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Early Childhood Development: Science, Practice, and Research

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Fall Global Health Practitioner Conference 2017
Early Childhood Development: Science, Practice, and Research
Joy Noel Baumgartner, Leslie Chingang, John
Hembling, Maureen Kapiyo, Alfonso
Rosales, Elena McEwan

Published in: Healthcare
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Early Childhood Development: Science, Practice, and Research

  1. 1. Early Childhood Development: From science to practice including research MaureenKapiyo-THRIVE ProjectCoordinatorKenya,TanzaniaandMalawi,CRS LeslieChingang-DeputyChiefofPartyKIDSSProject,CRSCameroon AlfonsoRosales-MaternalandChildHealthSeniorTechnicalAdvisor,WorldVisionUS JohnHembling-SeniorTechnicalAdvisorforHealthEvaluationandResearch,CRS JoyNoelBaumgartner-AssistantProfessor;Director,EvidenceLab,DukeUniversity ElenaMcEwan-MaternalandChildHealthSeniorTechnicalAdvisor, CRS 1
  2. 2. Session Objectives • Describe different ECD program implementation strategies and lessons learned in various countries • Discuss the evaluation design issues for ECD programs • Demonstrate communication strategies for engaging stakeholders on integrating ECD programming across sectors 2
  3. 3. Figure 1 The Lancet 2017 389, 77-90DOI: (10.1016/S0140-6736(16)31389-7) Copyright © 2017 Elsevier Ltd Terms and Conditions Theeffectsof contexts,environments,andnurturingcare
  4. 4. Relations among key processes in early childhood development policies The Lancet 2017 389, 77-90DOI: (10.1016/S0140-6736(16)31389-7) Copyright © 2017 Elsevier Ltd Terms and Conditions
  5. 5. Action at global, national, and local levels is needed to increase political commitment to and investment in early childhood development
  6. 6. The Lancet series reviewed: – evidence linking early childhood development with adult health and wellbeing – evidence related to key biological and psychosocial risks – Summarized neuroscientific evidence on both adverse and positive experiences affecting early brain development – Concluded that inequities in development begin prior before conception, and that timely interventions reduce inequities and increase productivity 6
  7. 7. 7 Country programs examples
  8. 8. Figure 1 OVC Social Services-Community -ECD-OVC Host Ministries/program & policy -Civil Society Organizations (CSO) ECD- OVC services & ECDC Network -Church/Dioceses ECD-OVC Programs -ECD-OVC TWG SOP - linkages/advocacy/OGD -Child Protection policy (GRC) -CRS-KIDSS PEPFAR (5 years) -INGO (CRS; UNICEF; Plan International) OVC Programs/Institutions PMTCT & Well-baby Clinic -Maternal & child health (responsive IYC feeding, immunization etc) -ECD messages (e.g. PP; child dev’t; fathers’ role; nutrition; hygiene; protection) -Growth & Dev’t monitoring -Dev’tal screening & follow up -ECD Referrals/Counter referral Early Childhood Education/Inclusive - Child Friendly/Play spaces/neighborhood School for ages 0-5 PTAs Community Workers & OVC Care Groups - Coordinated messages/counseling/demonstration on ECD, hygiene, nutrition, health, father’s role in ECD, -OVC; HES support, supervision, referral etc. OVC Group Homes -orphanages -handicap centers (e.g. pro-handicap; National Handicap Center - OVC House Hold (parents/caregivers/child/members of families/grandparents) -HIV+ Pregnant women Stable, sensitive & responsive relationship; child rights & protection -Early stimulation & positive parenting/child rearing practices -proper health & nutrition-appropriate feeding practices; breast feeding; supplementation (HES) -Safe & stimulating indoor/outdoor early childhood environment (e.g. ECD local materials- toys, books, shapes blocks, shakers) -Peer-group-social integration (neighborhood) -Referral/Counter referral/linkages -SILC focused on ECD HH Child Effective linkages between Social Systems for Continuum of Comprehensive Support & Care for OVC 0-5 (KIDSS MODEL)
  9. 9. Entry Points for a ECD intervention Programmatic entry points  Health programming targeting children, e.g. PMTCT/ANC, Growth and developmental screening, OVC, Immunization,  Nutrition programming, e.g. Food diversity, IYCF, nutritional screening, measurement of MUAC  Education programming, e.g. pre-school preparedness, early stimulation Service Delivery platform  Household; e.g. home-based care  Health facilities  Institutions like ECD safe spaces, schools, 9
