Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study
Introduction Small efficacy trials have demonstrated that multicomponent interventions can improve early child development. We evaluated the large-scale delivery of a multicomponent intervention delivered by government health workers throughout a rural subdistrict in northwestern Bangladesh.Methods...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-07-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/7/e018736.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849421849916604416 |
|---|---|
| author | Stephen P Luby Mahbubur Rahman Fahmida Tofail Helen O Pitchik Fahmida Akter Jesmin Sultana Abul Kasham Shoab Tarique Md. Nurul Huda Tania Jahir Md Ruhul Amin Jyoti Bhushan Das Farzana Yeasmin Laura H Kwong Jenna E Forsyth Malay K Mridha Peter J Winch Rezaul Hasan Md Khobair Hossain Rizwana Khan Jahangir Rashid Sabina Ashrafee Lia C. H. Fernald |
| author_facet | Stephen P Luby Mahbubur Rahman Fahmida Tofail Helen O Pitchik Fahmida Akter Jesmin Sultana Abul Kasham Shoab Tarique Md. Nurul Huda Tania Jahir Md Ruhul Amin Jyoti Bhushan Das Farzana Yeasmin Laura H Kwong Jenna E Forsyth Malay K Mridha Peter J Winch Rezaul Hasan Md Khobair Hossain Rizwana Khan Jahangir Rashid Sabina Ashrafee Lia C. H. Fernald |
| author_sort | Stephen P Luby |
| collection | DOAJ |
| description | Introduction Small efficacy trials have demonstrated that multicomponent interventions can improve early child development. We evaluated the large-scale delivery of a multicomponent intervention delivered by government health workers throughout a rural subdistrict in northwestern Bangladesh.Methods We evaluated a group-based, multicomponent intervention with a curriculum covering responsive parenting, caregivers’ mental health, lead exposure prevention strategies at the household level, water, sanitation, hygiene and nutrition. Group sessions were held throughout a rural subdistrict of Bangladesh (August 2019–March 2020). A longitudinal sample of caregivers (n=517) of children 6–24 months was assessed at baseline and endline (primary cohort), and 1179 additional caregivers were assessed only at endline (supplementary cross-sectional). Outcomes were the variety of child play activities and materials, number of books, caregiver depressive symptoms and nutrition and lead knowledge. For primary analyses, we used difference-in-difference.Results Over half (n=276, 53%) of the cohort participants attended any of the 16 intervention sessions and of these, 83% (228) attended 2+. Caregivers attending 2+ sessions, compared with ≤1 session, had more play materials (adjusted mean difference: 0.58; 95% CI: 0.30, 0.85) and were more likely to have any children’s books (adjusted prevalence difference (aPD): 0.26; 95% CI: 0.18, 0.34), to have heard of lead (aPD: 0.13; 95% CI: 0.07, 0.19) or to know how to avoid harm from lead (unadjusted PD: 0.13; 95% CI: 0.08, 0.17). These findings were similar to those from the supplementary cross-sectional analysis. There were no differences in caregiver depressive symptoms in either analysis. More child play activities and nutrition knowledge were associated with attendance in the cross-sectional sample.Conclusions A multicomponent child development intervention delivered by government health workers increased the presence of children’s toys and books and caregiver knowledge of lead in families who attended two or more sessions. Further adaptation and alternative delivery methods are likely to improve the reach and the breadth of impacts.Trial registration number NCT04111016. |
| format | Article |
| id | doaj-art-e11cf4091c9b491fa4ea9535a1bcbbfb |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-e11cf4091c9b491fa4ea9535a1bcbbfb2025-08-20T03:31:21ZengBMJ Publishing GroupBMJ Global Health2059-79082025-07-0110710.1136/bmjgh-2024-018736Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility studyStephen P Luby0Mahbubur Rahman1Fahmida Tofail2Helen O Pitchik3Fahmida Akter4Jesmin Sultana5Abul Kasham Shoab6Tarique Md. Nurul Huda7Tania Jahir8Md Ruhul Amin9Jyoti Bhushan Das10Farzana Yeasmin11Laura H Kwong12Jenna E Forsyth13Malay K Mridha14Peter J Winch15Rezaul Hasan16Md Khobair Hossain17Rizwana Khan18Jahangir Rashid19Sabina Ashrafee20Lia C. H. Fernald21Stanford University, Stanford, California, USAEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshNutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshDivision of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USAUniversity of South Carolina, Columbia, South Carolina, USAEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshDepartment of Public Health, Qassim University, Buraydah, Saudi ArabiaNursing and Health Sciences, University of Galway, Galway, IrelandEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshDivision of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley, California, USAStanford University, Stanford, California, USACenter for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BangladeshJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, BangladeshCommunity Based Health Care, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, BangladeshNational Newborn Health Program and Integrated Management of Childhood Illness, Directorate General of Health