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Delivering integrated child development care in Pakistan: protocol for a clustered randomised trial
Muhammad Amir Khan1, Syeda Somyyah Owais2, Claire Blacklock3
1Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
Insights
This study evaluated an early child development intervention in Pakistan. The program, delivered via private general practitioner (GP) clinics, aims to reduce developmental delays and improve child nutrition and maternal mental health.
Area of Science:
- Global Health
- Pediatrics
- Public Health
Background:
- Early childhood developmental delay is a significant issue in Pakistan, linked to poverty, malnutrition, and maternal depression.
- Private general practitioner (GP) clinics are a key source of primary healthcare in poor urban communities.
Purpose of the Study:
- To assess the effectiveness of an early child development counseling intervention delivered through private GP clinics in urban Pakistan.
- To promote child development, nutrition, and maternal mental health in disadvantaged populations.
Main Methods:
- A clustered randomized trial involving 2112 mother-child pairs across 32 private GP clinics in Pakistan.
- Intervention included counseling at 6 weeks, 3, 6, and 9 months, focusing on child development, nutrition, and maternal mental health.
- Primary outcome: developmental delay at 12 months (ASQ-3 scores); secondary outcomes: stunting and maternal depression (PHQ-9 scores).
Main Results:
- This section is not available in the provided abstract.
Conclusions:
- This trial is the first to evaluate an early child development intervention in private GP clinics for impoverished urban communities in Pakistan.
- A successful public-private model could offer a sustainable and feasible approach for improving child development in similar settings.
- Positive findings may support provincial-level scale-up of the intervention.
Background:
Early childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression.
Aim:
To assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities.
Design & Setting:
A clustered randomised trial in Pakistan.
Method:
The intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother-child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child's age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted.
Discussion:
This trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public-private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective.
Trial Registration:
The trial has been registered with the Current Controlled Trials ISRCTN48032200.
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