Delivery of an Integrated Child Development Intervention by Government Health Workers in Chatmohar, Bangladesh

• In Event: Family Context and Child Development in the Global South

Abstract

Introduction: In Bangladesh millions of children experience developmental delays, and prevalence of poor developmental outcomes is higher in rural, and lower-income households (Lu et al., 2020). Group-based interventions that target multiple risk factors may be effective at improving child development outcomes, however there is limited evidence on how to deliver such interventions through existing systems (Britto et al., 2018). If feasible and effective, delivering early child development interventions through government health systems may maximize their reach to children at high risk for developmental delay, including those living in rural and lower-income communities are reached.

Hypothesis: A group-based early child development intervention delivered through the government health system in Chatmohar, Bangladesh will be attended by community members, and attendance to the program will be associated with increased stimulating caregiving practices, and reduced depressive symptoms amongst caregivers.

Study Population: Primary caregivers and children under 24 months of age in Chatmohar, Bangladesh

Methods: We evaluated a multi-component group-based child development intervention delivered through the government health system throughout Chatmohar, Bangladesh. The aim of this analysis was to estimate the reach of the intervention in Chatmohar sub-district, and the effect of the intervention on stimulating caregiving practices and maternal mental health. Intervention sessions were delivered by government health workers at community health facilities. The 8-month intervention (August 2019-March 2020) consisted of group sessions for pregnant women and caregivers of children under 24 months of age. Pregnancy sessions were delivered monthly, and caregiver-child sessions were delivered fortnightly. Intervention content included responsive stimulation, nutrition, water, sanitation, hygiene, caregiver mental health, and lead exposure reduction (Table 1). We conducted two assessments with caregivers of children 6-27 months of age, one in person prior to the intervention (June-July 2019), and one by phone following intervention completion (July-September 2020). The sample is representative of Chatmohar sub-district (population proportional to size sampling methods). Three analytic approaches were used to estimate the effect of the intervention on stimulating caregiving practices and maternal mental health: 1) longitudinal difference-in-differences analysis using intervention attendance data as the exposure, 2) cross-sectional matched endline-only comparison between those that did and did not attend intervention sessions, and 3) a cross-sectional matched pre-post comparison.

Results: The total number of beneficiaries eligible to attend the group sessions at intervention baseline was 7986. Over 8 months 8 pregnancy and 16 mother-baby intervention sessions were delivered across 44 community health facilities in Chatmohar. The number of participants in each group session was 10-15 for both pregnancy and mother-child sessions. At baseline 1635 caregivers of children 6-24 months of age were assessed. At endline 1680 primary caregivers of children 6-27 months were assessed, with 520 part of a longitudinal cohort also assessed at baseline. Preliminary results show at endline 45% (n=753) of the sample reported attending at least 1 intervention session (amongst those that attended at least 1 session, median: 3 (IQR: 2-5)) (table 2). Results for estimates of intervention effects on stimulating caregiving practices and maternal mental health will be presented, and implications for further scale up will be discussed.

Authors

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

• Tarique M.N. Huda, icddr,b
  Non-Presenting Author

• Jesmin Sultana, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
  Non-Presenting Author

• Abul Shoab, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Md. Mahbubur Rahman, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Fahmida Tofail, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Fahmida Akter, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Tania Jahir, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Md. Ruhul Amin, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Khobair Hossain, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Jyoti B. Das, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Md. Rezaul Hasan, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Farzana Yeasmin, International Center for Diarrhoeal Disease Research, Bangladesh
  Non-Presenting Author

• Jenna E. Forsyth, Stanford University
  Non-Presenting Author

• Malay Kanti Mridha, BRAC University
  Non-Presenting Author

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

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

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