Improving health and development through play - Evaluation of a comprehensive ECCE programme at scale in Ghana

This study is the evaluation of a promising ECCE intervention developed by the International NGO Lively Minds and now adopted and taken to scale by the Government of Ghana. The intervention was previously evaluated by members of this research team (AEARCTR-0002777).

The program being implemented by the Government of Ghana was developed by the International NGO Lively Minds. Typical ECCE programs are one-dimensional, targeting either parents or pre-schools, or focusing only on one area of child development, such as cognitive skills or health. Lively Minds developed a hybrid ECCE program, designed with scalability in mind, that simultaneously improves the home and pre-school environments, as well as children’s health alongside cognitive and socio-emotional development. Its chosen approach is to (i) train KG teachers and caregivers in hard-to-reach rural communities to set up and run low-cost educational weekly play schemes and install tippytaps (simple handwashing devices) within public KGs and children’s homes. The play schemes are designed to support child learning through play, and the tippytaps allow regular hand-washing.(ii) Train KG teachers to run a monthly group parenting course, teaching caregivers simple ways to improve home-based care (nutrition, hygiene, malaria prevention, stimulation practices) using local resources. Teachers are given regular training, supervision and support through regional and district teams of the Ministry of Education (MoE).

2022-03-01

2024-09-01

Primary outcomes will be measured 2 to 3 academic terms (6 - 9 months approximately) after treatment commences:
(i) Child cognition as measured using the emergent numeracy, emergent literacy and executive functioning tasks in the IDELA as well as items relating to the same domains from the Harvard Laboratory for Development Studies
(ii) Child health, as measured using height/weight for age and height for weight Z score
(iii) Child socio-emotional development, as measured by the externalizing, internalizing and pro-social domains of the Strengths and Difficulty questionnaire and the the socio-emotional items in the IDELA

Our secondary outcomes are the following:
(1) Maternal mental health (Kessler-10 and WEMWBS) and knowledge of ECCE.
(2) Teacher knowledge, motivation and teaching quality (measured through classroom observations).
(3) Parent-child investment, as measured by quality of the home environment (FCI and HOME) and the parent-child relationship (CPRS).
(4) WASH practices in the home.
(5) Acute Malnutrition measured by MUAC

This study is an open label cluster randomized control trial, implemented through randomization of the order in which districts start to receive the ECCE program.

While the program is scaled to all districts in Northern Ghana, this study focuses on 55 districts (grouped into 9 district groups (DG)) and two cohorts of children, combined into 72 district-cohort pairs. District groups will be enrolled into the study from January 2021 to September 2024 in 5 tranches. In each tranche, one DG is allocated at random into the treatment group and one allocated to the control. District group six and seven is used with different cohorts of children as both a control and treatment district group - control with the first cohort of children, treatment with the second. DG 10 is used twice as a control (with different cohorts of children). The control DG in each tranche will begin to receive the program 2/3 terms after being enrolled into the study, after all data collection has been completed.

Data collection will start before the end of 2021 and proceed almost continuously through to the end of the project in 2024.

Not available

Randomization was conducted using R.

District-cohort

Yes

72 districts-cohort pairs

360 schools and 3240 children

180 schools and 1620 children in the control, 180 schools and 1620 children in the treatment

We leverage data available from the earlier efficacy trial on the same program to better inform how covariates increase our power to detect effects. Following McConnell and Vera-Hernandez (2015) we find MDE of 0.118 SD for our measure of cognition, 0.132 SD for MUAC.