scholarly journals Is integrated private-clinic based early child development care effective? A clustered randomised trial in Pakistan

BJGP Open ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. bjgpopen18X101593 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Syeda Somyyah Owais ◽  
Shazia Maqbool ◽  
Sehrish Ishaq ◽  
Haroon Jehangir Khan ◽  
...  
Keyword(s):  
Child Development ◽  
Maternal Depression ◽  
Maternal Mental Health ◽  
Care Delivery ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Early Child Development ◽  
Early Child ◽  
Counselling Intervention ◽  
Child Age

BackgroundIn Pakistan, high prevalence of delays in early child development (ECD) is associated with poverty and lack of mothers’ caregiving skills. GP clinics, the main sources of care in poor urban localities, lack quality ECD care delivery. A contextualised intervention was developed and tested to enable GPs to deliver clinic-based, tool-assisted ECD counselling of mothers on a quarterly basis.AimTo assess the effectiveness of delivering a contextualised ECD mother-counselling intervention.Design & settingClustered randomised controlled trial, in poor urban localities of Pakistan. Locality clusters were allocated to intervention and control arm using simple randomisation.MethodA total of 2327 mother–child pairs were recruited at 32 GP clinics, one from each cluster-locality; 16 GP clinics per arm. The clinic-based counselling intervention covering child stimulation, nutrition, and maternal mental health was delivered mainly by clinic assistants to mothers at ≤6 weeks, and 3, 6, and 9 months of child age. At 12 months of child age, each mother–child pair was assessed for the primary outcome, that is, delays in the five development domains (determined by Ages and Stages Questionnaire-3 [ASQ-3] score); and secondary outcomes, namely the prevalence of stunting and maternal depression (determined by Patient Health Questionnaire-9 [PHQ-9] score). The outcome assessors were blinded to the cluster–arm allocation. Outcome analyses were calculated on cluster-level.ResultsAt 12 months, the number of children with delay in two or more development domains was significantly lower in the intervention arm (-0.17 [95% confidence interval {CI} = -0.26 to -0.09]; P<0.001) compared to the control arm. The difference in the prevalence of child stunting and maternal depression were also significant at -0.21% (95% CI = -0.30 to -0.13; P<0.001) and -0.23% (95% CI = -0.29 to -0.18; P = 0.000) respectively.ConclusionContextualised ECD care, when delivered at GP clinics in poor urban localities, can effectively reduce the developmental delays during the first 12 months of the child's life.

scholarly journals Delivering integrated child development care in Pakistan: protocol for a clustered randomised trial

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100677 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Syeda Somyyah Owais ◽  
Claire Blacklock ◽  
Shirin Anil ◽  
Sehrish Ishaq ◽  
...  
Keyword(s):  
Child Development ◽  
Maternal Depression ◽  
Urban Communities ◽  
Developmental Delay ◽  
Maternal Mental Health ◽  
Randomised Trial ◽  
Adult Life ◽  
Early Child Development ◽  
Early Child ◽  
Counselling Intervention

BackgroundEarly childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression.AimTo assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities.Design & settingA clustered randomised trial in Pakistan.MethodThe intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother–child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child’s age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted.DiscussionThis trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public–private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective.Trial registrationThe trial has been registered with the Current Controlled Trials ISRCTN48032200.

scholarly journals Maternal mental health modifies the association of food insecurity and early child development

2020 ◽  
Vol 16 (4) ◽  
Author(s):  
Jéssica Pedroso ◽  
Gabriela Buccini ◽  
Sonia Isoyama Venancio ◽  
Rafael Pérez‐Escamilla ◽  
Muriel Bauermann Gubert
Keyword(s):  
Mental Health ◽  
Child Development ◽  
Food Insecurity ◽  
Maternal Mental Health ◽  
Early Child Development ◽  
Early Child

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

2016 ◽  
Vol 71 (3) ◽  
pp. 217-224 ◽  
Author(s):  
Stella Maria Hartinger ◽  
Claudio Franco Lanata ◽  
Jan Hattendorf ◽  
Jennyfer Wolf ◽  
Ana Isabel Gil ◽  
...  
Keyword(s):  
Child Development ◽  
Randomised Trial ◽  
Control Design ◽  
Cluster Randomised Trial ◽  
Early Child Development ◽  
Early Child ◽  
Cluster Randomised

scholarly journals 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

2018 ◽  
Author(s):  
Stella M Hartinger ◽  
Nestor Nuño ◽  
Jan Hattendorf ◽  
Hector Verastegui ◽  
Mariela Ortiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drinking Water ◽  
Randomised Controlled Trial ◽  
Child Development ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Early Child Development ◽  
Early Child ◽  
Cluster Randomised ◽  
Randomised Controlled

