Strategies For Reducing Inequalities And Improving Developmental Outcomes

Strategies For Reducing Inequalities And Improving Developmental Outcomes


The cumulative risks to which many children across the world, particularly in the developing nations are exposed to, suggest the need for intervention. Early child development programmes are designed to improve the survival, growth and development of young children, prevent the occurrence of risks and ameliorate the negative effects of risks. Though evidence suggests that integrated interventions are definitely effective, there are also a range of early childhood programs which are promising. These include programs to improve food intake and reduce stunting (supplementation programs, exclusive breastfeeding, conditional cash transfers, nutrition monitoring), stimulation programs combined with nutrition and health programs, centre based programs, parenting and parent-child programs.

Featured below are abstracts of publications focussing on interventions/strategies that aim to enhance early childhood development:

  • Ade, A., Gupta, S.S., Maliye, C., Deshmukh, P.R., & Garg, B.S. (2010). Effect of improvement of pre-school education through Anganwadi center on the intelligence and development quotient of children. Indian Journal of Pediatrics (March 31). PMID: 20358312 [Pub Med – as supplied by publisher]

OBJECTIVE: To find usefulness of a package of interventions to improve preschool educationthrough Anganwadi centers on psychosocial development of children. METHODS: A case-control study was undertaken to evaluate an intervention. Eight Anganwadi centers were selected using simple random samplingout of sixteen Anganwadi centers in Talegaon PHC area where intervention was done. Ten children in age group of 4-6 years were selected randomly from each of the eight Anganwadi center in intervention arm. For each child from intervention arm, one age matched child was selected from the matched Anganwadi center. For each subject, Intelligence Quotientand Development Quotient were assessed. RESULTS: Mean Development Quotient (DQ) and Intelligence Quotient (IQ) values were higher among children in intervention Anganwadi centers (16.2 points for DQ and 10.2 points for IQ). This difference was found statistically significant (p = <0.01). Mean DQ among boys was found 10.1 points higher than that among the girls in control arm, this was statistically significant. According to multivariate linear regression model, the determinants of DQ were: intervention; age of the child; education of mother; sex of child; and PEM grade and the determinants for IQ were: intervention; age of the child; and income. CONCLUSION: This study shows that intervention to improve the Early Childhood Educationand Development component through Anganwadi centers results in improvement in Developmental and Intelligence Quotient of children.

  • Ames, P., Rojas, V., and Portugal, T. (2010) Continuity and respect for diversity: Strengthening early transitions in Peru. Working Paper No. 56, Studies in Early Childhood Transitions. The Hague, The Netherlands: Bernard van Leer Foundation

This working paper is part of a series on early transitions from Young Lives, a 15-year longitudinal study of childhoodpoverty in Ethiopia, India, Peru and Vietnam. It explores the diverse experiences of 28 children from four contrasting communities in Peru as they start school. These detailed case studies highlight common problems: exclusion of certain parts of the population from pre-school services, lack of coordination between pre-schools and primary schools, issues with physical punishment and cultural diversity. It proposes four ways in which children’s early educational transitions can be enhanced, looking at such factors as educational structures, curriculum planning and teacher training.

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  • Bernal, R., Fernández, C., Elisa Flórez, C., Gaviria, A., René Ocampo, P., Samper, B., & Sánchez, F. (2009). Evaluacion de impacto del Programa Hogares Comunitarios de Bienestar del ICBF (Evaluation of the impact of  the program of Community homes of well-being of ICBF) Bogota, Colombia: Centro de Estudios sobre Desarrollo Economico Universidad de los Andes.

This document summarizes the main results of the Impact Evaluation Study of Hogares Comunitarios de Bienestar in Colombia. During 2007,

Universidad de los Andes and PROFAMILIA collected information for about twenty eight thousand children including participants and potential

participants of the program and evaluated the effects of the intervention on nutritional status, health, cognitive and non-cognitive development

of children.The results indicate that there is a positive and significant effect of the program on nutritional status measured by a reduction in the

probability of chronic malnutrition of around 2 percentagepoints for children between the ages of 2 and 4. In addition, we report a negative

effect of the program on children’s health as measured by incidence of diarrhoea and respiratory illness. However, the negative effect declines

as exposition to the program increases. The results also indicate positive effects on cognitive development of children with at least 15 months

of exposition to the program and medium-run cognitive effects as measured by gains in standardized tests in fifth grade. Finally, we report

significant improvement in psychosocial development of participants with at least 15 months of exposition to the program, in particular,better

play interactions and lower play disconnection.

