Sustained two-year impacts of Msingi Bora, an evidence-based group-based parenting intervention in rural Kenya

• In Event: What happens next? Sustained impacts of early childhood interventions in low- and middle-income countries

Abstract

Background: An estimated 43% of children under age 5 in low- and middle-income countries (LMICs) experience compromised development due to poverty, poor nutrition, and inadequate psychosocial stimulation. Numerous early childhood development (ECD) parenting interventions have been shown to be effective at improving ECD outcomes, at least in the short-term, but they are a) still too expensive to implement at scale in low-resource and rural settings, and b) their early impacts tend to fade over time in the absence of continued support over a period of years. This begs the questions of how to cost-effectively sustain early program impacts long-term, and whether and how continued program support is needed to maintain the underlying parental behavioral changes over time.
Methods: We evaluate the impacts after two years of Msingi Bora (Swahili for “Strong Foundation”), a group-based parenting intervention evaluated in a multi-arm cluster Randomized Control Trial (cRCT) across 60 villages and 1,152 households in rural Kenya that was previously shown to improve child development and parenting behaviors immediately after its conclusion in Fall 2019 (Luoto et al., 2020), and comprised the most cost-effective parenting intervention to date among the limited few from LMICs reporting costs (Lopez Garcia et al., 2021).
Beginning in Fall 2019, in half of intervention villages, we extended Msingi Bora with “booster” group sessions held every other month for a total of two years to test how this light-touch extended intervention contributes to sustaining impacts over a longer horizon. The booster curriculum scaffolded on that of the original program, but added new and more advanced responsive stimulation strategies adapted to older children and introduced topics of positive disciplinary practices to manage child behaviors. While the onset of the global COVID-19 pandemic in March 2020 caused delays and forced a reduction to the size of group sessions, attendance rates remained high (71%), and a total of nine booster sessions were held over two years. In Fall 2021, a survey across all 60 villages and 908 of the originally enrolled 1,152 households (79%) measured medium-term impacts two years after the end of the original program.
Results: Households in villages that received only group meetings during the original intensive 8-month Msingi Bora program had sustained impacts on children’s cognitive development (0.19 SD), maternal knowledge (0.31 SD) and nutrition behaviors (0.19 SD) after two years relative to the control group, though short-term impacts on children’s socioemotional development and parental stimulation behaviors faded from significance. Households in villages that received group meetings and the subsequent extended boosters saw positive impacts on children’s socioemotional development (0.17 SD), parental stimulation scores (0.30 SD), children’s cognition (0.20 SD), and maternal knowledge (0.24 SD). These medium-term impact sizes represent declines of 29%-65% from two years prior, but nonetheless avoid the common problem of fade-out affecting parenting interventions in LMICs and are despite the ongoing global COVID-19 pandemic.
Conclusions: A cost-effective and potentially scalable group-based intervention can realize sustained impacts after two years on many ECD outcomes. Adding a light-touch booster intervention can further strengthen these sustained impacts.

Authors

• Italo Lopez Garcia, University of Southern California

• Jill E Luoto, University of Southern California
  Presenting Author

• Frances E Aboud, Centre universitaire de santé McGill

• Lia C.H. Fernald, University of California - Berkeley