Services, Government of the People’s Republic of Bangladesh Ministry of Health and Family Welfare, Dhaka, BangladeshDivision of Community Health Sciences, School of Public Health, University of California Berkeley School of Public Health, Berkeley, California, USAIntroduction Small efficacy trials have demonstrated that multicomponent interventions can improve early child development. We evaluated the large-scale delivery of a multicomponent intervention delivered by government health workers throughout a rural subdistrict in northwestern Bangladesh.Methods We evaluated a group-based, multicomponent intervention with a curriculum covering responsive parenting, caregivers’ mental health, lead exposure prevention strategies at the household level, water, sanitation, hygiene and nutrition. Group sessions were held throughout a rural subdistrict of Bangladesh (August 2019–March 2020). A longitudinal sample of caregivers (n=517) of children 6–24 months was assessed at baseline and endline (primary cohort), and 1179 additional caregivers were assessed only at endline (supplementary cross-sectional). Outcomes were the variety of child play activities and materials, number of books, caregiver depressive symptoms and nutrition and lead knowledge. For primary analyses, we used difference-in-difference.Results Over half (n=276, 53%) of the cohort participants attended any of the 16 intervention sessions and of these, 83% (228) attended 2+. Caregivers attending 2+ sessions, compared with ≤1 session, had more play materials (adjusted mean difference: 0.58; 95% CI: 0.30, 0.85) and were more likely to have any children’s books (adjusted prevalence difference (aPD): 0.26; 95% CI: 0.18, 0.34), to have heard of lead (aPD: 0.13; 95% CI: 0.07, 0.19) or to know how to avoid harm from lead (unadjusted PD: 0.13; 95% CI: 0.08, 0.17). These findings were similar to those from the supplementary cross-sectional analysis. There were no differences in caregiver depressive symptoms in either analysis. More child play activities and nutrition knowledge were associated with attendance in the cross-sectional sample.Conclusions A multicomponent child development intervention delivered by government health workers increased the presence of children’s toys and books and caregiver knowledge of lead in families who attended two or more sessions. Further adaptation and alternative delivery methods are likely to improve the reach and the breadth of impacts.Trial registration number NCT04111016.https://gh.bmj.com/content/10/7/e018736.full |
| spellingShingle | Stephen P Luby Mahbubur Rahman Fahmida Tofail Helen O Pitchik Fahmida Akter Jesmin Sultana Abul Kasham Shoab Tarique Md. Nurul Huda Tania Jahir Md Ruhul Amin Jyoti Bhushan Das Farzana Yeasmin Laura H Kwong Jenna E Forsyth Malay K Mridha Peter J Winch Rezaul Hasan Md Khobair Hossain Rizwana Khan Jahangir Rashid Sabina Ashrafee Lia C. H. Fernald Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study BMJ Global Health |
| title | Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study |
| title_full | Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study |
| title_fullStr | Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study |
| title_full_unstemmed | Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study |
| title_short | Evaluation of a multicomponent child development intervention delivered through the government health system: a feasibility study |
| title_sort | evaluation of a multicomponent child development intervention delivered through the government health system a feasibility study |
| url | https://gh.bmj.com/content/10/7/e018736.full |
| work_keys_str_mv | AT stephenpluby evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT mahbuburrahman evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT fahmidatofail evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT helenopitchik evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT fahmidaakter evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT jesminsultana evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT abulkashamshoab evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT tariquemdnurulhuda evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT taniajahir evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT mdruhulamin evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT jyotibhushandas evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT farzanayeasmin evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT laurahkwong evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT jennaeforsyth evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT malaykmridha evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT peterjwinch evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT rezaulhasan evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT mdkhobairhossain evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT rizwanakhan evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT jahangirrashid evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT sabinaashrafee evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy AT liachfernald evaluationofamulticomponentchilddevelopmentinterventiondeliveredthroughthegovernmenthealthsystemafeasibilitystudy |