  • Bonilla, M.N., Go’mez, V.M.,Stacey, L., Eguiguren, F.C., Carrasco, F.,Torre, A., Torre, C. &Larrea, F.(2004). Global Report of Final Evaluation of the ProgramNuestros Niños,Summary of Evaluation, Final versión,vol. 1.

The PNN comes as innovation for childhood sector in Ecuador through a new organizational strategy aimed at stimulating the participation of other actors in the sector (community organizations, NGOs, municipal authorities, etc.) for the provision of care services and policy development for children. The main actions taken by the NNP have focused on three areas: i). Actions to improve educational facilities of the existing care units. (ii) Actions related to the care of children, under new forms of care of children, and (iii) actions related to the institutional strengthening of the sector.

  • Cole, C.F., Labin, D.B, & Galarza, M.R. (2008). Begin with the children: What research on Sesame Street’s international co productions reveals about using media to promote a new more peaceful world. International Journal of Behavioral Development, 32 (4), 359–365. DOI: 10.1177/0165025408090977

For nearly four decades, Sesame Workshop1 has brought the joy of learning to the world’s youngest citizens through the introduction of locally-produced co productions of the preschool television series, Sesame Street. Many of these television shows have been specifically designed to forward important prosocial messages directly linked to the complex socio-political backdrop in which they are created. Focusing on recent projects in Israel, Palestine, Jordan, and Kosovo, this article reviews research on the educational effectiveness of these initiatives and highlights the ways in which study results provide information on best practices for media projects designed for children living in regions of conflict. The paper also reviews the strengths and weaknesses of various approaches and provides practical information on how difficult issues have been presented in an age-appropriate and culturally-relevant manner. By acknowledging the challenges inherent to producing media designed to effect attitudinal and behavior changes in places mired in ongoing conflict, these studies, when examined as a group, provide emerging evidence of the need for increasingly direct and specific media intervention efforts. Presenting these studies in light of the projects that they evaluate and the related socio-political circumstances offer a body of evidence suggesting the educational value of these media efforts and indicating a need for further study in this field.

  • Engle, P. (2010). Care for Development in three Central Asian Countries: Report of Process Evaluation in Tajikistan, Kyrgyzstan, and Kazakhstan to UNICEF Tajikistan and UNICEF CEE CIS Regional Office.

The Care for Development Module of IMCI provides age-based recommendations for parents in how to play (cognitive development) and communicate (language and social development) with their children from birth through 2 years of age, as well as problems that caregivers may encounter and possible solutions. This report is a process evaluation including quantitative and qualitative data to determine the extent to which the Care for Development component has been incorporated into the health system, and whether it has influenced medical workers, consultations, families or children in three Central Asian countries. It also assesses the opinions of leaders at local, regional, and national levels in the Ministry of Health, and in IMCI Centers about Care for Development.   Finally, it provides recommendations for implementation of Care for Child Development in health systems.

  • Engle, P. (2008).  National plans of action for orphans and vulnerable children in sub-Saharan Africa: Where are the youngest children?  Working Paper No. 50. The Hague, The Netherlands: Bernard van Leer Foundation.    

