Helping children in vulnerable communities in West Bank to reach their full developmental potential: A quasi-experimental study

• In Event: Roundtable Session (Monday II)
  In Refereed Round-Table Session: Nurturing care: building evidence for program implementation and effectiveness_session II

Proposal

Most communities in Palestine don’t have access to basic, quality health, and early childhood development (ECD) services given the complex political environment, border closures and extreme poverty. Toxic stress is prevalent which increases the risk factors for developmental delays in young children. Consequently, WV in West Bank started implementing in 2011 the Timed & Targeted Counseling (ttC) approach applying behavior change communication strategies. The approach consists of home visits delivered by Community Health Volunteers (CHV) whom are trained to promote health and nutrition in the first 1000 days. In 2016, WV enhanced the ttC approach (EttC) by integrating ECD and maternal mental health interventions to promote holistic child development aligned with the Nurturing Care framework.

To test the effectiveness of EttC, WV selected 520 participants (258 intervention, 262 control group) from North and Southern areas of West Bank, using purposive non-probability sampling methodology. Control groups received the original ttC approach (mainly health interventions), whereas the intervention group received the EttC approach. In both groups women enrolled in the programme at the 3rd trimester of pregnancy, received home visits by CHVs twice a month up until their child’s one-year birthday. The battery of tools were administered at different intervals (baseline/endline and child development at specific intervals).

The research revealed improvement among the two study groups regarding maternal, child health and nutrition indicators. The two scales such as Maternal Antennal attachment scale (MAAS) and Maternal Postnatal Attachment Scale (MPAS) measured mother’s attachment to baby. Findings revealed that MASS scores, being comparable among both groups at baseline, after 12 months the intervention group scored significantly higher on MPAS compared to the control group. Findings showed a significant relationship between MPAS and child interaction, or valuable time being spent with the child.

Mothers in the intervention and control group showed significant decrease in depression symptoms compared to baseline. At baseline, measured by the Edinburgh postnatal depression scale (EPDS), 37.3% of mothers (105 control, 85 intervention) had depression. The final evaluation showed only 14.4% of the whole study group exhibited depression. This indicates that both ttC and EttC are effective in improving maternal mental well-being.

The Ages & Stages Questionnaire (ASQ) findings showed that the EttC intervention is effective in promoting child development in most of the domains. The ASQ measurements done at 6 and 12 months of age showed significant differences between control and intervention groups particularly in communication, senses, and gross motor development domains. Social development domain in the intervention group was above the cut-off point which means that those children had sufficient normal development milestone according to their age.

Conclusion
The integrated EttC package proved to be effective in promoting child holistic development. Community approaches are very effective, especially in areas were access to services is poor. Two levels of scale up for this intervention are envisioned: scale-up to reach the most vulnerable communities, and ensure sustainability through institutionalizing this service as part of the Ministry of Health program.

Authors

• Viktoria Sargsyan, World Vision International

• Hana Rabadi, World Vison