Testing Ways to Scale Early Childhood Development Interventions in Kenya

Background

An estimated 250 million children under age 5 in low- and middle-income countries (LMICs) are not achieving their full developmental potential due to poverty, nutritional deficiencies, and inadequate stimulation. Early childhood development (ECD) interventions that promote responsive parenting and nutrition education have effectively improved child development outcomes in numerous LMIC settings. Early childhood can also be a cost-effective period to address developmental outcomes, since early investments have the potential to improve adult human capital. However, much less is known about why or how these interventions work - the underlying mechanisms leading to these improved child outcomes, nor how to bring these interventions and programs to scale in limited resource settings. Our study, funded by the National Institute of Child Health and Development, aims to help fill these gaps.

Methods

The study focuses on two different and potentially sustainable models to deliver an ECD intervention to improve psychosocial outcomes of very young children. The intervention is delivered in three subcounties of rural western Kenya using a multi-arm clustered randomized control trial across 60 villages and 1,152 households. Eligible households had children aged 6-24 months at enrollment. We randomly assigned 20 villages (clusters) each to one of three arms: 1) group-only delivery with 16 fortnightly sessions; 2) mixed delivery combining 12 group sessions with four home visits; and 3) a comparison group. In the treatment villages, fathers were invited to participate in half of the sites, which were randomly selected. Primary outcomes were child development and parental stimulation.

Selected households participated in baseline and follow up surveys to measure the short-term impacts in parental behaviors and children’s developmental outcomes. A follow-up survey two years after the end of the planned intervention will enable testing the sustainability of impacts as well as the presence of any spillovers onto younger siblings. The study aims to provide policymakers with rigorous evidence of how best to expand ECD interventions in low-resource settings to improve child developmental outcomes in both the short- and longer-term.

Preliminary Findings

We found improvements in child cognition, receptive language and socio-emotional development under both delivery models as well as improvements in parental stimulation practices at the first follow-up survey. The study will run from 2017-2022, with preliminary results published in summer 2020. Our early results comprise the first effectiveness trial featuring an exclusively group-based ECD intervention for all age-eligible children in an LMIC (and who are not receiving conditional cash transfer benefits), and to demonstrate positive program impacts on cognitive, language, and socioemotional development.