Improving early childhood outcomes through caregiving interventions: Effectiveness of Building Brains in seven low- and middle-income countries

• In Event: Evidence from integrated ECD-Health interventions in low- and middle-income country contexts

Proposal

With large proportions of children still failing to achieve early development milestones and foundational learning, there is a strong rationale and growing endorsement for early childhood parenting programs in low- and middle-income countries. Such interventions can mitigate the risks that young children face due to inequalities, poverty, and other contextual and environmental threats, (Belsky et al., 2007) and contribute to overall better learning, development and health outcomes (Jervis et al., 2023). Implementing evidence-based ECD programs is complex and involves substantive adaptations to local contexts and circumstances (Grantham-McGregor et al., 2023). Program effectiveness can be affected by these adaptations and by implementation challenges which may lead to stronger or weaker impacts in terms of improving child development outcomes (Jervis et al., 2023).

In 2018, Save the Children launched the Building Brains approach, a manualized intervention based on group and individual sessions with caregivers to foster responsive care and opportunities for early learning through play. Since then, this program has since been deployed in 30 countries from all world regions, and across varied contexts, including humanitarian settings. While Building Brains can be integrated into and delivered through any existing platforms across the health, education or child protection sectors, it is commonly delivered in integration with Nutrition and/or Health programs. A recently launched series of studies aims to take stock of these and other insights about Building Brains, to understand its reach and impact to date, and to improve and increase programmatic deployment. In this presentation, we describe the results of a systematic review and meta-analysis of impact evaluations of seven caregiver-based interventions using the Building Brains approach.
From a total of twenty evaluation reports for programs using Building Brains, we identified ten eligible impact evaluations using an intervention and a control group. From these, we were able to extract effect size information for three randomized controlled trials and four quasi-experimental studies. Two reviewers screened, extracted data, and assessed study quality from eligible studies. We assessed results for child (cognitive, language, motor, and socioemotional development) and caregiver outcomes (knowledge and practices). For each outcome, we calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using random-effects meta-analytic approaches. We used meta-regression models to further assess potential effect modification by implementation setting, delivery platform, duration, delivery, setting, and study quality.
At abstract submission, preliminary results for pooled effect sizes indicate a positive benefit of Building Brains on early childhood development (SMD=0.29, 95%CI 0.06-0.52, p<.001). Our presentation will include the final results for the remaining child and caregiver outcomes and discuss study limitations including unexplained heterogeneity, insufficient documentation of intervention content and implementation, and varying quality of evidence across studies. We will also link the meta-analysis results to our global Building Brains programming and discuss future efforts to increase enabling factors for ECD programs, thereby increasing the potential return on investment of high-quality caregiving interventions in LMICs.

Authors

• Filipa de Castro, Save the Children

• Emily Weiss, Save The Children International

• Sara Dang Dang, Save the Children