Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal control design

Abstract

ObjectiveStimulation in early childhood can alleviate adverse effects of poverty. In a community-randomised trial, we implemented 2 home-based interventions, each serving as an attention control for the other. One group received an integrated household intervention package (IHIP), whereas the other group received an early child development (ECD) intervention. The primary objective of the study was to evaluate the effect of IHIP on diarrhoea and respiratory infections, the details of which are described elsewhere. Here, we present the impact of the ECD intervention on early childhood development indicators.MethodsIn this non-blinded community-randomised trial, an ECD intervention, adapted from the Peruvian government's National Wawa Wasi ECD programme, was implemented in 25 rural Peruvian Andean communities. We enrolled 534 children aged 6–35 months, from 50 communities randomised 1:1 into ECD and IHIP communities. In ECD communities, trained fieldworkers instructed mothers every 3 weeks over the 12 months study, to stimulate and interact with their children and to use standard programme toys. IHIP communities received an improved stove and hygiene promotion. Using a nationally validated ECD evaluation instrument, all children were assessed at baseline and 12 months later for overall performance on age-specific developmental milestones which fall into 7 developmental domains.FindingsAt baseline, ECD-group and IHIP-group children performed similarly in all domains. After 12 months, data from 258 ECD-group and 251 IHIP-group children could be analysed. The proportion of children scoring above the mean in their specific age group was significantly higher in the ECD group in all domains (range: 12–23%-points higher than IHIP group). We observed the biggest difference in fine motor skills (62% vs 39% scores above the mean, OR: 2.6, 95% CI 1.7 to 3.9).ConclusionsThe home-based ECD intervention effectively improved child development overall across domains and separately by investigated domain. Home-based strategies could be a promising component of poverty alleviation programmes seeking to improve developmental outcomes among rural Peruvian children.Trial registration numberISRCTN28191222; results.

Feasibility and acceptability of a home‐based intervention to promote nurturing interactions and healthy behaviours in early childhood: The Amagugu Asakhula pilot study

“…That Amagugu Asakhula activities were simple, relevant, enjoyable, and intentional—along with its focus on development, rather than only health behaviours and obesity—appeared to contribute to the intervention's feasibility and acceptability. These findings align with existing evidence on the feasibility of home‐based stimulation interventions (Hartinger et al, ;West et al, ; Yousafzai et al, ), including those delivered by community‐based workers (West et al, ; Yousafzai et al, ). These findings also suggest that in low‐income settings, interventions with caregivers of preschool children do not necessarily require expensive resources to be acceptable; intervention activities that are easy, practical, visual, and fun for children and caregivers can be well received.…”

“…Home-based interventions have been shown to be feasible (West, Aparicio, Berlin, & Jones Harden, 2017) and effective (Hartinger et al, 2017;Yousafzai, Rasheed, Rizvi, Armstrong, & Bhutta, 2014), including those delivered by community-based workers (West et al, 2017;Yousafzai et al, 2014). In particular, interventions integrating multiple domains of child development have been shown to be beneficial (Grantham McGregor, Fernald, Kagawa, & Walker, 2013), with sustained effects (Yousafzai et al, 2016).…”

A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings

“…We chose the locations based on the coverage of the national ECD programme (“Programa Nacional Cuna Mas” (PNCM)) and on-going relationships with local stakeholders who partook in a previous cluster-randomised controlled trial conducted in the region. The results of our previous research endeavours enhanced the implementation of this new trial (“IHIP-2 trial” in the following) [17, 20]. Both sites are high altitude rural resource-limited locations with chronic malnutrition and illiteracy [23].…”

“…The use of improved cookstoves (ICS) lessened HAP exposure and improved health [15]. ECD interventions enhanced health status [16] and development in children [16, 17].…”

“…The reduction of poor health and development requires integrated approaches addressing the underlying risks and structural determinants at the household level [18]. Multiple studies demonstrated that low-cost interventions focused on various health risks factors simultaneously had a synergic effect and increased opportunities for a sustained use over time [17, 19]. Integrating ECD and home-hygiene interventions is promising, as they both target young children within their homes [20].…”