ABSTRACTBackgroundExposure to unhealthy environments and poor cognitive development are the main risk factors that affect children’s health and wellbeing in low- and middle-income countries. Interventions that simultaneously address several risk factors at the household level have great potential to reduce these negative effects. We present the design and baseline findings of a cluster-randomised controlled trial to evaluate the impact of an integrated home-environmental intervention package and an early child development programme to improve diarrhoea, acute respiratory infections and childhood developmental outcomes in children under 36 months of age living in resource-limited rural Andean Peru.MethodsWe collected baseline data on children’s developmental performance, health status and demography as well as microbial contamination in drinking water. In a sub-sample of households, we measured indoor and personal 24-hour air concentration levels of carbon monoxide (CO) and fine particulate matter (PM2.5).ResultsWe recruited and randomised 317 children from 40 community-clusters to four study arms. At baseline, all arms had similar health and demographic characteristics, and the developmental status of children was comparable between arms. The analysis revealed that more than 25% of mothers completed primary education, a large proportion of children were stunted and diarrhoea prevalence was above 18%. Fifty-two percent of drinking water samples tested positive for thermo-tolerant coliforms and the occurrence of E.coli was evenly distributed between arms. The mean levels of kitchen PM2.5 and CO concentrations were 213 μg/m3 and 4.8 ppm, respectively.ConclusionsThe trial arms are balanced with respect to most baseline characteristics, such as household air and water pollution, and child development. These results ensure the possible estimation of the trial effectiveness. This trial will yield valuable information for assessing synergic, rational and cost-effective benefits of the combination of home-based interventions.Trial registrationretrospectively registered on 15th January 2018. SRCTN reference: 26548981

scholarly journals Poor Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 280-280
Author(s):  
Jessica Silva ◽  
Fernando José Herkrath ◽  
Gabriela Buccini ◽  
Sonia Isoyama Venancio ◽  
Rafael Pérez-Escamilla ◽  
...  
Keyword(s):  
Mental Health ◽  
Child Development ◽  
Food Insecurity ◽  
Maternal Mental Health ◽  
Unwanted Pregnancy ◽  
Early Child Development ◽  
Household Food Insecurity ◽  
Early Child ◽  
Household Food ◽  
The Relationship

Abstract Objectives The aim of the study was to evaluate whether maternal mental health and infant's diet mediate the association between Household Food Insecurity (HFI) and Early Child Development (ECD) using Structural Equation Modeling (SEM). We hypothesized a priori that both maternal mental health and infant's diet would mediate the association between HFI and ECD. Methods A cross-sectional study was carried out with 474 mother-infant dyads at Primary Health Centers in the Federal District, Brazil. Mothers answered a questionnaire that evaluated variables through validated instruments. SEM analyses were conducted including the following observed variables: HFI, ECD, consumption of a healthy and diverse diet, presence of a partner in the household, wanted pregnancy and current breastfeeding. Latent variables were included to evaluate mental health (created from maternal depression, trait anxiety and state anxiety), poverty (created from maternal educational level, household per capita income and participation in the Brazilian cash transfer program) and infant health (created from preterm birth, hospitalization after birth and Neonatal Intensive Care Unit needed after birth). Results Poor maternal mental health mediated the relationship between HFI and ECD (β = –0.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower ECD scores directly (β = 0.21) and indirectly (β = 0.02). Not having a partner (β = 0.05) and having an unwanted pregnancy (β = 0.02) predicted indirectly lower ECD scores. Conclusions Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood and unwanted pregnancy through different pathways. Therefore, it is necessary that public policies and interventions that aim to promote an optimal ECD also approach these aspects. Longitudinal cohort studies are needed to determine causality and identify promising approaches to improve parenting skills and ECD outcomes in the context of HFI. Funding Sources This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) (Finance Code 001, CAPES scholarship Programa Doutorado Sanduíche no Exterior Process number 88,881.189710/2018–01).

Effects of Poverty and Maternal Depression on Early Child Development

2001 ◽  
Vol 72 (6) ◽  
pp. 1794-1813 ◽  
Author(s):  
Stephen M. Petterson ◽  
Alison Burke Albers
Keyword(s):  
Child Development ◽  
Maternal Depression ◽  
Early Child Development ◽  
Early Child
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