Development of children at risk for adverse outcomes participating in early intervention in developing countries: a randomized controlled trial

Abstract

Background: Previous research has indicated positive effects of early developmental intervention (EDI) on the development of children in developing countries. Few studies, however, have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation. Also, birth asphyxia as a risk condition has not been well studied. To address these limitations, we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India, Pakistan, and Zambia.

Methods: Children with and without birth asphyxia were randomized to EDI or control intervention, which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months. Development was assessed in 376 children at ages 12, 24, and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition.

Results: Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities, regardless of risk condition, maternal resources, child gender, or country. Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities, but were not statistically different between intervention conditions. Developmental differences were observed first at 36 months of age.

Conclusion: Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions. EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty.

Keywords: Early developmental intervention; at risk; birth trauma; low resource countries.

Figure 1

Participant flowchart of screening, randomization, and completion of developmental assessments, resulting in analysis sample for each intervention condition

Figure 2

Model-Adjusted Mean by Intervention Condition for MDI (upper), PDI (middle), and ASQ Total Scores (lower). Means are adjusted for corrected age, intervention condition, age x intervention condition, birth asphyxia, gestational age, maternal age and education, child gender, country, and age x country interaction