Care for Child Development in rural Malawi: a model feasibility and pilot study

Abstract

Evidence demonstrates that encouraging stimulation, early communication, and nutrition improves child development. Detailed feasibility studies in real-world situations in Africa are limited. We piloted Care for Child Development through six health surveillance assistants (HSAs) in group and individual sessions with 60 caregivers and children <2 years and assessed recruitment, frequency, timings, and quality of intervention. We collected baseline/endline anthropometric, child development (MDAT), maternal stress (SRQ), and family care indicators (FCIs) data and determined acceptability through 20 interviews with caregivers and HSAs. HSAs could only provide coverage on 14.2% of eligible children in their areas; 86% of group sessions and a mean of 3.6/12 individual sessions offered to mothers were completed. Pre- and post-assessment of children demonstrated significant changes in MDAT language and social Z-scores and FCIs. Caregivers perceived sessions as beneficial and HSAs good leaders but that they could be provided through other mechanisms. Integrated Care for Child Development programs for 0-2 years old are readily accepted in Malawi, but they are not feasible to conduct universally through HSAs due to limited coverage; other models need to be considered.

The Irie Classroom Toolbox: developing a violence prevention, preschool teacher training program using evidence, theory, and practice

“…42,[44][45][46] Teachers' motivation was enhanced when they recognized the benefits of the intervention to the children and to themselves; the importance of ensuring the benefits of intervention are made tangible to program recipients and staff is an emerging theme in the implementation of early child development (ECD) programs in LMICs. [44][45][46][47] Other aspects of implementation that have been found to be important in ECD implementation research include group support from peers and provision of intervention materials and these were also recognized as enablers to intervention implementation by Jamaican preschool teachers in this study. 44,45 These common enablers across several studies of implementation of ECD programs correspond to the following domains in the Theoretical Domains Framework: skills, beliefs about consequences, social influences, and environmental context and resources.…”

“…Teachers valued interactive training methods, including rehearsal, practice and feedback, over more passive methods such as watching videos and discussion; this preference for hands‐on training activities has also been reported for early childhood parenting interventions in LMICs and is a key characteristic of effective programs . Teachers’ motivation was enhanced when they recognized the benefits of the intervention to the children and to themselves; the importance of ensuring the benefits of intervention are made tangible to program recipients and staff is an emerging theme in the implementation of early child development (ECD) programs in LMICs . Other aspects of implementation that have been found to be important in ECD implementation research include group support from peers and provision of intervention materials and these were also recognized as enablers to intervention implementation by Jamaican preschool teachers in this study .…”

Measuring the implementation of early childhood development programs

“…Core features should be those that have some evidence supporting their link to desired outcomes, such as nurturing care practices and child development. Adaptation to a context calls for some modification, but rarely in core features . For example, changes in emphasis on nutrition messages may occur depending on the need in that context.…”

Integrating psychosocial early childhood development into reproductive, maternal, newborn, and child health services in Uganda: perceptions of governance stakeholders and primary healthcare providers

“…However, these have not been comprehensively scaled up, integrated and implemented across all maternal and child health (MCH) services (37,48). The latest global dialogue on ECD, emphasises the need for research that examines how to scale up proven and effective interventions in LMICs, with a particular focus on using health systems and MCH services to deliver important ECD services (3,14,49). This should include making national and government level initiatives that make the public health sector more actively involved in promoting psychosocial ECD.…”

“…Based on ECD best practice research and evidence, the CCD package has been developed as a public health tool to support and provide caregivers with key information and skills on responsive caregiving using health workers and community health services (43,45,71,72). Given the existing success of Integrated Management of Childhood Illness (IMCI), the CCD Package was initially developed as a module and component of IMCI (16,32,43,49,71). In efforts to target those at most need (and not just children presenting with illness), it was developed into a separate health package which would be implemented alongside routine MCH services 2 (33,73).…”