In low- and middle-income countries, a large number of children aged under five do not achieve their full potential development due to risks associated with poverty, malnutrition and inadequate stimulation.
The recommendation has been to integrate early childhood development interventions into health and nutrition services. However, existing information on effective and feasible interventions delivered through health services is limited. This experiment develops and evaluates a parental support program that could be incorporated into visits to primary health care centers.
The group intervention consisted of working with groups of mothers of babies aged 3-18 months in five routine visits and included short films with messages on child development shown in the waiting room, discussions and demonstrations directed by community health agents, and practice of activities with the mothers.
The nurses handed out and reviewed message cards with the mothers along with some play materials. A randomized trial by conglomerates in the Caribbean (Jamaica, Antigua and St Lucia) was carried out in 29 health centers. The centers, stratified by the three countries, were assigned to a control group (n=15) or to an intervention group in health centers (n=14). Only In Jamaica was the intervention of home visits adapted to increase the scale feasibility which was evaluated together with the group intervention.
Participants were recruited in the health visits of babies aged 6-8 weeks. The primary outcomes were the child's cognition, language and eye-hand coordination; and the secondary outcomes were the knowledge of caregivers, their practices, postpartum depression, and child growth, measured after the 18-month visit.
Children aged under 5
Improve children's development potential
Results
The multilevel analysis in which the intervention in the health center was compared with control groups in the three countries showed significant benefits for the cognitive development of the intervention in the health center with an effect size of 0.38SD and benefits for parental knowledge with an effect size of 0.4.
The analysis of the two interventions in Jamaica shows that both favored cognitive development with effect sizes of 0.34SD (home visit) and 0.38SD (health center). For their part, qualitative interviews showed that mothers and health workers perceived benefits of the intervention for themselves and for the children.
The main implementation challenges reported related to the work overload of the staff and the management of the groups. The most conservative analyzes found a benefit/cost ratio of 5.3 for the intervention in the health center and 3.8 for home visits.