From surviving to thriving: What evidence is needed to move early child-development interventions to scale?

Résumé

Previous research has established that delivering interventions in the first 1,000 days of life improves mother-child attachment [1], contributes to the reduction of health inequities [2], has a significant impact on adult health [3], and is cost-effective [4].At the global level, the importance of the early years of a child's life is reflected in high-level World Health Organization (WHO) and United Nations Children's Fund (UNICEF) support [5], the Global Strategy for Women's, Children's and Adolescents' Health (with its focus on not only survival but also children's ability to thrive and progress successfully into adolescence) [6], and the Nurturing Care Framework to be launched at the WHO World Health Assembly in May 2018.In this week's PLOS Medicine, 2 Research Articles present findings from trials conducted in Zambia and Colombia that add to the burgeoning evidence base on the implementation of early interventions designed to improve early child development (ECD) in low-and middle-income countries (LMICs). Child development interventions: Mechanism of impactPeter Rockers and colleagues [7] assessed the impact on ECD of community-based home visiting incorporating health screening and parenting groups.The study was a 2-year follow-up of a cluster-randomised controlled trial conducted in Zambia with the caregivers of children between the ages of 6 and 12 months.The study included fortnightly home visits conducted by child development agents (CDAs) for the first year as well as parenting groups every 2 weeks for 2 years.The intervention significantly reduced stunting (odds ratio [OR] 0.45, 95% CI 0.22-0.92;p = 0.028) and was associated with an improvement in child language (β 0.14, 95% CI 0.01-0.27;p = 0.039), but there was no impact on other child-development outcomes.While Rockers and colleagues' study is important and speaks to the difficulties of improving child development in low-resource contexts, one of the key conclusions of the paper is that parenting groups may be a promising avenue for improving physical growth and child development.This of course may be true, but it is more likely that the improvements in stunting were a result of the home visits of the CDAs, and not the parenting groups, given that their visits focused on screening for infections and acute malnutrition and encouraging caregivers to attend routine health services.Without an understanding of the mechanisms involved, drawing conclusions about what component of a complex intervention is the likely agent of change is difficult.Alison Andrew and colleagues [8] describe the medium-term impacts of an ECD intervention in Colombia.They followed up a cohort that had previously received a psychosocial

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