Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development.

Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.

Socio-demographic, maternal, and infant characteristics associated with early childhood development delays among children of young mothers in Brasília, Brazil.

BACKGROUND: Holistic attention to adolescent health is needed to sustain the benefits of investment in early childhood development. Any such interventions must make sure to address the needs of adolescent and young adult parents. This study explored the social and demographic maternal variables associated with risk of early childhood development (ECD) delay for children of young mothers in Brazil. METHODS: Cross-sectional secondary data analysis was done using data from young mothers (aged 13-24) and their children (aged 0-2), collected from community health centers in Brasília, Brazil, between 2017-2018. The Denver Developmental Screening Test II was used to assess risk of ECD delay outcomes. Descriptive analyses were conducted across the full sample and sub-groups of adolescent (13-19) and young adult (20-24) mothers. Multivariable logistic regressions based on theory modelling approach were conducted for the full sample to examine the associations between maternal age and risk of ECD delay, adjusted for a battery of household, maternal, pregnancy, and infant variables. RESULTS: Risk of ECD delay was found in 17.39% (N = 76) of the children who participated (N = 437). No significant differences in risk of ECD delay were found for children of adolescent mothers compared to children of young adult mothers. Across the full sample, 60.36% (N = 236) of mothers were living in poverty, 73.17% (N = 319) had 9 or more years of education, and 86.14% (N = 373) were not working outside the home at time of data collection. Furthermore, 90.11% (N = 392) did not identify as head of their household and 73.68% (N = 322) were primiparous. Socially-mediated factors such as lower maternal educational attainment, unemployment, and lack of household support were associated with increased risk of ECD delays for children under age 2. Adjusted logistic regression identified multiparity as an independent maternal factor associated with increased risk of ECD delay (AOR = 2.51; 95% CI, 1.23-5.13). CONCLUSIONS: Multiparity was the only independent maternal factor associated with ECD delay among children under 2 years old. Other socio-demographic factors relevant to young mothers may influence ECD delays. Ensuring sustained, concurrent attention to children's and young parent's developmental needs may improve multi-generational health outcomes.

When principles and pedagogy clash: Moving beyond the limits of scholarly practices in an academic-community partnership with sex worker activists.

While U.S. public health education increasingly promotes community-based participatory research (CBPR) as a mode of socially-responsive research, today's intertwined health and social injustice crises demand honest reckoning with the limitations of CBPR as a framework for change. We are a team of students, fellows, and faculty reflecting on the complexities encountered over three years of collaborative work with street-based sex worker activists, in a city characterised by stark wealth disparities reinforced by policies of the university within which we operate. We centre a peer-based needs assessment survey and report on barriers to resources and services for sex workers to highlight hard choices and often unacknowledged challenges to academic partnerships. Our process intends to unsettle the too-sanguine narratives of CBPR, draw from insights arising in the discipline of law, and illuminate practices needed to honour commitments, translate knowledge to power-shifting action, and constructively engage with those most affected in determining the policies that structure their lives.We ask: Can our privileged position within the academy be usefully analysed, confronted, instrumentalised, and even subverted as we shape new practices and interventions in the name of health justice? How might we imagine principles and practices towards a movement public health?