Research Article: Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial

Date Published: April 24, 2018

Publisher: Public Library of Science

Author(s): Peter C. Rockers, Arianna Zanolini, Bowen Banda, Mwaba Moono Chipili, Robert C. Hughes, Davidson H. Hamer, Günther Fink, James K. Tumwine

Abstract: BackgroundEarly childhood interventions have potential to offset the negative impact of early adversity. We evaluated the impact of a community-based parenting group intervention on child development in Zambia.Methods and findingsWe conducted a non-masked cluster-randomized controlled trial in Southern Province, Zambia. Thirty clusters of villages were matched based on population density and distance from the nearest health center, and randomly assigned to intervention (15 clusters, 268 caregiver–child dyads) or control (15 clusters, 258 caregiver–child dyads). Caregivers were eligible if they had a child 6 to 12 months old at baseline. In intervention clusters, caregivers were visited twice per month during the first year of the study by child development agents (CDAs) and were invited to attend fortnightly parenting group meetings. Parenting groups selected “head mothers” from their communities who were trained by CDAs to facilitate meetings and deliver a diverse parenting curriculum. The parenting group intervention, originally designed to run for 1 year, was extended, and households were visited for a follow-up assessment at the end of year 2. The control group did not receive any intervention. Intention-to-treat analysis was performed for primary outcomes measured at the year 2 follow-up: stunting and 5 domains of neurocognitive development measured using the Bayley Scales of Infant and Toddler Development–Third Edition (BSID-III). In order to show Cohen’s d estimates, BSID-III composite scores were converted to z-scores by standardizing within the study population. In all, 195/268 children (73%) in the intervention group and 182/258 children (71%) in the control group were assessed at endline after 2 years. The intervention significantly reduced stunting (56/195 versus 72/182; adjusted odds ratio 0.45, 95% CI 0.22 to 0.92; p = 0.028) and had a significant positive impact on language (β 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (β 0.11, 95% CI −0.06 to 0.29; p = 0.196), motor skills (β −0.01, 95% CI −0.25 to 0.24; p = 0.964), adaptive behavior (β 0.21, 95% CI −0.03 to 0.44; p = 0.088), or social-emotional development (β 0.20, 95% CI −0.04 to 0.44; p = 0.098). Observed impacts may have been due in part to home visits by CDAs during the first year of the intervention.ConclusionsThe results of this trial suggest that parenting groups hold promise for improving child development, particularly physical growth, in low-resource settings like Zambia.Trial NCT02234726

Partial Text: Children in low- and middle-income countries continue to be exposed to a large number of risk factors affecting healthy development, ranging from exposure to malnutrition and infectious diseases to lack of appropriate stimulation and learning opportunities in their home environment and community [1,2]. According to the latest estimates, 40% of Zambian children under age 5 years are stunted and 6% are wasted [3]. More than 60% of the country’s population lives below the national poverty line, and the under-5 mortality rate is 64 per 1,000 live births [4]. Only 32% of Zambian children receive any form of early childhood care and education by age 6 years [5]. Efforts are currently underway to address the country’s malnutrition burden, most notably through the Scaling Up Nutrition funding mechanism [6].

We investigated the impact of community-based parenting groups on child development in Southern Province, Zambia. After 2 years, the intervention substantially reduced the odds of stunting and improved child language development. The intervention had a positive impact on caregiver–child interaction, which appears to have persisted during a 5-month interruption in delivery of the intervention.



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