Early Childhood Development and Parental Involvement: The role of information

The intervention will run an information campaign with mothers on caring of children aged 1-3 years and examine the association between maternal knowledge on child development and developmental outcomes of their children in the short and medium run in a resource poor setting. This will be a randomized controlled trial (RCT) on early childhood development (ECD) implemented in southwestern rural Bangladesh. In particular, mothers who have children in this age range at present will be invited to participate in a set of three information sessions on rearing and caring of 1-3 years old children. Sessions will focus primarily on child nutrition and feeding, hygiene practice in child caring, and home environment favorable to child development.

2018-11-16

2021-07-15

Primary outcomes will be measured on the following indicators, each of which are constructed using multiple variables. Construction of primary outcomes are as follows
Index A: Maternal knowledge (mother)
Variable 1: Age appropriate nutritious food
Variable 2: Balanced feeding and food safety
Variable 3: Good hygiene
Variable 4: Stimulant home environment

Index B: Maternal practice (nutrition)
Variable 1: Age appropriate nutritious food offered to child
Variable 2: Balanced feeding and food safety performed

Index C: Maternal practice (hygiene)
Variable 1: Clean house
Variable 2: Using safe water
Variable 3: Good hygiene practice
Index D: Maternal practice (Engagement with child)
Variable 1: Interaction with child
Variable 2: Investing in child

Index E: Health index (child)
Variable 1: Height-for-age (stunting), weight-for-height (wasting), weight-for-age (malnutrition)
Variable 2: Vaccination status
Variable 3: Frequency of diarrheal diseases in the last 3 months

Index F: Development index (child)
Variable 1: Cognitive development on Bayley scale III (Cognitive test)
Variable 2: Language development on Bayley scale III (Receptive and expressive communication tests)
Variable 3: Motor development on Bayley scale III (Gross and fine motor test)

The baseline survey collected data on most of these outcome variables and they are balanced across the different treatment control groups (except for the sub-index of stimulant home environment of index A and one sub-category in Index D) as is shown in Appendix C.

Primary outcomes will be measured on the following indicators, each of which are constructed using multiple variables. Construction of primary outcomes are as follows
Index A: Maternal knowledge (mother)
Variable 1: Age appropriate nutritious food
Variable 2: Balanced feeding and food safety
Variable 3: Good hygiene
Variable 4: Stimulant home environment

Index B: Maternal practice (nutrition)
Variable 1: Age appropriate nutritious food offered to child
Variable 2: Balanced feeding and food safety performed

Index C: Maternal practice (hygiene)
Variable 1: Clean house
Variable 2: Using safe water
Variable 3: Good hygiene practice
Index D: Maternal practice (Engagement with child)
Variable 1: Interaction with child
Variable 2: Investing in child

Index E: Health index (child)
Variable 1: Height-for-age (stunting), weight-for-height (wasting), weight-for-age (malnutrition)
Variable 2: Vaccination status
Variable 3: Frequency of diarrheal diseases in the last 3 months

Index F: Development index (child)
Variable 1: Cognitive development on Bayley scale III (Cognitive test)
Variable 2: Language development on Bayley scale III (Receptive and expressive communication tests)
Variable 3: Motor development on Bayley scale III (Gross and fine motor test)

Timeline: After one year of the start of the intervention and then finally after two years

1. Attitude towards child immunization (both targeted and older children in the households in short and medium run)
2. Pattern of health care expenditure on children (both targeted and older children in the households in short and medium run)
3. Morbidity among the younger and older children outside our target group
4. Overall health status of the younger and older children outside our target group
5. Breastfeeding practice among the younger children outside our target group.
6. Practice of breastfeeding during diarrhoea and other diseases among children aged less than 2 and half years outside our target group.
7. Immunisation status of younger and older children outside our target group.
8. Food consumption pattern among the younger and older children outside our target group.
9. Association between maternal knowledge and stunting in child in medium run (i.e. two years post intervention);
10. Association between maternal knowledge and selection of food for and feeding habit for younger child (aged 0-11 months) and/or older child aged over 3 years;
11. Assessment of child on Wechsler Primary and Preschool Scale of Intelligence (WPPI and Ages and Stages Questionnaire (ASQ) ) in order to measure IQ and motor development respectively two years post intervention.

