A parenting intervention delivered at routine primary health visits improved child cognitive development and parenting knowledge

OBJECTIVE: Several agencies have recommended integrating early child development interventions with health services. We developed and evaluated a parent training programme integrated into primary health visits. DESIGN AND METHODS: A cluster randomised trial conducted in Jamaica, Antigua and St Lucia with health centre as the unit of randomization. Fifteen centres were randomised to control (n=250 mother-child pairs) and 14 to intervention (n=251). Participants were recruited at the 6-8 week child health visit. Intervention was provided at routine health visits from age 3-18 months and comprised short films of child development messages followed by discussion and demonstration led by community health workers, and mothers’ practice of activities. Nurses distributed message cards and a few play materials. Primary outcomes were child development, measured 2 weeks after the 18 month visit, with the Griffiths Mental Development Scales and the Communicative Development Inventory (CDI). RESULTS: 85% of enrolled children were tested (control = 210; intervention=216). Loss did not differ by group. Multilevel analyses showed significant intervention benefits for cognitive development, (3.09 points; 95% CI 1.31, 4.87), effect size 0.30 SD. There were no benefits to language or hand and eye subscales, or CDI vocabulary score. Of six secondary outcomes there was a significant benefit to parenting knowledge, treatment effect 1.59 (95% CI 1.01 to 2.17), effect size 0.40. CONCLUSION: An innovative parenting intervention, requiring no additional clinic staff or mothers’ time, can be integrated into health services, with benefits to cognitive development and parent knowledge.

Building human capacity through early childhood intervention: the Child Development Research programme at the Tropical Medicine Research Institute, The University of the West Indies, Kingston, Jamaica / Construcción de la capacidad humana mediante intervención en la primera infancia: Programa de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, Universidad de West Indies, Kingston, Jamaica

Research conducted by the Child Development Research Group in the Tropical Medicine Research Institute has made significant contributions to the understanding of the importance of early nutrition and the home environment for children's development and the impact of psychosocial stimulation for disadvantaged and/or undernourished children. The work has provided critical evidence that has contributed to the increasing attention given to early childhood development in the work and policies of agencies such as the World Bank, World Health Organization (WHO) and United Nations Children Fund (UNICEF). This review concerns research which documented the impact of malnutrition on children's development and for the first time demonstrated the benefits and necessity of psychosocial stimulation for improvement in development. Subsequent research was critical in establishing the importance of linear growth retardation (stunting) as a risk factor for poor child development. A twenty-two-year study of stunted children has demonstrated benefits through to adulthood in areas such as educational attainment, mental health and reduced violent behaviour, from an early childhood home visiting programme that works through mothers to promote their children's development. The group's research has also demonstrated that it is feasible and effective to integrate the stimulation intervention into primary care services with benefits to children's development and mothers' child rearing knowledge and practices. The group is currently conducting a study to provide information needed for scaling-up of parenting programmes through evaluation of a new approach to improving parenting through health centres and a modified home visit programme.

Una investigación dirigida por el Grupo de Investigación del Desarrollo Infantil en el Instituto de Investigación de Medicina Tropical, ha contribuido de manera significativa a comprender, por una parte, la importancia que tanto la nutrición temprana como el ambiente hogareño poseen para el desarrollo infantil de niños, y por otra parte, el impacto de la estimulación psicosocial para los niños desfavorecidos y/o desnutridos. La evidencia crítica ofrecida por este trabajo ha hecho que se le conceda mayor atención al desarrollo de la primera infancia en el trabajo y las políticas de agencias como el Banco Mundial, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF). Este estudio trata de una investigación que documenta el impacto de la desnutrición en el desarrollo de niños, y por primera vez demuestra los beneficios y la necesidad de la estimulación psicosocial para favorecer el desarrollo. La investigación subsiguiente fue decisiva para establecer la importancia del retraso del crecimiento linear (RCL) como un factor de riesgo para el desarrollo del niño pobre. Un estudio de veintidós años sobre niños con retraso en el crecimiento ha demostrado los beneficios hasta llegar a la adultez, en áreas como la educación, la salud mental y la reducción del comportamiento violento, a partir de un programa de visita a hogares de la primera infancia, que trabaja con las madres para promover el desarrollo de sus hijos.