Association for Public Policy Analysis & Management

This paper examines the effects of parental early childhood stimulation training on parent-child interactions and child’s nutritional and cognitive outcomes in Guatemala. This study assesses the cost effectiveness of using home-visits or group-sessions. More than 40 percent of Guatemala’s population is indigenous, making this country an ideal setting for new comparative research of an at-risk population that has not been studied comprehensively. Additionally, the literature on cost-effectiveness and cost-benefit analysis of early childhood stimulation programs is limited (Gowani, Yousafzai, Armstrong, & Bhutta, 2014). While more common in the developed world (Barnett & Masse, 2007; Belfield, Nores, Barnett, & Schweinhart, 2006), this type of analysis is most needed in the developing world given the limited resources of governments and organizations and the need to assess programs’ feasibility and sustainability. Moreover, while prior literature finds sizeable positive effects for home visitation on cognitive skills (Yousafzai, Rasheed, Rizvi, Armstrong, & Bhutta, 2014; Gardner, Walker, Powell, & Grantham-McGregor, 2003; Powell, Baker-Henningham, Walker, Gernay, & Grantham-McGregor, 2004), results are mixed in the case of group-session interventions (Aboud, Singla, Nahil, & Borisova, 2013; Jin et al., 2007; Nahar et al., 2012). This study will shed light on that.

To our knowledge, this study is the first that uses a clustered randomized controlled trial to assign communities (n=111) to three treatment arms: home visitations, group sessions, and no intervention in an indigenous setting. As such, it will advance the literature by providing evidence as to whether one early childhood stimulation modality produces better outcomes than the other does and, if so, by how much and at what cost. More than 2,000 children between 6 and 18 months of age were assessed at baseline. The interventions were also complemented with training, supervision, and mentoring of mother educators. Children received 10 months of intervention on average, and 85 percent of the original sample was re-interviewed at follow-up data collection. Attrition was mainly due to deaths and migration, but it did not show a systematic pattern. We assessed program effects on: (a) children’s nutritional status using anthropometric measures, (b) receptive and expressive language, and fine motor, using the MDAT scales of child development, (c) physical and emotional environment, using the HOME and FCI instruments, and (d) maternal depression using the Center for Epidemiologic Studies Depression Scale, Revised (CESD-R).

Intent-to-treat preliminary findings suggest that children who receive home visits are less likely to be overweight, and more likely to have a positive home environment than children who participate in group meetings or children in the control group. We also found that mothers who received home visits were less likely to be depressed than mothers in the control group. Our findings reveal a promising line of study that will be of particular interest to organizations concerned with early stimulation and its effects on child development during the crucial first two years of life. Specifically, these findings speak to policy makers of rural, indigenous and disadvantaged communities, where some parents rarely spend time reading, playing, or even talking with their infants and toddlers.