Association for Public Policy Analysis & Management

In resource-limited settings such as Southern Africa, malnutrition and infectious diseases need to be an integral part of thinking about early childhood interventions. We conducted a cluster-randomized trial to test the feasibility and preliminary impact of a package of community-based early childhood services in a rural area of Southern Province, Zambia. As part of the trial, households in communities randomized to the intervention group received two main services: 1) biweekly visits from a local health worker who screened and referred children for management of infections and malnutrition; and 2) an invitation to attend a biweekly mothers’ group meeting based on cognitive stimulation and play practices, child nutrition and cooking practices. Groups self-organized and elected a mother volunteer who was mentored by the community health worker on the curriculum and its implementation.

The primary eligibility criterion for inclusion in the study was having a child between 6 and 12 months of age at the time of enrollment in the study. Households were randomized at the level of the health zone (cluster) to the intervention or the control group. There were a total of 30 health zones in the final study sample, with six in each of the five facility catchment areas.

In total, 526 caregiver-child dyads were enrolled in the study at baseline. Children were on average 8 to 9 months old at the start of the study, with a relatively uniform distribution within the range of eligibility (6 to 12 months). There was a total of 23 visit rounds during the study period and a total of 20 meetings held in each community during the study period.

We found a significant positive impact on parenting behavior. Caregivers in the intervention group were almost 30 percentage points more likely to have done activities such as telling stories, labeling and naming things, and reading with the children. They knew more songs and were 25% more likely to talk with other peers about their child development.  Children in the intervention group also had 1.9 times higher odds of consuming non-meat protein in the previous 24 hours than did children in the control group and a statistically significant increase in the dietary diverse score. For outcomes, we find consistent, though statistically insignificant, positive impacts on physical growth, including WAZ and HAZ. However, the intervention package does not appear to have had a statistically significant impact on children’s cognitive and socioemotional development.

This paper adds to a growing literature that aims to identify effective methods for delivering interventions to improve early childhood development outcomes in diverse settings globally. Regular household visits coupled with mothers’ groups appear to positively impact caregiver behaviors.