RESUMEN
BACKGROUND: Evidence from low-income settings around early education interventions that can improve young children's development is sparse, particularly with regard to the most marginalized children. This study used a two-arm parallel cluster randomized control design to evaluate the impact of an adapted staff training programme on the developmental outcomes of children attending community-based early learning centres in Thyolo district, rural Malawi. METHODS: At baseline we randomly selected 48 centres, from each of which 20 children were randomly selected, although data from one centre was incomplete resulting in 932 children from 47 centres. Centres were randomly allocated to either the intervention or control arm. Twelve months later, follow-up data were collected from 44 centres. At baseline and endline, community-based childcare centre (CBCC) managers provided information about the centre, and parents/guardians provided information on the children, including the primary outcomes of age-standardized development scores in the language and social domains, measured using the Malawi Developmental Assessment Tool. Children in the bottom 2.5 percentile of either domain were considered to have a delay; a third outcome variable, Any Delay, was developed to indicate children with a delay in either or both domains. Centre-level mean scores were calculated, and linear regression models were constructed to assess differences between baseline and endline and between allocation groups. RESULTS: Analysis of the difference between baseline and endline measures in the allocation groups shows a non-significant reduction in delay associated with the study intervention across all domains. Adjustment for baseline characteristics within the CBCCs showed little impact on the magnitude of the observed effect, and the difference remained non-significant. CONCLUSIONS: Despite no observed differences between allocation groups, the data did indicate a positive change in the intervention groups in both domains, particularly language. Community-based early learning in Malawi holds tremendous potential for promoting inclusive development and learning.
Asunto(s)
Guarderías Infantiles , Desarrollo Infantil , Niño , Preescolar , Intervención Educativa Precoz/métodos , Humanos , Malaui , Padres/educaciónRESUMEN
BACKGROUND: Early childhood development (ECD) is a critical stage in children's lives, influencing future development and social integration. ECD research among children with disability and developmental delay in low- and middle-income countries is limited but crucial to inform planning and delivery of inclusive services. This study is the first to measure and compare the prevalence of disability and developmental delay among children attending preschool centres in rural Malawi. METHODS: A cross-sectional survey was conducted in 48 preschool centres in Thyolo district, Malawi. Data were collected from parents or guardians of 20 children per centre. Disability was ascertained using the Washington Group/UNICEF Child Functioning Module. Child development was measured using the language and social domains of the Malawi Development Assessment Tool. RESULTS: A total of 960 children were enrolled; 935 (97.4%) children were assessed for disability and 933 (97.2%) for developmental delay; 100 (10.7%) children were identified as having a disability. The prevalence of disability was higher among children 5+ years (n = 60; 29.3%) than children 2-4 years (n = 40; 5.5%); 109 of 933 (11.7%) children were classified as having developmental delay, 41 (4.4%) in "language" and 77 (8·3%) in "social" domains. CONCLUSIONS: This study found that disability and developmental delays are common among preschool children in Malawi. It is one of the first to measure disability and delay among children in a preschool setting in Africa.
Asunto(s)
Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/epidemiología , Factores de Edad , Niño , Cuidado del Niño , Preescolar , Estudios Transversales , Discapacidades del Desarrollo/psicología , Femenino , Humanos , Malaui , Masculino , Prevalencia , Población Rural , Factores SocioeconómicosRESUMEN
Given the narrow scope and conceptualisation of inclusion for young children with disabilities in research within low- and middle-income countries (LMICs) contexts, we draw on a bioecological systems perspective to propose the parameters for a broader unit of analysis. This perspective situates human development within a specific cultural context in which family, peers and schooling are regarded as key in responding to young children with disabilities in a given setting. We outline a new bioecological model to illustrate the proximal and distal factors that can influence inclusive early development for children with disabilities within LMICs. To illustrate the relevance of this model to early child development research, we consider its application, as a conceptual framework, with reference to a research study in Malawi. The study was designed to promote greater inclusive practice for young children with disabilities in Community-Based Childcare Centres (CBCCs) with a particular focus on the role of the CBCC volunteer 'caregiver' in rural Malawi. It has significance for educators, service providers and researchers concerned with facilitating inclusive early development across national boundaries and contexts.
L'étroitesse de la portée et de la conceptualisation de l'inclusion de jeunes enfants handicapés dans le corpus de recherche dans les pays à revenu faible et (PRFI) contextes intermédiaire, nous puisons dans une perspective de systèmes bioécologiques pour proposer des paramètres pour une unité d'analyse plus large. Notre perspective situe le développement humain dans un contexte culturel spécifique dans lequel la famille, les pairs et la scolarité sont considérés comme des éléments clés pour apporter une réponse à la question des jeunes enfants handicapés dans un contexte donné. Nous décrivons un nouveau modèle bioécologique pour illustrer les facteurs proximaux et distants qui peuvent influencer le développement des enfants handicapés dans les PRFI pendant leurs premières années. Pour illustrer la pertinence de ce modèle pour la recherche sur le développement des jeunes enfants, nous prenons en considération son application comme cadre conceptuel, en référence à une étude menée au Malawi. L'étude a été conçue aboutir de promouvoir des pratiques plus inclusives pour les enfants handicapés fréquentant des garderies communautaires, en mettant un accent particulier sur le rôle de l'«assistant ¼ bénévole dans les zones rurales du Malawi. Elle est importante pour les éducateurs, les prestataires de services et les chercheurs qui veulent faciliter un développement inclusif des jeunes enfants, au-delà des frontières et contextes nationaux.
Debido al poco alcance y la conceptualización limitada de la inclusión de niños de edad temprana con discapacidades en investigaciones realizadas en el contexto de países de ingresos bajos y medios, utilizamos una perspectiva de sistemas bio-ecológicos, con el fin de proponer parámetros más amplios de análisis. Esta perspectiva sitúa al desarrollo humano dentro de su contexto cultural específico en el cual la familia, los compañeros y la escuela son considerados como factores vitales en la atención a niños de edad temprana con discapacidades. Se describe un modelo bio-ecológico para ilustrar los factores proximales y distales que pueden influenciar el desarrollo temprano en contextos inclusivos para niños con discapacidades en países de ingresos bajos y medios. Con el fin de ilustrar la importancia de este modelo para la investigación del desarrollo infantil temprano, consideramos su aplicación, como marco conceptual, con referencia a una investigación llevada a cabo en Malaui. El estudio se diseñó con el objeto de promover mejores prácticas inclusivas para niños pequeños con discapacidades en Centros Infantiles Comunitarios (CICs) con un enfoque especial en el papel que juega el cuidador voluntario del CIC en zonas rurales de Malaui. Este estudio es relevante para educadores, centros de educación e investigadores interesados en brindar desarrollo temprano inclusivo en diferentes contextos y territorios.