Testing Means to Scale Early Childhood Development Interventions in Rural Kenya

摘要 最近的神经生物学和心理学研究证实，重要的发育发生在语言中， 在生命的最初几年，认知、运动和社会情感发展，以及早期生活的结果是 成人结果的关键决定因素，如教育成就、劳动力市场结果和健康。还没有 在LMIC中，超过2亿5岁以下的儿童将无法发挥他们的发展潜力 成年人，主要是由于贫穷、健康和营养不良以及认知和心理社会不足 刺激。儿童早期发展(ECD)综合营养和儿童刺激的干预措施 已提议将活动作为一种强有力的政策工具，以弥补穷人的早期劣势。 环境，以及许多实地研究表明，它们可以有效地改善儿童的发展 以及健康结果，至少在短期内是这样。然而，关键问题仍然是什么交付模式是 最有效和最具成本效益的，可在LMIC中潜在扩展的，以及如何维持父母 随着时间的推移，行为的变化，这可以导致儿童发展的长期改善和 可能产生积极的溢出效应，使年幼的兄弟姐妹受益。更好地理解潜在的 从干预到父母行为改变，再到对孩子的影响，行为路径也是关键 向政策部门通报干预措施的最佳设计，以最大限度地提高其可扩展性和可持续性。 我们的研究将在60个村庄和1200个村庄进行多臂整群随机对照试验 肯尼亚农村家庭测试ECD干预的不同潜在成本效益交付模式 课程包括儿童心理社会刺激和营养教育。我们的假设是 以村庄为基础的小组会议，包括有限数量的后续家访，以加强信息 并给予更多的机会来实践新的行为，并收到个性化的反馈 能够对父母的行为和孩子产生持续影响的有前途的、经济高效的模式 结果。选定的家庭将接受基线和后续调查，以衡量#年的短期影响。 父母的行为和儿童的发展结果，我们将收集关于潜在的媒介的数据 父母的行为变化，通过分解分析揭示导致影响的途径。一个 计划干预结束后两年的跟踪调查将使测试 影响，以及是否存在对弟弟妹妹的任何溢出效应。 与当地一个非政府组织合作，销售健康和营养产品的社区卫生工作者(CHW) 在他们的社区中，作为一种赚取收入的手段，将接受培训，通过整合 将ECD课程纳入其现有做法，大大提高了该项目的潜在可持续性。 我们的研究将为政策制定者提供严格的证据，说明如何最好地在低收入地区扩大ECD干预。 为农村环境提供资源，以改善儿童在短期和长期的发展成果。

Abstract Recent neurobiological and psychological research has established that vital development occurs in language, cognitive, motor and socio-emotional development during the first few years of life, and early life outcomes are key determinants of adult outcomes such as educational achievement, labor market outcomes, and health. Yet more than 200 million children under age five in LMICs will fail to reach their developmental potential as adults, predominantly due to poverty, poor health and nutrition, and inadequate cognitive and psychosocial stimulation. Early childhood development (ECD) interventions that integrate nutrition and child stimulation activities have been proposed as a powerful policy tool for the remediation of early disadvantages in poor settings, and numerous field studies have shown they can be effective in improving children's developmental and health outcomes, at least in the short-term. Yet key questions remain on what models of delivery are the most effective and cost-effective that can be potentially scalable in LMICs, as well as how to sustain parental behavioral changes over time, which can lead to long-term improvements in child development and the possibility of positive spillovers to benefit younger siblings. Having a better understanding of the underlying behavioral pathways leading from intervention, to parental behavior changes, to child impacts, is also key to inform policy about the optimal design of interventions to maximize their scalability and sustainability. Our study will conduct a multi-arm clustered randomized controlled trial across 60 villages and 1200 households in rural Kenya that tests different potentially cost-effective delivery models for an ECD intervention with a curriculum that integrates child psychosocial stimulation and nutrition education. Our hypothesis is that village-based group meetings that include a limited number of follow-up home visits to reinforce the messages and give greater opportunity to practice the new behaviors and receive personalized feedback is the most promising and cost-effective model able to achieve sustained impacts in parental behaviors and child outcomes. Selected households will undergo baseline and follow-up surveys to measure short-term impacts in parental behaviors and children's developmental outcomes, and we will collect data on potential mediators of parental behavioral change to uncover the pathways leading to impacts through a Decomposition Analysis. A follow-up survey two years after the end of the planned intervention will enable testing the sustainability of impacts, as well as the presence of any spillovers onto younger siblings. In collaboration with a local NGO, community health workers (CHWs) who sell health and nutrition products in their communities as a means to earn incomes will be trained to implement the intervention by integrating the ECD curriculum into their existing practices, significantly increasing the project's potential sustainability. Our study will provide policymakers with rigorous evidence of how best to expand ECD interventions in low- resource rural settings to improve child developmental outcomes in both the short- and longer-term.