 The HIV pandemic in the sub-Saharan Africa has rendered the youngest orphans, infected/affected by HIV, the most vulnerable. A review of National plans of action of 17 countries in the region, found that there is a wide range in the developmental appropriateness of the plans within the 17 countries. The most common interventions are health and nutrition and birth registration. Slightly less than half of the plans have components that include childcare centres (8) or community-based centre programmes (7). Some NPAs incorporated concerns for psychosocial support for younger children (4), a holistic approach to the treatment of HIV-infected children (6) and incorporating young children’s concerns into home-based care (3). Only two programmes mentioned capacity building for working with young children and three plans had age categories in their monitoring and evaluation plans. Some NPAs included programmes for young children but did not include funding. The evidence suggests that there is a clear and significant trend over time for increased incorporation of developmentally informed perspectives into plans, with the more recent plans having many more components. This change has been influenced by a series of advocacy efforts by the early childhood development (ECD) community and the HIV/AIDS community. However, these plans remain vague and not well defined. More efforts are needed to ensure that they will in fact be implemented, and that there will be sufficient quality in the responses. The author makes recommendations to evaluate assumptions, provide adequate funding, develop capacity in ECD at the country level and strengthen the role of the health sector, as well as strengthen structures at the local, regional and national levels for an integrated approach among others.

  • Fernald, L.C.H., Gertler, P.J., & Neufeld, L.M. (2009).10-year effect of Oportunidades, Mexico’s conditional cash transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up study,The Lancet, Published Online November 4, DOI:10.1016/S0140-6736(09)61676-7

Background: Mexico’s conditional cash transfer programme, Oportunidades, was started to improve the lives of poor families through interventions in health, nutrition, and education. We investigated the effect of Oportunidades on children almost 10 years after the programme began.

Methods: From April, 1998, to October, 1999, low-income communities were randomly assigned to be enrolled in Oportunidades immediately (early treatment, n=320) or 18 months later (late treatment, n=186). In 2007, when1093 children receiving early treatment and 700 late treatments in these communities were aged 8–10 years; they were assessed for outcomes including physical growth, cognitive and language development, and socioemotional development. The primary objective was to investigate outcomes associated with an additional 18 months in the programme. We used cluster-adjusted t tests and multivariate regressions to compare effects of programme participation for height-for-age, body-mass index (BMI), and cognitive language and behavioural assessment scores in early versus late treatment groups.

Findings: Early enrolment reduced behavioural problems for all children in the early versus late treatment group(mean behaviour problem score –0·09 [SD 0·97] vs. 0·13 [1·03]; p=0·0024), but we identified no difference between groups for mean height-for-age Z scores (–1·12 [0·96] vs. –1·14 [0·97]; p=0·88), BMI-for-age Z scores (0·14 [0·99] vs. 0·17 [1·06]; p=0·58), or assessment scores for language (98·8 [13·8] vs. 98·4 [14·6] p=0·90) or cognition (98·8 [12·9] vs. 100·2 [13·2]; p=0·26). An additional 18 months of the programme before age 3 years for children aged 8–10 years whose mothers had no education resulted in improved child growth of about 1·5 cm assessed as height-for-weight Z score (β 0·23 [0·023–0·44] p=0·029), independently of cash received.

Interpretation: An additional 18 months in the Oportunidades programme has independent beneficial effects other than money, especially for women with no formal education. The money itself also has significant effects on most outcomes, adding to existing evidence for interventions in early childhood.

  • Jones,L., Morris,J., Berrino, A., Crow, C., Jordans,M., and Okema,L. (2011). Does combining infant stimulation with emergency feeding improve psychosocial outcomes for displaced mothers and babies: A controlled evaluation from Northern Uganda. Draft Report

Combined psychosocial and nutrition interventions improve the development of infants. However, there is a paucity of studies examining the effectiveness of such interventions in humanitarian settings. This paper examines the impact of combining a group based psychosocial intervention with an existing emergency feeding programme for internally displaced mothers in Northern Uganda.  The intervention consisted of mother and baby group sessions and home visits for 70 mothers attending three emergency feeding centres. Psychosocial outcomes were compared with a contrast group who received nutritional support alone. The outcomes investigated were infant stimulation and maternal mood. Mothers in the intervention group showed greater involvement with their babies, more use of play materials, greater emotional responsiveness, and less sadness and worry at follow up in comparison to the contrast group. After controlling for the effects of interview site and baseline scores, significant group effects remained for the play materials, maternal involvement and sadness and worry outcomes. The intervention was acceptable to the mothers, easily taught and showed some evidence of being self sustaining. Further research needs to be done to validate these preliminary findings, explore the longer term impact on child growth and intellectual development as well as maternal mood. 

