Early Childhood Development in the Slums of Cuttack, Odisha, India.

We will carry out a stimulation programme that aims to improve the interaction between mothers and their infants in everyday activities by introducing a systematic week-by-week curriculum that follows the natural developmental stage of the child. The curriculum will be delivered by local women (home visitor) during weekly individual home visits to 400 children, aged 10 - 20 months at the start of the intervention, and their caregivers.
The key organising element of the home visit will be the curriculum and protocols originally developed by Sally Grantham-McGregor specialy adapted for the context of Odisha. The curriculum is progressive and enables the facilitator to let the child dictate the pace. Emphasis is placed on improving maternal-child interaction, using positive reinforcement, and on using everyday child care activities and household tasks to teach the child new words and concepts. During the visits, the facilitator will interact with the mother and her young child and will demonstrate play activities using home-made toys and objects around the home. She will also discuss child development with the mother and emphasise the importance of chatting and play. As part of this research project, we will ensure that the curriculum is both age relevant and adapted to the cultural context.

2013-11-11

2014-12-15

Children's cognitive, language, motor, socio-emotional development, height, weight, morbidity. Quality of the home environment, play activities, play materials. Maternal depressive symptoms. Child, maternal and household socio-economic characteristics.

Children's cognitive, language, motor and socio-emotional development will be measured using the ASQ-3 (at baseline) and possibly an adapted version of the Bayley-III or DAS-II (at follow up).
Quality of the home environment: play activities and play materials will be measured using FCI instrument at baseline and follow up.
Maternal depressive symptoms will be tested using FCI questions from CES-D at baseline and follow up.
Child, maternal and household socio-economic characteristics will be assessed through household survey at baseline and follow up.

Intervention group:
27 clusters will receive psychosocial stimulation through weekly home visits - lasting around one hour - to mothers/primary care givers of children aged 10 - 20 months. The home visitors will be local women and will follow the Grantham-McGregor's curriculum and protocols specially adapted for the context of Odisha. They home visitors will interact with carers and children and will discuss the importance of stimulation and play for child development with the carer.
Control group:
27 clusters will receive no intervention.
Total duration of intervention: 12 months (2 periods of 1 month of data collection will precede and follow the interventions).

The randomisation is conducted by a computer in the office, using the statistical program Stata version 12. The steps we follow are:
1. Identify sample of eligible slums: this means those with at least 7 children in the defined age range (10 - 20 months). Exclude children with physical or mental disabilities and twins.
2. Stratify sample of slums by slum size, i.e. the stratification variable is an indicator = 1 if the slum has more than nine children in our target age range according to the initial listing conducted in the slums, 0 otherwise.
3. Within strata,
3.1 randomly assign a number between 0 and 1 to each slum;
3.2 sort the number of slums by randomly assigned number;
3.3 assign the first half of the slums to treatment and the second half to control.

Slums with at least 7 children aged 10 - 20 months.

Yes

54 slums.

400 children in the target age range.

27 slum intervention group, 27 slum control group.