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Early childhood interventions show mixed results on child development

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Early childhood interventions may have some efficacy in boosting measures of child health and development in low income countries, but more work is needed to sort out how to implement these interventions, according to a new set of studies published this week in PLOS Medicine.

Previous work has suggested that early childhood interventions--those focused on the first 1000 days of life--have the potential to offset some negative impacts of adversity on child development. In one new study, Peter Rockers of Boston University, USA, and colleagues followed 526 pairs of children and caregivers in a cluster-randomized trial done in Southern Province, Zambia. All children were 6 to 12 months of age at the start of the study. 258 pairs received no intervention, while the other 268 were visited twice a month by a Child Development Agent, to monitor the child's health, and invited to attend twice monthly parenting group meetings, where they learned a diverse parenting curriculum.

After two years, children who had been in the intervention group were less likely to show signs of stunting and scored higher on measures of language, but the intervention did not significantly impact cognition, motor skills, or adaptive behavior. "In settings like Zambia, where optimal child nutrition and stimulation are often lacking, parenting groups hold promise for improving child health and welfare," the authors say. "However, improvements in child development may not be immediate and continued and sustained efforts are likely needed."

In a second paper, Alison Andrew of University College London, UK, and colleagues randomized 1419 children aged 12-24 months, living in 96 towns in Colombia, to receive either no intervention, participation in a home visit program, micronutrient supplementation, or both of the latter interventions. Home visits followed a structured curriculum, with an emphasis on cognition and language, and the goal of increasing maternal-child interactions. After two years, the researchers found no effect on cognition, behavior, or home stimulation. "It is possible that the initial effects on child development were too small to be sustained or that the lack of continued impact on home stimulation contributed to fade out," the authors write.

In an accompanying Perspective, Mark Tomlinson of Stellenbosch University, South Africa, discusses the challenge of determining why the effects of early interventions may fade out by middle childhood. "In contexts of high risk and adversity the impact of early interventions may be more durable when they are built upon by interventions during later years," he writes. Scaling up these interventions also requires more work, he adds, noting that some interventions are not scalable in their current form. "Looking to the future, the early childhood development field requires rigorous implementation science research that examines the best models... to achieve impact."

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Research Article - Rockers et al

Funding:

The first year of the study was funded through grants from Grand Challenges Canada (0349-03) and PATH (DFI.1836-672968-GRT). The second year of the study was funded through a grant from the Policy Research Fund at the Department for International Development (DFID), United Kingdom (55204321). At the time of the study, author RCH worked in the DFID Zambia office and was not part of the Policy Research Fund team. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Rockers PC, Zanolini A, Banda B, Chipili MM, Hughes RC, Hamer DH, et al. (2018) Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial. PLoS Med 15(4): e1002555. https://doi.org/10.1371/journal.pmed.1002555

Author Affiliations:

Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America

American Institutes for Research-Zambia Office, Lusaka, Zambia

Zambia Center for Applied Health Research and Development, Lusaka, Zambia

Department of Psychology, University of Zambia, Lusaka, Zambia

UK Department for International Development, London, United Kingdom

Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America

Swiss Tropical and Public Health Institute, Basel, Switzerland

University of Basel, Basel, Switzerland

In your coverage please use this URL to provide access to the freely available paper:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002555

Research Article - Andrew et al

Funding:

This study was supported by a grant from the World Bank's Strategic Impact Evaluation Fund (http://www.worldbank.org/en/programs/sief-trust-fund), grant reference #7172151. In addition OA's time was partly funded by the Economic and Social Research Council (ESRC) Professorial Fellowship #ES/K01070011. CM's time was partly funded by the Cowles Foundation and National Institutes of Health #R01 HD 7210. AA's, MRC's and EF's time was partly funded by the ESRC Centre for Microeconomic Analysis of Public Policy at the Institute for Fiscal Studies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Andrew A, Attanasio O, Fitzsimons E, Grantham-McGregor S, Meghir C, Rubio-Codina M (2018) Impacts 2 years after a scalable early childhood development intervention to increase psychosocial stimulation in the home: A follow-up of a cluster randomised controlled trial in Colombia. PLoS Med 15(4): e1002556. https://doi.org/10.1371/journal.pmed.1002556

Author Affiliations:

Institute for Fiscal Studies, London, United Kingdom

Department of Economics, University College London, London, United Kingdom

Institute of Education, University College London, London, United Kingdom

Institute of Child Health, University College London, London, United Kingdom

Department of Economics, Yale University, New Haven, Connecticut, United States of America

Inter-American Development Bank, Washington, District of Columbia, United States of America

In your coverage please use this URL to provide access to the freely available paper:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002556

Perspective

Funding:

The author received no specific funding for this work.

Competing Interests:

I have read the journal's policy and the author of this manuscript has the following competing interest: MT is a member of the Editorial Board of PLOS Medicine.

Citation:

Tomlinson M (2018) From surviving to thriving: What evidence is needed to move early child-development interventions to scale? PLoS Med 15(4): e1002557. https://doi.org/10.1371/journal.pmed.1002557

Author Affiliations:

Department of Psychology, Stellenbosch University, Stellenbosch, South Africa Centre of Excellence in Human Development, University Witwatersrand, Johannesburg, South Africa

In your coverage please use this URL to provide access to the freely available paper:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002557

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