Program

Oct 17, 2016

OVERVIEW

The Colombian Early Childhood Development (ECD) Program consists of two different parental support initiatives targeted at the poorest 20 percent of households.  It aims to have an impact on children’s cognitive and physical development.  The first is a stimulation program that supports parents to engage in better quality interactions between them and their children.  This is done by bringing new toys to play with and showing parents how to use them to engage with their children.  The second involves providing mothers with a nutritional supplement for their children.  An evaluation of the program explored the impacts of each arm as well as a combined arm that hypothesized that they might interact in positive ways compared to the control group.  There were impacts on cognition and receptive language from the stimulation program, but there were no impacts on other outcomes of interest and there was no evidence of increased impacts from receiving the two programs together.

DESCRIPTION OF PROGRAM

Target population: Mothers of children between the ages of 12 and 24 months who are in the poorest 20 percent of households in Colombia

There are two different components of this early childhood development (ECD) program.  The first is a stimulation program which consists of weekly home visits in which home visitors demonstrate play activities and each week bring new play items.  The items are left in the home for two weeks and are intended to improve the quality of interactions between the child and the mother.  The second component of the program is a nutrition supplementation program.  Mothers are provided with a micronutrient supplement called Sprinkles that includes iron, zinc, vitamin A, folic acid, and vitamin C.  Mothers are provided enough sachets for all children under age six. These two programs can be delivered independently or together.  The program lasts for approximately 18 months.  Mother leaders from the community are chosen periodically (as a part of another welfare program led by Familias en Acción) to visit other mothers on a weekly basis (and brought new toys each week).  Mentors from around Colombia also visit each community once every seven to ten weeks.  These mentors, who have higher levels of education, receive a six-week training before the program begins.

EVALUATION OF PROGRAM

Attanasiom O.R., Fernandez, C., Fitzsimons, E.O.A. Grantham-McGregor, S.M., Meghir, C., & Rubio-Codina, M. (2014). Using the infrastructure of a conditional cash transfer program to deliber a scalable intergration early child development program in Colombia: cluster randomized controlled trial. BMJ, 349: g5785.

Evaluated population:  There were 1,420 children at baseline.  The mean age of the children across all groups was 18 months, 47 to 54 percent of the participants were boys by group, 12 to 19 percent of the babies had been born prematurely, 10 to 16 percent of the children were stunted (by WHO definitions), just under 50 percent were anemic, and 36 to 42 percent were first children.  The mothers were on average 28 years old, had had seven years of schooling, and over two thirds of them were married.  Most households had approximately five members.  Households were located in three different regions close to Bogotá and already had program with Familias en Acción.

Approach: The program was randomized at the village level.  Thirty-two municipalities that ranged in size from 2,000 people to 42,000 people were chosen out of those that were already participating in a conditional cash transfer program with Familias en Acción so that there were eight villages in each intervention group (control, stimulation, nutrition, stimulation and nutrition).  In each of these towns, mother leaders, women elected by the 50 households around them, were identified and three were randomly selected.  Door-to-door identification of the families with children between the ages of 12 and 24 months was conducted in the areas of these three mother leaders.  Of all of these families, five were randomly selected to participate in the program.

There were three types of primary outcomes: infant and toddler development, anemia, and growth.  Development was measured using the Bayley-III subscales for cognition, receptive language, expressive language, fine motor skills, and gross motor skills.  The children were assessed at a community center by trained psychologists.  Anemia was measured with a hemoglobin level.  Weight and length were measured in order to assess stunting.  Maternal depression was also assessed as a secondary outcome as it was hypothesized that depression may mediate the impact of the intervention on the outcomes.  Data was collected at baseline and 18 months later.  At baseline the four groups were statistically alike except that the supplementation group had a lower proportion of single mothers but a higher proportion of divorced mothers.  Clustering at the village level was taken into consideration – and within village correlations were actually lower than anticipated – and the attrition rate was 10.7 percent.  Adjustments were taken into consideration for multiple hypothesis testing.

Results: The stimulation group had a significant impact on cognition (d = 0.26).  There was no impact of supplementation on cognition and no additional benefit of receiving the two interventions.  The stimulation intervention also had a significant impact on receptive language (d = 0.22); but there no impacts of the supplementation program and no additional impact of receiving both interventions.  Expressive language and fine motor skills were not impacted by the stimulation program.  There were no impacts on hemoglobin, height, weight or gross motor skills, all of which the researchers had initially hypothesized would be impacted by the supplementation program.

SOURCES FOR MORE INFORMATION

References

Attanasiom O.R., Fernandez, C., Fitzsimons, E.O.A. Grantham-McGregor, S.M., Meghir, C., & Rubio-Codina, M. (2014). Using the infrastructure of a conditional cash transfer program to deliber a scalable intergration early child development program in Colombia: cluster randomized controlled trial. BMJ, 349: g5785.

KEYWORDS: toddlers, males and females, Hispanic/Latino, home-based, mentoring, parent or family component, parent training/education, physical health (other)

Program information last updated on 10/17/16.

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