KARACHI: Educating and training parents and other caregivers in basic childcare skills could have a significantly positive impact on the mental and physical development of disadvantaged children, especially those most at risk, shows a recently published study that utilised the Lady Health Workers (LHWs) programme to get results.

An important finding of the research relates to mothers facing psychological stress that was found to be reduced markedly as the child received combined enhanced nutrition and development care.

Titled ‘Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial’, the study was conducted in district Naushahro Feroze by an Aga Khan University Hospital (AKUH) research team led by Dr Aisha K.Yousafzai and Dr Zulfiqar A. Bhutta.

The United Nations Children’s Fund (Unicef) had funded the research published in The Lancet.

According to the study, Pakistan has high maternal, neonatal infant and under-five mortality rates and high costs of stunting (42pc of children are stunted by two years of age). Recent research suggests that prevalence of maternal depression ranges from 25-28 per cent. Overall, an estimated eight million children are unlikely to meet their development potential in their first five years.

The LHWs programme was chosen as the pathway for carrying out the Pakistan Early Development Scale-up trial as it covers 60pc of the population and is central to delivering healthcare to disadvantaged communities across Pakistan, with a strong focus on mothers and children.

Under the study, lady health workers delivered the interventions to families with young children under two years old in their catchment areas, a total of 3,550 young children.

To evaluate in depth the impact of the interventions on child growth and development, four groups of children aged birth to 2.5 months were enrolled and followed to the age of two years, as follows: the Care for Child Development group under which caregivers received training in basic skills on how to promote cognitive, motor, social and effective development of infants; the Enhanced Nutrition group which received nutritional intervention; the combined Care for Child Development and Enhanced Nutrition group which received both interventions and the control which received only the baseline lady health worker services.

“Children who received responsive stimulation had significantly higher development scores on the cognitive, language, and motor scales at 12 and 24 months of age, and on the social-emotional scale at 12 months of age, than did those who did not receive the intervention.

“Children who received enhanced nutrition had significantly higher development scores on the cognitive, language, and social-emotional scales at 12 months of age than those who did not receive this intervention, but at 24 months of age only the language scores remained significantly higher.

“We did not record any additive benefits when responsive stimulation was combined with nutrition interventions,” it says.

According to the study, the development benefits of Care for Child Development for most-at-risk children in the study are one of the most crucial findings of the trial. Children most at risk are defined here as girls, children from the poorest households, children with mothers with no formal education, those of mothers with psychological distress, children who are stunted, and those from households with food insecurity,” it says.

Most-at-risk children, according to the study, exposed to learning activities achieved development scores that exceed the scores of children not considered to be at risk and who didn’t receive the intervention.

The intervention groups also reported reduced morbidity. The group sessions of LHWs with mothers and focus on quality time helped mothers cope with daily stress.

A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children’s early development.

Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is about $4 per month per child, it says.

“The responsive stimulation intervention can be delivered effectively by LHWs and positively affects development outcomes. The absence of a major effect of the enhanced nutrition intervention on growth shows the need for further analysis of mediating variables (example, household food security status) that will help to optimise future nutrition implementation design,” it says.

Published in Dawn, July 1st, 2014