Association for Public Policy Analysis & Management

Background. Globally, at least 200 million children younger than five years old are falling short of their potential for development and growth. In Bangladesh, 22% of infants have low birth weight and 64% are exclusively breastfed until age 6 months. Forty-one percent of children under five have stunted growth, and the majority lack appropriate stimulation and early learning opportunities.  There is some evidence that improvements to children’s health, nutrition, and development outcomes can be made through programs that provide direct learning experiences to children and families. Yet there are serious gaps in knowledge about how to deliver integrated early childhood interventions in cost-effective ways in low-income settings.

Intervention. The early childhood stimulation program developed by Save the Children seeks to improve child development by promoting positive early stimulation practices and maternal responsiveness to the emotional and physical needs of children up to three years old. The program builds on an existing delivery platform—household visits and community clinics—and trains community health care and family planning providers to counsel families (especially mothers of young children) on early childhood stimulation practices. Each household receives a Child Development Card, a booklet with key messages, and two picture books. The Save the Children early childhood stimulation intervention builds on the NNS platform, which already reaches out to frontline service providers.  The NNS program trains service providers to deliver a comprehensive nutrition package to households with young children, and Save the Children complements this by providing additional training modules on early stimulation and responsive care. 

Setting and Population. The study was carried out in rural Bangladesh in the sub-districts of Muladi, Satkania, and Kalaura. Within these sub-districts the study took place in 78 community clinics located in 30 unions. The sample consists of 2574 households with children aged between 3 months and 18 months of age. The study sample frame was generated from community clinic health assistant records.

Research Design. This evaluation is a cluster-randomized control trial (RCT), in which community clinics within the same union (or administrative unit) are randomly assigned to either receive the intervention or not receive the intervention. A total of 78 community clinics were randomly assigned to the treatment and control groups. Within each community clinic catchment area, we randomly selected 33 households with children aged between 3 months and 18 months. The same set of households surveyed during the baseline data collection period were surveyed during the endline data collection period. 

Data Collection and Analysis. Data collection took place face to face in the field, using highly scripted surveys. The team collected the following type of data: a) Household survey; b) Anthropometric measures; c) The cognitive and language subscales of the third version of the Bayley Scales of Infant and Toddler Development (BSID–III); c) Service provider survey; d) Administrator survey; e) Non-compliance survey. 

Results. The study team just completed the endline data collection and is in the process of preparing the final impact report, which is expected to be completed by April 2015.