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Evaluation of a child development intervention delivered through the government health system in Chatmohar, Bangladesh

Thu, March 23, 11:45am to 1:15pm, Salt Palace Convention Center, Floor: 1, Grand Ballroom E

Abstract

Background: Millions of children in Bangladesh experience developmental delays, and the prevalence of delay is higher in rural and lower-income households (Lu et al., 2020). A group-based intervention that targets multiple risk factors for poor development has been shown to improve child development outcomes in this setting (Pitchik et al., 2021). However, sustained delivery of a stand-alone early childhood development interventions in resource constrained settings is challenging due to lack of human resources, limited funding opportunities, and lack of inter-sectoral coordination (Bidwell and Watine, 2014; Britto et al., 2014; Samman et al., 2016). If feasible and effective, delivering early child development interventions through existing government health systems may maximize their reach to children at high risk for developmental delay.

Methods: We evaluated a group-based child development intervention delivered by government health workers at government health centers throughout Chatmohar, Bangladesh. The intervention included contents on responsive parenting, maternal mental health, lead exposure prevention, water, sanitation, hygiene, and nutrition. Pregnant women in their 2nd or 3rd trimesters and caregivers of children under 14 months living in Chatmohar were notified of the intervention starting and invited to attend sessions. Separate sessions were held for pregnant women (4 monthy sessions) and caregivers of young children (16 sessions two times a month). We collected data on caregivers of children 6-24 months at baseline (n=1635) and endline (n=1696). Approximately a third of the sample (n=517) are part of a longitudinal cohort assessed at both time points. Outcomes include child play activities and materials, maternal depressive symptoms, and nutrition knowledge. We used a difference-in-differences (DID) analyses to compare differences in outcomes over time between participants in the cohort who attended 2+ intervention sessions to those who attended <2 sessions. As a supplementary analysis we used linear regression to estimate mean differences in outcomes between the same groups in the cross-sectional endline sample. All analyses were adjusted for theoretical confounders.

Results: Forty-four percent (n=228) of the longitudinal cohort and 29% (n=335) of endline cross-sectional sample attended 2+ sessions. In the cohort those that attended 2+ sessions had a larger decrease in maternal depressive symptoms (DID: -0.46; 95% CI -1.98, 1.06), and a larger increase play activities (DID: 0.23; 95% CI:-0.11, 0.57) and play materials scores (DID: 0.58; 95% CI: 0.30, 0.85) compared to the group that attended <2 sessions. There were no differences in nutrition knowledge scores. When comparing mean differences in the endline cross-sectional sample, those who attended two or more intervention sessions had higher scores on all outcomes.

Conclusion and recommendation: When a multi-component child development intervention was delivered through the government health system, moderate initial uptake was observed at the population level. Attending two or more intervention sessions was associated with improvements in stimulating parenting behaviors and maternal mental health, though magnitudes were smaller than in a recent randomized control trial delivered by session facilitators hired specifically for the study. Understanding the barriers to session attendance will inform future interventions delivered through the government health system and inform the scalability of such interventions.

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