Summarized by: Elizabeth Weage & Leonie Akofio-Sowah
What is the context for this research?
About 43% of children under-five in developing countries are at risk of not growing to their full potential. Poverty, severe malnutrition, and exposure to armed conflict are key reasons why many children do not reach their full potential.
This study sought to identify interventions to improve children's development in the early years (0-8years). The researchers reviewed interventions in five main areas: health, nutrition, education, child protection and social protection.
How was the research conducted?
The study reviewed multiple research papers from studies in countries such as Bangladesh, Jamaica, and Pakistan and summarized the results.
What were the main findings?
The study found that it was better for intervention packages to combine nurturing care with other sector specific programs. Nurturing care implied a stable environment that provides children with their health and nutritional needs, emotional support and protection from harm.
Nurturing care combined with other programs in health, nutrition, child and social protection, and child care and learning could improve child developmental outcomes.
For example, including stimulation (talking, singing, and playing) in nutrition programs could improve developmental outcomes, which could not be fully promoted through nutrition interventions alone.
The study also found that interventions needed to focus on the entire life course of a child. They were necessary at all the stages of childhood development: pregnancy, birth and the newborn period, infancy, and early childhood. Interventions prior to birth included measures to improve maternal healthcare and nutrition such as iodine supplementation during pregnancy, magnesium sulphate for women at risk for pre-term birth, aspirin for women at risk of high blood pressure as well as psychological support for mothers.
Evidence from the study revealed that psychological support and interventions provided by community health workers for mothers with depression showed an improvement in their moods and their ability to care for their infants. Furthermore, providing pregnant women with iron supplements reduced their risk of premature birth.
Interventions that occurred after birth included parenting support, effective breastfeeding and healthy nutrition, protection from harm and access to high quality childcare in both formal and informal preschools.
These interventions had positive impacts on children's growth.
For instance the study found that, parenting support including at home visits and group sessions resulted in positive effects on children's language and brain development. Also, breastfeeding supported healthy nutrition as well as infant-mother bonding. Teenagers who were breastfed had higher intelligence quotient (IQ) scores.
The study proposed three intervention packages which focused on aspects of nurturing care as well as the entire life course of the child. These were: the family support and strengthening package which aimed at equipping families to provide nurturing care; the multi-generational nurturing care package which focused on the care and protection of parents' physical and mental health while enhancing their ability to provide nurturing care for their children; and the early learning and protection package which combined parental support and the assistance of teachers' and caregivers' in order to create a nurturing environment in early childhood centers, classrooms, and community settings for learning.
What were the study's conclusions or recommendations?
The paper concluded that early child development interventions were most effective when they combined nurturing care with other child development interventions. There was evidence that interventions which focused on the entire life course of a child resulted in long-lasting positive effects on child development. Moreover, the study stated that interventions focused on improving children's early years should be able to target the specific challenges facing children in a particular environment.
Even though the study identified interventions that are effective, more work is needed to be done to understand how successful these interventions would be especially in conflict affected and fragile countries.
Britto, Pia R., et al. "Nurturing care: promoting early childhood development." The Lancet 389.10064 (2017):91-102
Indicators of key interventions relevant to early childhood development in Ghana
Nurturing Care: It consists of good nutrition, adequate care, provision of learning opportunities from birth onwards, and protection from disease, violence and stress. Only 6 % of households with children under-five have 3 or more books available. Besides, only 41% of children aged 0-59 months have 2 or more playthings in their homes
Ghana Statistical Service, 2011. Ghana Multiple Indicator Cluster Survey with an Enhanced Malaria Module and Biomarker, 2011, Final Report. Accra, Ghana.