Integrating an early child development intervention into an existing primary healthcare platform in rural Lesotho: a prospective case-control study

Abstract

Objectives: This study evaluated a novel early childhood development (ECD) programme integrated it into the primary healthcare system.

Setting: The intervention was implemented in a rural district of Lesotho from 2017 to 2018.

Participants: It targeted primary caregivers during routine postnatal care visits and through village health worker home visits.

Intervention: The hybrid care delivery model was adapted from a successful programme in Lima, Peru and focused on parent coaching for knowledge about child development, practicing contingent interaction with the child, parent social support and encouragement.

Primary and secondary outcomes measures: We compared developmental outcomes and caregiving practices in a cohort of 130 caregiver-infant (ages 7-11 months old) dyads who received the ECD intervention, to a control group that did not receive the intervention (n=125) using a case-control study design. Developmental outcomes were evaluated using the Extended Ages and Stages Questionnaire (EASQ), and caregiving practices using two measure sets (ie, UNICEF Multiple Indicator Cluster Survey (MICS), Parent Ladder). Group comparisons were made using multivariable regression analyses, adjusting for caregiver-level, infant-level and household-level demographic characteristics.

Results: At completion, children in the intervention group scored meaningfully higher across all EASQ domains, compared with children in the control group: communication (δ=0.21, 95% CI 0.07 to 0.26), social development (δ=0.27, 95% CI 0.11 to 0.8) and motor development (δ=0.33, 95% CI 0.14 to 0.31). Caregivers in the intervention group also reported significantly higher adjusted odds of engaging in positive caregiving practices in four of six MICS domains, compared with caregivers in the control group-including book reading (adjusted OR (AOR): 3.77, 95% CI 1.94 to 7.29) and naming/counting (AOR: 2.05; 95% CI 1.24 to 3.71).

Conclusions: These results suggest that integrating an ECD intervention into a rural primary care platform, such as in the Lesothoan context, may be an effective and efficient way to promote ECD outcomes.

Keywords: HIV & AIDS; international health services; maternal medicine; mental health; paediatrics; public health.

Figure 1

Study flow diagram. The control group comprised caregiver–infant dyads in which infants were 7–11 months old in May–July 2017, the recruitment period. Caregiver–infant dyads in the control group were assessed immediately on study enrolment only. The intervention group comprised caregiver–infant dyads in which infants were 0–2 months in May–July 2017. Caregiver–infant dyads in the intervention group were assessed three times (baseline, midterm, final assessment), with baseline assessment conducted immediately on study enrolment and final assessment conducted an average of 8 months later, when infants were 7–11 months old.