TY - JOUR
T1 - A holistic approach to promoting early child development
T2 - A cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh
AU - Pitchik, Helen O.
AU - Tofail, Fahmida
AU - Rahman, Mahbubur
AU - Akter, Fahmida
AU - Sultana, Jesmin
AU - Shoab, Abul Kasham
AU - Huda, Tarique Md Nurul
AU - Jahir, Tania
AU - Amin, Md Ruhul
AU - Hossain, Md Khobair
AU - Das, Jyoti Bhushan
AU - Chung, Esther O.
AU - Byrd, Kendra A.
AU - Yeasmin, Farzana
AU - Kwong, Laura H.
AU - Forsyth, Jenna E.
AU - Mridha, Malay K.
AU - Winch, Peter J.
AU - Luby, Stephen P.
AU - Fernald, Lia C.H.
N1 - Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/3/16
Y1 - 2021/3/16
N2 - 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 (â € group'); alternating groups and home visits (â € 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).
AB - 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 (â € group'); alternating groups and home visits (â € 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).
KW - child health
KW - cluster randomized trial
KW - maternal health
KW - prevention strategies
UR - http://www.scopus.com/inward/record.url?scp=85102891735&partnerID=8YFLogxK
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U2 - 10.1136/bmjgh-2020-004307
DO - 10.1136/bmjgh-2020-004307
M3 - Article
C2 - 33727278
AN - SCOPUS:85102891735
SN - 2059-7908
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
IS - 3
M1 - e004307
ER -