits. We propose a cost-effectiveness method using a single outcome, in this case the improvement in cognitive development per home-visit session, as an indication of efficiency comparable across similar interventions. The trial intervention cost US$456 per family. This cost will likely fall below US$200 if the intervention is scaled through government systems. The cost-effectiveness analysis suggests that while SM generated a relatively small impact on markers of early development, it did so efficiently. The observed improvements in cognitive development per home-visit are similar to other home-visiting interventions of longer duration. SM by focusing on the family had benefits beyond ECD, including reductions in violence against children and intermate partner violence, further analysis is needed to include these returns in the economic evaluation.