Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India
A cluster RCT
Bibliographic Data
Background: To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children. Methods: Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months. Findings: At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%. Interpretations: The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program. Funding: The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020)
Child development · Cluster randomised controlled trial · Environmental health · Psychiatry · Randomized controlled trial · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Computer Science · Infant Development and Preterm Care · Medicine · Gerontology · Pediatrics
Community engagement in early childhood development intervention trials
Impact of an integrated parenting and nutrition intervention on growth and development in stunted children at 24 months
Exploring the impact of Rebt and mindfulness based parenting program on parental beliefs, practices and well-being
Whose child is it? A psychological perspective on responsibility and accountability in decision making on nurturing care in early childhood
Implementation, context and complexity
Nutritional supplementation, psychosocial stimulation, and mental development of stunted children
Inequality in early childhood
An Integrated Scientific Framework for Child Survival and Early Childhood Development
Parenting interventions to promote early child development in the first three years of life
Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world
Early childhood development
Child development
Nurturing care
Developmental potential in the first 5 years for children in developing countries
Early childhood development coming of age
Physical Status
Rapid-Cycle Evaluation in an Early Intervention Program for Children With Developmental Disabilities in South India
Rapid-cycle evaluation and learning for the effective delivery of integrated interventions in early childhood in rural India
The Aspirations of Measurement for Change
Photostory—A “Stepping Stone” Approach to Community Engagement in Early Child Development
Measurement for Change
Effectiveness of family-centered program for enhancing competencies of responsive parenting among caregivers for early childhood development in rural India
Cluster‐randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers
| Unique citing works | 4 |
|---|---|
| Citations per year | 2 |
| Citation span | 2024 - 2026 (3) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 4 |