Early childhood development for the poor: impacting at scale

INTERVENTION: We will carry out a psycho‐social stimulation programme coupled with nutrition education that aims to improve interactions between mothers or principal caregivers and their infants/children with the aim of achieving better child outcomes. The ECD intervention follows a systematic weekly curriculum based on the natural developmental stages of the child. Alternative service provisions include delivery of the curriculum by local women either (i) during weekly individual home visits to mother and child, or (ii) in a suitably modified way, within the context of weekly mother‐child group meetings. These two versions of the ECD intervention will be coupled with an educational nutritional intervention. The delivery of these interventions will last for 24 months and will be evaluated using a randomised control trial. We will collect data on child development outcomes and detailed maternal and household level data before the start, halfway through and at the end of the intervention. Our focus will be on communities in rural areas of Odisha and will involve children aged 7‐16 months. We propose to implement and compare four variants of our intervention: 1. Provision of education on nutritional issues (hereafter referred to as NE): Regular visits to the home will be carried out by local women hired and trained for the project (henceforth referred to as educators) to deliver the nutritional education curriculum, which will be designed to produce positive changes in food choice, preparation and storage. 2. Individual Stimulation via Home Visits (IS) (+ NE): Weekly visits to the home will be carried out by local women hired and trained for the project (henceforth referred to as facilitators) to deliver the stimulation curriculum and involve mother and child in play and learning activities. 3. Group Stimulation (GS) (+ NE): In this variant, the facilitator will deliver a specially‐designed version of the stimulation curriculum to a group of mothers and children. The group will m CONDITION: Child development ; Not Applicable PRIMARY OUTCOME: 1. Children’s child cognitive, language and motor development ‐ We will assess cognitive, language and motor development at the time of the follow‐up surveys using the third version of the Bayley Scales of Infant and Toddler Development (Bayley‐III), suitably adapted for the context.; 2. Children’s nutritional status ‐ We will measure height and weight both at baseline and at the two follow ups, using standard methods. We will also collect information on feeding practices by food type, frequency and quantity.; 3. Children���s morbidity ‐ We will collect data on the incidence of diarrhoea, fever and respiratory infections using the definitions of the WHO as measures of morbidity. We will also collect records of immunisations. SECONDARY OUTCOME: 1. Child rearing practices: level of stimulation in the home ‐ The presence of toys and learning materials in the house will be assessed together with parental involvement with the child, the child’s routines and organisation of the child’s time inside and outside the family house. This will be assessed using the Family Care Indicators, developed by UNICEF, and possibly selected subscales of the Home Observation for the Measurement of the Environment (HOME).; 2. Maternal knowledge of child rearing practices ‐ We will collect information on the mother’s knowledge of nutrition and stimulation, and her beliefs regarding the importance of these for children’s development. To test knowledge, we will rely on a selection of items from the Knowledge of Infant Development (KIDI). ; INCLUSION CRITERIA: Children aged 7 ‐ 16 months and their families