Building Parental Capacity to Improve Child Development in Bangladesh
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 six 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; are targeted toward younger and disadvantaged children; are of longer duration; and are integrated with family support, health, nutrition, or educational systems and services.
Yet there are serious gaps in knowledge about how to deliver integrated early childhood interventions in cost-effective ways in low-income settings—that particularly focuses on improving growth and child development in the first thousand days of a child’s life. This study will present results for an evaluation of one such intervention in Bangladesh.
With funding from the World Bank, AIR and its Bangladesh partners used a rigorous mixed-methods cluster-randomized controlled trial to determine the impact of Save the Children’s early childhood stimulation program on the cognitive and language development skills of children 0-3 years old in Bangladesh. The program sought to improve child development outcomes by delivering actionable messages to caregivers. These messages promoted positive early stimulation practices and maternal responsiveness to the emotional and physical needs of young children. The program built on an existing delivery platform—community clinics—and trained community health care providers to deliver messages on early childhood stimulation practices in addition to their usual messages about the children’s nutritional needs.
We collected baseline data in 2013 and follow-up data at the end of 2015 for 2,578 households with children. We also gathered survey data from service providers and community leaders, as well as focus group data from parents. The baseline data validated the study design showing that the randomization process created equivalent groups before the start of the program. During the study, we also implemented a dynamic monitoring strategy that collect monitoring data every two months from a random set of individuals (beneficiaries and suppliers) from both the control and treatment groups. These monitoring surveys allowed the impact evaluation team to have a deep understanding of how the program was implemented and learn what happened in households and communities because of the program activities.
As detailed in a 2017 World Bank Report, the Save the Children program had positive impacts on a number of important child outcomes, including their cognitive and language development, physical growth and socio-emotional skills. The impact on physical growth was surprising and encouraging because both the treatment and control groups received nutritional counseling and there was a concern that the new emphasis on early stimulation might reduce the time that case workers could discuss the children’s nutritional needs and associated practices. Instead, it appeared that the early stimulation messages helped reinforce the underlying nutritional intervention. We concluded that Save the Children’s intervention was both technically feasible and cost-effective. The program was implemented thorough community clinics as an extension of their existing health services and as a result the program cost was only U.S.$6.84 (BDT 530) per beneficiary child over a 1.5-year intervention period. Leveraging the existing community-clinic system helped minimize the program’s implementation costs. AIR is currently exploring funding options for long-term follow-up of the children and families in the study to capture any long-term benefits of the intervention.