  10. 10. Evidence based Strategies Health & Nutrition  Rapid development of the brain occurs first 2 years  Feeding in the first 1000 days is essential for optimal growth & Development  Immunization EPI, combine with Vit. A Community-based  Home visit 10
  11. 11. ECD best practices in KIDSS - An ECD baseline survey describing gaps in development and ECD health, nutritional and educational services - ECD framework for KIDSS (delivery platform, delivery agents, number of messages, message materials, Dosage, Delivery strategy, Supervision and Training/Refresher) - Develop flipchart for home-based care to facilitate key messages, and demonstration - Pretest-learn-adjust-implementation-monitor/supervision - KIDSS strengthen family wellbeing through positive parenting during home visit (0-5years) - Government buy-in (adopting KIDSS tool, KIDSS supporting to develop national ECD policy. - Families positive feedback on positive parenting and early stimulation demonstrations. 11
  12. 12. Gaps in KIDSS ECD programming - Donor restriction (is a core, near core or non-core activity?) - Agents profile not clear, lack of trained personnel in ECD, Child protection, nutrition, development milestone monitoring - Non-systematic ECD referral system and formal linkages - Nurses and doctors lack the knowledge in ECD, and not motivated to practice new things. - Lack of standard for budgeting. 12
  13. 13. Factors important for scale up of ECD program (case KIDSS) 13 • National ECD policy document, strategic plan or implantation plan • Sufficient human resources (trained agents, full time as against volunteers. • Integrated ECD program which include MCH, Growth monitoring, Breastfeeding, nutrition, WASH, Immunization, • Establishing play areas in health facilities, day-care centers, community-based safe spaces
  14. 14. The Lancet series reviewed: – evidence linking early childhood development with adult health and wellbeing – evidence related to key biological and psychosocial risks – Summarized neuroscientific evidence on both adverse and positive experiences affecting early brain development – Concluded that inequities in development begin prior before conception, and that timely interventions reduce inequities and increase productivity 14 The Lancet 2017 389, 77-90DOI: (10.1016/S0140-6736(16)31389-7)
  15. 15. Hypothesis tested StuntedCognitive, language and motor development Early learning support Child feeding practice Population in GBG vs. control will have … Agu! Violating disciplining
  16. 16. Delivery Platform Design Time 1 Nov 2014 Time 2 Apr 2015
  17. 17. Measurements 1. Caregiver’s survey (adapted MICS tool) 2. Weight and height assessment 3. Ireton scale 4. Bayley III 5. Focus group discussions
  18. 18. Outcome indicators 1. % of children scoring above 85 in all 3(cognitive, language, and motor composited sub-scales per BSID III) 2. % children stunted 1. % children whose household members in the past 3 days were engaged at least in 4 early leaning support activities (UNICEF MICS) 2. % of children receiving minimum diversity in last day. 3. % of parents with violating disciplining practice (MICS)
  19. 19. Overall effect of intervention Stunted Cognitive, language and motor development Early learning support Minimum diversity Agu! OR 1.83 P=0.025 OR 1.55 p=0.013 OR 2.22 p=0.012 OR 0.96 p=0.013 OR 1.11 P=0.501
  20. 20. 59% 75% 83% 75% 71% 82% 87% 81% Total score Cognitive Language Motor Contol Intervention % of children that achieved at least 85 scores on BSID III OR=1.5 p=0.175 OR=1.68c 0.151 OR 1.82 p=0.025 OR=1.36 P=0.291
  21. 21. % of children that achieved at least 85 in total composite in Vardenis region only 46% 64% 84% 62% 73% 78% 94% 81% Total scores Cognitive Language Motor Contol Intervention OR 3.41 p=0.003 OR 2.03 p=0.073 OR 1.68 p=0.151 OR 1.36 p=0.291
  22. 22. Conclusions • GBG is effective for all who participate • Even more effective economically disadvantaged areas • Longer duration studies are needed to view the long-term effects of GBG

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