Background
Poor development in young children in developing countries is a major problem. Professionals are calling for child development interventions to be integrated into health services but there are few robust evaluations of such programmes. Previous small Bangladeshi trials of interventions using individual play sessions with mother and child at home or clinic run by especially employed women found moderate effects on child development. We integrated a modified intervention into government health clinics and evaluated effects on children’s development in a cluster randomised trial.
Methods
Ninety clinics were randomised to intervention or control clusters and up to 25 underweight children aged five to 24 months living in the areas surrounding the clinics were enrolled (n=2423). Eight children from each clinic (n=718) were randomly selected for impact evaluation and were assessed at pre-test and post-test on the Bayley Scales and Wolke’s behaviour ratings. The intervention lasted for one year and consisted of 25 sessions where mothers were shown how to support their child’s development through play and interactions. Government health workers ran play sessions at the clinics as part of their routine work and, mothers and children attended fortnightly in pairs instead of individual weekly home visits as designed for the original programme.
Findings
Mean attendance at the sessions was 86%, 92% of planned sessions were run and 688 children (96% of evaluation sample) were assessed at endline. Intent to treat analysis, showed intervention had substantial benefits on children’s cognition, language and motor composite scores (effect size[95%CI]1·3SD[1·1,1.5], 1·0SD[0·9,1·2], and 1·2SD[1·0,1·3] respectively) and behaviour ratings (ranging from 0·7 to 1·1SD) but not on growth. Home stimulation, maternal child-rearing knowledge and depressive symptoms improved significantly (effect sizes 0·8, 1·7 and -0·3SD respectively).
Interpretation
The size and range of benefits are encouraging and the intervention model is promising to take to scale in that the HWs ran most of the sessions effectively and attendance was good. However researchers trained and supervised the health workers and the next step will be to determine if the Ministry of Health can perform these tasks. More attention needs to be paid to the nutrition of the children.
Trial registration number: ClinicalTrials.gov NCT02208531
Funding: Grand Challenges Canada (Saving Brains)