  • Kaga, Y., Bennet. J., & Moss, P. (2010). Caring and learning together: a cross-national study on the integration of early childhood care and education within education.  Paris: UNESCO. Retrieved from UNESCO website- 25th June, 2010.   

A new UNESCO study on ECCE governance focuses on examining the policy option of integrating ECCE within the education system, which is being adopted by a growing number of countries. It analyses and documents the experience of five countries – Brazil, Jamaica, New Zealand, Slovenia and Sweden – and one municipality – Ghent in Belgium Flanders – which have chosen this option, to generate a better understanding of the rationales, processes and consequences of integration within-education. It also looks at why other countries have not followed this course of action. This study offers a rare assessment of the policy of integrating care and early education services within education, and provides key policy insights and recommendations on the subject.

  • Kagitcibasi, C., Sunar. D., Bekman.S., Baydar, N., & Cemalcilar, Z. (2009). Continuing effects of early enrichment in adult life: The Turkish Early Enrichment Project 22 years later,Journal of Applied Developmental Psychology, doi:10.1016/j.appdev.2009.05.003.

Long-term studies of early intervention, spanning over decades, are scarce in the United States and nonexistent in the rest of the world. The Turkish Early Enrichment Project (TEEP) is the only non-U.S. example to date. This paper reports a new follow-up assessment of the long-term outcomes of TEEP, an intervention carried out in 1983–1985 with 4–6 year old children from deprived backgrounds (previous evaluations were carried out at the completion of the intervention and seven years later). Findings from 131 of the original 255 participants indicate more favorable outcomes for children who received either mother training or educational preschool, or both, compared to those who had neither, in terms of educational attainment, occupational status, age of beginning gainful employment, and some indicators of integration into modern urban life, such as owning a computer. Further analyses of the intervention effects on the complete post-intervention developmental trajectories indicated that children whose cognitive deficits prior to the intervention were mild to moderate but not severe benefited from early enrichment. Thus, a majority of the children who received early enrichment had more favorable trajectories of development into young adulthood in the cognitive/achievement and social developmental domains than comparable children who did not receive enrichment.   

  • Neill, T., & Amanya, A. (2007)CARE ECD: 5×5 Survive and Thrive! Busia Uganda ECD Evaluation Results.Atlanta,GA.

The Early Childhood Development (ECD) project in Busia, Uganda, funded by USAID through the Hope for African Children Initiative (HACI), is one of the first two CARE ECD pilot interventions to implement the 5×5 model of programming. The impact evaluation of the Busia ECD project represents a first step in an effort to demonstrate the impact of CARE’s 5×5 model by measuring the development of individual children. The outputs of this evaluation include (1) An assessment of the status of traditional developmental domains of the children enrolled in the intervention program and (2) an exploration of the relevance of standardized tools, the Ages and Stages Questionnaire (ASQ), the Early Development Instrument (EDI), and the Early Childhood Environmental Rating Scale (ECERS) in a sub-Saharan low resource setting.

  • Nodira, A., Yakupov, S., & Yakupov, T. (2009).  Impact Assessment Family Education Project. UNICEF Project:  Tashkent- Uzbekistan.  Sharh va Tavsiya, Sociology Centre,

The Family Education Project (FEP) was initiated in May 2003 by the Government of Uzbekistan with technical support from UNICEF Uzbekistan, initially piloted in 13 mahallas now enveloping 26 rayons. Impact Assessment is KAP survey in three pilot and one control rayons compared to Baseline KAP survey (2006). Sampling size is 360 households. 978 respondents were interviewed. Total research obtained data about caretaking practices of 568 children from vulnerable families. The assessment is reported for prenatal and post natal conditions of women, family planning and child development amongst other indicators.

