Testing Means to Scale Early Childhood Development Interventions in Rural Kenya

• In Event: 2-154 - Cost-effective and Scalable Early Childhood Interventions in LMICs: Evidence from Chile, Kenya, India, and Madagascar.

Integrative Statement

Recent neurobiological and psychological research has established that vital development occurs in language, cognitive, motor and socio-emotional development during the first few years of life, and early life outcomes are key determinants of adult outcomes such as educational achievement, labor market outcomes, and health. Yet more than 200 million children under age five in lower and middle income countries (LMICs) will fail to reach their developmental potential as adults, predominantly due to poverty, poor health and nutrition, and inadequate cognitive and psychosocial stimulation. Early childhood development (ECD) interventions featuring parent-child psychosocial stimulation and nutrition activities have been proposed as a powerful policy tool for the remediation of early disadvantages in poor settings, and numerous field studies have shown they can be effective in improving children’s developmental and health outcomes, at least in the short-term. Yet key questions remain on what models of delivery are the most effective and cost-effective that can be potentially scalable in LMICs, as well as how to sustain parental behavioral changes over time, which can lead to long-term improvements in child development and the possibility of positive spillovers to benefit younger siblings. Having a better understanding of the underlying behavioral pathways leading from intervention, to parental behavior changes, to child impacts, is also key to inform policy about the optimal design of interventions to maximize their scalability and sustainability.

Msingi Bora (“good foundation” in Swahili) is a multi-arm cluster randomized controlled trial across 60 villages and 1200 households in rural Kenya that tests different, potentially cost-effective and scalable models to deliver ECD interventions to affect parenting behaviors and child outcomes. Msingi Bora’s integrated child psychosocial stimulation and nutrition and preventive health education intervention is adapted from previous successful ECD trials in LMICs and includes a total of 16 biweekly sessions over 7 months. Our primary hypotheses are 1) village-based group meetings that include a limited number of follow-up home visits to reinforce the messages and give greater opportunity to practice the new behaviors and receive personalized feedback is the most promising and cost-effective model able to achieve sustained impacts in parental behaviors and child outcomes; 2) Engaging fathers in the sessions will lead to greater impacts on children’s development and sustained parental behavioral changes. Selected households will undergo a comprehensive baseline survey in September 2018 that includes rich measures of potential mediators and moderators of parental behavioral change. The sessions will begin in November 2018. A follow-up survey is planned for summer 2019 to measure short-term impacts in parental behaviors and children’s developmental outcomes. Additionally, we will again collect data on potential mediators of parental behavioral change to uncover the pathways leading to impacts. A follow-up survey two years after the end of the intervention will enable testing the sustainability of impacts, as well as the presence of any spillovers onto younger siblings. For this talk in March 2019, we will present results from our baseline survey as well as early results and experiences from the first half of sessions from Msingi Bora.

Authors

• Jill Luoto, RAND Corporation
  Presenting Author

• Italo Lopez Lopez Garcia, RAND Corporation
  Non-Presenting Author

• Frances Aboud, McGill University
  Non-Presenting Author

• Daisy Singla, University of Toronto
  Non-Presenting Author

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