The following secondary outcomes will be measures
1) maternal knowledge and stunting in child in medium run (i.e. two years post intervention);
2) assessment of child on Wechsler Primary and Preschool Scale of Intelligence (WPPI) and Ages and Stages Questionnaire (ASQ)) in order to measure IQ and motor development respectively two years post intervention;
3) maternal knowledge and selection of food and feeding habit for younger child (aged 0-12 months) and/or older child aged over 3 years.
Therefore, the variables and indices for measuring secondary outcomes are:
Index G: Health index (child, two years post intervention)
Variable 1: Height-for-age (stunting), weight-for-height (wasting), weight-for-age (malnutrition)

Index H: Development index (two years post intervention)
Variable 1: Score on Wechsler Primary and Preschool Scale of Intelligence (WPPI)
Variable 2: Score on Ages and Stages Questionnaire (ASQ)

Index I: Maternal practice (nutrition, safe water use, vaccination, and diarrheal disease episode for child aged 0-11 months and over but <12 months)
Variable 1: Nutrition food offered to child
Variable 2: Using safe water
Variable 3: Vaccination
Variable 4: Frequency of diarrheal diseases in the last 3 months

Index J: Maternal practice (nutrition, safe water use, vaccination, and diarrheal disease episode for child aged >3 years and 10 years)
Variable 1: Nutrition food offered to child
Variable 2: Using safe water
Variable 3: Vaccination
Variable 4: Frequency of diarrheal diseases in the last 3 months

This intervention is running an information campaign with mothers on caring of children aged 1-3 years and examine association between maternal knowledge on child development and developmental outcomes of their children in short and medium run in the context southwestern rural Bangladesh. The intervention have been delivered in the mode of specially developed modules of brief curricula through a set of three information sessions. Mothers of children aged 1-3 years old were invited to participate in a set of three information sessions. Sessions have focused primarily on child nutrition and feeding, hygiene practice in child caring, and home environment favorable to child development. The three information sessions were followed by a refresher sessions and/or additional support through home visits at different intervention arms. Control group households were regularly invited to participate in community based cultural events and activities to encourage them to continue their participation in the project. The study intends to assess after 12 months (and again after two years) of the completion of the intervention change in maternal knowledge on targeted aspects of child caring and development; standard anthropometry i.e. height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ); attainment of motor milestone for age; attainment of motor skills; association between level of maternal knowledge in child development and developmental outcomes of children; child immunization, and health care expenditure on children.

Female and male children aged 1-3 years and their mothers living in 140 study villages randomized into two treatment and one control arm had the opportunity to be included in the intervention. While we planned to obtain 12-14 children of 1-3 years old from each village, living in closer neighborhoods, lottery were used in selecting the children in villages/neighborhood where there were more than 10 children in this age group. We target about 1800 mothers/children from treatment and control villages, with more than 1000 children and mothers from 80 treatment villages. The treatment villages were further divided (randomly) into two groups equally- 40 villages in each treatment. The mothers in both treatment arms will participate in three half day information sessions followed by a half day refresher sessions midway through the intervention while one of the arms will receive additional support in the form of fortnightly home visits paid by facilitators/fieldworkers. Children in the same age group from households randomized into control arm (containing 60 villages) will be considered as control group.

Simple randomization were conducted on the recruited sample using the random number generator created by the statistical software, Stata (version 14).

Randomization was carried out at the village level. 140 villages were randomized into treatment and control arms. There are 80 treatment villages and 60 control villages. The treatment villages were further divided (randomly) into two groups equally- 40 villages in each treatment.

Yes

A total of 140 village were randomized.

A total of 1802 mothers and their child aged between 1-3 years.

40 villages in the Treatment arm 1;
40 villages in the Treatment arm 2; and
60 villages in the Control arm