Early Childhood Development for the Poor: Impacting at Scale

描述(由申请人提供)：神经生物学已经证实，生命的头三年为终生结果奠定了基础。但在这一生命周期阶段，生活在贫困中的儿童往往容易受到负面影响，包括营养不良、疾病、缺乏刺激的环境，可能使他们无法充分发挥其潜力，并使贫困代代相传。小规模研究表明，向幼儿提供刺激和营养可以对短期和长期结果产生积极影响，如认知、自尊、抑郁和其他重要指标。然而，尚未证明可以扩大这些干预措施，使之成为可持续和有效的儿童发展政策的基础。该项目将引入一项刺激计划，并辅之以微量营养素补充，以改善母亲与其年幼子女之间的互动，以期实现更好的子女结局。该计划将遵循基于儿童自然发展阶段的系统的每周课程。它将在印度奥迪萨的农村社区实施，该地区是贫困和营养不良的普遍地区。培训将由社区内的妇女以下列形式提供：(1)每周对儿童及其主要照顾者/母亲进行个人家访，或(2)在每周主要照顾者/母亲和儿童小组会议的范围内，以适当修改的方式提供。干预将伴随着一项基于随机对照试验的评估，该试验有五个变量，其中包括一个对照组。将在干预开始前、干预中途和干预结束时收集有关儿童发育结果的数据以及详细的孕产妇和家庭数据。让当地妇女提供干预是设计低成本和可持续政策的关键。组建小组可以进一步降低成本，加强良好育儿做法的传播。其目的是测试有效性，并了解这些干预措施实现其结果的途径。因此，该项目与美国国立卫生研究院应用知识增进健康、延长寿命和减轻疾病负担的使命直接相关。这项研究将通过在学术会议上发表演讲，在专门设计的会议上向政策制定者和利益相关者传播，并将成为提交给顶级同行评议期刊(如《柳叶刀》和《美国经济评论》)的基础。结果将在一个专门的网站上公布。

DESCRIPTION (provided by applicant): Neurobiological science has established that the first three years of life lay the basis for lifelong outcomes. But during this life-cycle stage children living in poverty are often vulnerable to negative influences including malnutrition, illnesses, an un-stimulating environments, possibly preventing them from reaching their full potential and perpetuating poverty across generations. Small-scale studies have demonstrated that offering stimulation and nutrition to young children can have positive effects on short and long-term outcomes, such as cognition, self-esteem, depression and other important measures. However it has not yet been demonstrated that these interventions can be scaled-up to form the basis of sustainable and effective policy towards child development. The project will introduce a stimulation program, coupled with micronutrient supplementation, to improve interactions between mothers and their young children with the aim of achieving better child outcomes. The program will follow a systematic weekly curriculum based on the natural developmental stages of the child. It will be implemented in rural communities of Odisha in India, an area where poverty and malnutrition are prevalent. It will be delivered by women from within the communities, which will have been trained for this purpose, in the following forms: (i) weekly individual home visits to the child and its main caregiver/mother, or (ii) in a suitably modified way, within the context of weekly main caregiver/mother and child group meetings. The intervention will be accompanied by an evaluation based on a randomized control trial with five variants including a control group. Data will be collected on child developmental outcomes and detailed maternal- and household-level data before the start, halfway through and at the end of the intervention. Having local women deliver the intervention is key to designing low-cost and sustainable policies. The formation of groups could further reduce costs and enhance the dissemination of good child rearing practices. The aim is to test for effectiveness and to understand the pathways through which these interventions achieve their outcomes. As such the project relates directly to the NIH mission of applying knowledge to enhance health, lengthen life, and reduce the burdens of illness. The research will be disseminated through presentations at academic conferences, to policy makers and stakeholders at specially designed meetings and will form the basis for submission to top peer-reviewed Journals such as the Lancet and the American Economic Review. Results will be posted on a dedicated website.