Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT
Sally Grantham-McGregor1, Akanksha Adya2,3, Orazio Attanasio4,5,6,7
1Institute for Global Health, University College London, London, England; sallymcgregor@yahoo.com.
Insights
Weekly mother-child group sessions are a cost-effective intervention for improving early childhood development in low-income countries. These sessions showed similar benefits to home visits but were significantly cheaper, offering a scalable solution.
Area of Science:
- Global Health
- Developmental Psychology
- Public Health Interventions
Background:
- Poor early childhood development is a significant public health issue in low- and middle-income countries.
- Scaling up early childhood development interventions is challenging and expensive.
- Effective delivery strategies for early childhood development are needed.
Purpose of the Study:
- To compare the effectiveness of weekly home visits versus weekly mother-child group sessions for early childhood development.
- To assess the impact of nutritional education as a standalone intervention.
- To identify scalable and cost-effective delivery models for early childhood development.
Main Methods:
- An open-label cluster-randomized controlled trial was conducted in 192 villages in Odisha, India.
- 1449 mothers and their children (aged 7-16 months) were enrolled.
- Interventions included nutritional education, home visits, and group sessions over two years, with outcomes measured at baseline, 12, and 24 months.
Main Results:
- Both home visiting and group sessions significantly improved child cognition and language development.
- Nutritional education alone did not yield significant benefits.
- Most positive impacts were observed within the first year of intervention.
Conclusions:
- Mother-child group sessions are as effective as home visits for improving early childhood development outcomes.
- Group sessions represent a more scalable and cost-effective intervention model.
- Early impact realization has important implications for intervention design and implementation.
Objectives:
Poor early childhood development in low- and middle-income countries is a major public health problem. Efficacy trials have shown the potential of early childhood development interventions but scaling up is costly and challenging. Guidance on effective interventions' delivery is needed. In an open-label cluster-randomized control trial, we compared the effectiveness of weekly home visits and weekly mother-child group sessions. Both included nutritional education, whose effectiveness was tested separately.
Methods:
In Odisha, India, 192 villages were randomly assigned to control, nutritional education, nutritional education and home visiting, or nutritional education and group sessions. Mothers with children aged 7 to 16 months were enrolled (n = 1449). Trained local women ran the two-year interventions, which comprised demonstrations and interactions and targeted improved play and nutrition. Primary outcomes, measured at baseline, midline (12 months), and endline (24 months), were child cognition, language, motor development, growth and morbidity.
Results:
Home visiting and group sessions had similar positive average (intention-to-treat) impacts on cognition (home visiting: 0.324 SD, 95% confidence interval [CI]: 0.152 to 0.496, P = .001; group sessions: 0.281 SD, 95% CI: 0.100 to 0.463, P = .007) and language (home visiting: 0.239 SD, 95% CI: 0.072 to 0.407, P = .009; group sessions: 0.302 SD, 95% CI: 0.136 to 0.468, P = .001). Most benefits occurred in the first year. Nutrition-education had no benefit. There were no consistent effects on any other primary outcomes.
Conclusions:
Group sessions cost $38 per child per year and were as effective on average as home visiting, which cost $135, implying an increase by a factor of 3.5 in the returns to investment with group sessions, offering a more scalable model. Impacts materialize in the first year, having important design implications.
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