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A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh

Pitchik HO 1 , Tofail F 2 , Rahman M 3 , Akter F 3 , Sultana J 3 , Shoab AK 3 Show all authors , Huda TMN 3 , Jahir T 3 , Amin MR 3 , Hossain MK 3 , Das JB 3 , Chung EO 4 , Byrd KA 5 , Yeasmin F 3 , Kwong LH 6 , Forsyth JE 6 , Mridha MK 7 , Winch PJ 8 , Luby SP 9 , Fernald LC 10

Affiliations 

  • 1 Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA hpitchik@berkeley.edu
  • 2 Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
  • 3 Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
  • 4 Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  • 5 WorldFish, Bayan Lepas, Penang, Malaysia
  • 6 Woods Institute for the Environment, Stanford University, Stanford, California, USA
  • 7 Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
  • 8 International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  • 9 Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
  • 10 Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
BMJ Glob Health, 2021 03;6(3).
PMID: 33727278 DOI: 10.1136/bmjgh-2020-004307

Abstract

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 ('group'); alternating groups and home visits ('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).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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