This report provides an assessment of the Early Childhood Development (ECD) Parental Education Programme (PEP) launched in 2004 in rural Gambia. The program targeted parents caregivers and community leaders with the aim of influencing their attitudes positively towards the holistic development of children resulting in such outcomes as physical wellbeing, emotional maturity, social competences, cognitive development and language and communication. The PEP covered 69 communities in three regions. In order to assess the impact of the programme at the end of the 4 year period 72 controlled communities and matched with those where the programme was implemented were chosen. For the purpose of the evaluation 43 intervention and 27 control communities were randomly selected. Both qualitative and quantitative approaches were developed. Questionnaires on the various aspects of holistic development of children including nutrition, health, psychosocial development and protection were developed to guide interviews and focus group discussions (FGDs). Data was collected through interviews, focus group discussions (FGDs) and direct observation of parents and other key family members. Findings revealed that many parents and care-givers in both the experimental and control communities have been able to build on their traditional child rearing knowledge and practices and demonstrated improvement in skills in early child care and development.  Recommendations for further work have been put forth.

  • Tinajero, A.R. (2010).Scaling-Up Early Child Development in Cuba – Cuba’s Educate Your Child Program: Strategies and Lessons from the Expansion Process. Working paper 16. Wolfensohn Center for Development at Brookings.

     The Educa a Tu Hijo program is a noninstitutionalized, multisector, community-based program run by the Ministry of Education with 70% of Cuban children under six participating in the program, along with pregnant women. This case study attempts to present and discuss the implementation, strategies and expansion of the Educate Your Child Program in Cuba between 1992 and 1998. The study found that the program had a positive impact on child development and families’ ability to promote development, as well as contributed to high levels of children’s preparedness for school and performance in primary and secondary education. It also indicates the need to integrate health and education programs, as well as the role of socio-political systems in universal early child development  programs .The report discusses the replication experiences in Brazil and Ecuador.

  • Tofail, F.(2008). Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study, The American Journal of Clinical Nutrition,87 (3), 704-711.

BACKGROUND: Few data exist for the effects of multiple micronutrient (MM) or food supplementation to undernourished pregnant women on their offsprings’ development. OBJECTIVE: We aimed to compare the effects on infant development of early (8–10 wk gestation) or usual (17 wk gestation) supplementation with food and MM, 30 mg Fe + 400 µg folate, or 60 mg Fe + 400 µg folate. DESIGN: A large, randomized, controlled trial of pregnancy supplementation was conducted in Bangladesh. A subsample of infants (n = 2853) were assessed on 2 problem-solving tests (support and cover tests), the motor index of the Bayley Scales of Infant Development, and Wolke’s behavior ratings at 7 mo of age. RESULTS: There were no significant effects of any intervention in the group as a whole. However, infants of undernourished mothers [body mass index (BMI; in kg/m2) < 18.5] who received early food supplementation performed slightly but significantly (P = 0.035) better on the support test than did infants of mothers who received usual food supplementation (z score: 0.17; 95% CI: 0.01, 0.33). There were no benefits in infants of higher-BMI mothers (P = 0.024 for BMI x food interaction). Children of low-BMI mothers who received MMs had slightly better motor scores (z score: 0.28; 95% CI: 0.08, 0.48) and activity ratings (z score: 0.24; 95% CI: 0.037, 0.45) than did those who received 30 mg Fe + 400 µg folate, whereas other children did not benefit (P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients). CONCLUSIONS: Small benefits from early food and MM supplementation were found in infants of low-BMI but not of high-BMI mothers. However, the benefits were of doubtful functional importance, and longer follow-up is required to determine programmatic implications.

  • A Comprehensive Report on Plan’s Myanmar Disaster Response: Period Report: July 2008-June 2010 (August, 2010), Plan- International Asia Regional Office.

The report outlines details of Plan’s programme interventions following Cyclone Nargis in Myanmar. Children being the hardest hit by the disaster, Plan intervened to rebuild ECCD centres and primary schools, along with partnering to provide psychosocial and trauma healing support and disaster reduction planning in education. It focuses on efforts to mitigate the devastating impact of any future natural disasters by improving infrastructure and empowering children, teachers, parents and the community at large.

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