A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent
Helen O Pitchik1, Fahmida Tofail2, Mahbubur Rahman3
1Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA hpitchik@berkeley.edu.
Insights
A group-based early child development intervention in Bangladesh improved child stimulation and development outcomes. This multicomponent program, delivered by community members, shows potential for scalable implementation in low-income settings.
Area of Science:
- Global health
- Developmental pediatrics
- Public health interventions
Background:
- Children in low- and middle-income countries face numerous risks for developmental delays.
- Early child development interventions are crucial for mitigating these risks and promoting optimal growth.
Purpose of the Study:
- To evaluate a multicomponent, group-based early child development intervention in rural Bangladesh.
- To assess the intervention's impact on child stimulation, development, and related health and environmental factors.
Main Methods:
- A 9-month, cluster-randomised controlled trial involving 621 pregnant women and caregivers of children under 15 months.
- Intervention arms included group sessions or combined group sessions and home visits, compared to a passive control.
- Primary outcomes were child stimulation (Family Care Indicators) and child development (Ages and Stages Questionnaire Inventory, ASQi).
Main Results:
- Caregivers in both intervention arms engaged in more play activities and provided more diverse play materials compared to the control group.
- Children in the group-only arm showed significantly higher ASQi scores compared to the control arm.
- The combined group and home visit arm did not show a statistically significant difference in ASQi scores compared to the control.
Conclusions:
- Group-based, multicomponent early child development interventions can effectively enhance child development outcomes in rural Bangladesh.
- The intervention's design demonstrates potential for large-scale implementation and positive public health impact.
Introduction:
In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.
Methods:
We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions ('group'); alternating groups and home visits ('combined'); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.
Results:
In July-August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July-August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, -0.07 to 0.54).
Conclusion:
Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.
Trial Registration Number:
The trial is registered in ISRCTN (ISRCTN16001234).
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