Poster #156 - Impact of Integrated Caregiving Intervention on Maternal Caregiving Practices and Mental Health in Rural Bangladesh

• In Event: 2-002 - Special Poster Session 05 with Continental Breakfast Reception
  In Poster Session: PS 05 - International Section

Integrative Statement

Background:
Early motor, language, cognitive, and socioemotional development are predictive of later life outcomes, including educational attainment, economic earnings, and behavior in early adulthood (Black et al. 2017). In low- and middle-income countries (LMICs), children experience a disproportionally high burden of simultaneous risk factors for delayed development, including inadequate early learning opportunities, a lack of responsive caregiving and poor maternal mental health, poor sanitation, nutritional deficiencies and environmental hazards (Britto et al. 2017). Caregiving interventions – providing direct child stimulation and nutrition or specifically supporting parents in a one-on-one model to provide these inputs – have been shown to improve child development outcomes (Yousafzai et al. 2014). While there has been widespread enthusiasm to support the implementation of integrated interventions, some studies have shown that child development messages may be lost when added to or integrated with many other health messages.

Methods:
We assessed the impact of a mixed-age, group-based, caregiving-support intervention that integrates behavioral recommendations on water, sanitation, and hygiene, maternal and child nutrition, lead exposure prevention, child stimulation, and maternal mental health. Key outcome measures were maternal caregiving practices using the Family Care Indicators and maternal depressive symptoms using the Center for Epidemiologic Studies Depression Scale. Other variables include a range of individual- and household-level characteristics. We conducted a 9-month, cluster-randomized controlled pilot trial, which took place in 31 rural villages in the Kishorganj district of Bangladesh. We enrolled pregnant mothers and mothers of children up to 14 months of age, with 20 women per cluster. Each village was randomly assigned to one of two intervention arms or a passive control arm. Intervention arms were: 1) community group sessions (group arm, 5-8 mother-child dyads) or 2) alternating group sessions and home visit sessions (mixed arm); contacts occurred every two weeks in both intervention arms. We compared the outcomes in the combined intervention group to those in the control group, and conducted all analyses as intention to treat.

Results:
In August 2017, 621 women were enrolled in the RINEW trial in 31 villages: 321 women were allocated to an intervention arms, and 300 women to the control arm. At endline, 7.4% of women were lost to follow-up or did not complete the endline assessment; women lost to follow-up were not significantly different from those not lost to follow-up on baseline asset ownership or years of maternal education. When compared to the control group at endline, stimulating maternal caregiving practices were significantly higher in the intervention groups (effect size: 0.70, 95% CI 0.60 to 0.94), and mothers in the intervention groups reported significantly fewer depressive symptoms (effect size: -0.17, 95% CI -0.30 to -0.03).

Interpretation:
An integrated, mixed-age, caregiving-support intervention delivered by trained community members in rural Bangladesh improved stimulating maternal caregiving behaviors and maternal mental health. This integrated platform may be a unique and feasible way to simultaneously address multiple risk factors for child development to improve maternal well-being.

Authors

• Helen Osborne Pitchik, University of California, Berkeley
  Presenting Author

• Fahmida Tofail, icddr,b
  Non-Presenting Author

• Abul Kasham Shoab, icddr,b
  Non-Presenting Author

• Jesmin Sultana, icddr,b
  Non-Presenting Author

• Tarique Md. Nurul Huda, icddr,b
  Non-Presenting Author

• Fahmida Akter, icddr,b
  Non-Presenting Author

• Peter J. Winch, Johns Hopkins School of Public Health
  Non-Presenting Author

• Stephen P. Luby, Stanford University
  Non-Presenting Author

• Md Mahbubur Rahman, icddr,b
  Non-Presenting Author

• Tania Jahir, icddr,b
  Non-Presenting Author

• Md. Ruhul Amin, icddr,b
  Non-Presenting Author

• Md. Khobair Hossain, icddr,b
  Non-Presenting Author

• Jyoti Bhushan Das, icddr,b
  Non-Presenting Author

• Esther Chung, UNC Chapel Hill
  Non-Presenting Author

• Malay Mrinda, BRAC University
  Non-Presenting Author

• Christine P Stewart, University of California Davis
  Non-Presenting Author

• Kendra A. Byrd, World Fish
  Non-Presenting Author

• Jenna Forsyth, Stanford University
  Non-Presenting Author

• Lia Fernald, University of California, Berkeley
  Non-Presenting Author