EN-REACH: Every Newborn - Reach up Early Education intervention for All Children in Bangladesh, Nepal & Tanzania

可持续发展目标将未完成的儿童生存议程作为目标，防止530万儿童在5岁生日前死亡。重要的是，可持续发展目标还反映了家庭和国家政府的愿望，即所有儿童都能茁壮成长，生存下来，充分发挥其发展潜力。不幸的是，风险最大的儿童包括神经发育迟缓和脑瘫等发育障碍儿童，他们比同龄人更不可能获得学前和小学教育。虽然48%的低收入和中等收入国家制定了解决学前教育问题的政策，但在提供学前教育方面仍存在重大差距，在包括患有NDD/D儿童的循证可行方法方面也存在重大差距。机会：“伸出援助之手”（牙买加的一个家访项目）是最以证据为基础的育儿项目之一，旨在支持儿童早期发展和教育成果。这种影响一直持续到成年，包括赚钱能力的增强。到目前为止，“伸手向上”的重点是3岁以下的儿童，不包括严重发育迟缓和残疾的儿童。对5岁儿童学前准备的影响是长期教育成就的一个重要因素，迄今尚未进行研究，这是“每个新生儿-为所有儿童提供早期教育干预”（EN-REACH）研究伙伴关系的重点：我们的建议建立在孟加拉国、尼泊尔、坦桑尼亚和英国三家领先研究机构自2015年以来建立的完善、公平的伙伴关系基础上。我们对这三个国家的2000名年龄在2-3岁的儿童进行了队列研究，以比较早期儿童发展（ECD）评估工具的准确性和可行性，这些工具被称为EN-SMILING研究。EN-SMILING正在与世界卫生组织和儿童基金会合作，为中低收入和低收入国家的儿童准确衡量幼儿发展和早期发现残疾作出贡献。它提供了一个及时的机会，严格检验更可行的方法，以改善包括残疾儿童在内的所有儿童的教育成果。EN-REACH研究有3个目标：目标1：创新调整现有的“Reach Up”育儿方案，包括残疾儿童和其他材料，以支持所有儿童的学前准备。目标2：影响评价开展一项“准实验”研究，比较接受经调整的“推广”一揽子计划的儿童及其家庭的早期儿童发展指标和其他重要发展、健康和福祉结果。目标3：实施：提高我们对实施新的经调整的“伸手可及”一揽子计划的重要因素的理解，以支持在发现该计划有效时将其纳入常规儿童保健系统。预期影响：EN-REACH可对这三个高度优先国家的儿童产生重大影响，包括对面临不良发展结果风险的儿童的教育和护理，并与包括卫生部、世卫组织、联合国儿童基金会和许多利益攸关方在内的国家和全球政策建立密切联系。直接的研究收益将包括确定和推出测试工具，以筛查儿童的发育迟缓和残疾，以确保及早发现困难。这项研究将有助于了解在整个非洲和亚洲更广泛地包括残疾儿童在内的一揽子养育办法的可接受性。由于该团队拥有5年的协作工作记录，拥有强大的现场团队，并已证明有能力在2020年全年提供产出和联合出版物，因此尽管2019冠状病毒病大流行，仍可继续开展有效的工作。

The Sustainable Development Goals (SDGs) target the unfinished agenda for child survival with 5.3 million deaths of children before their fifth birthday. Importantly, the SDGs also reflect families' and national governments' aspirations that all children thrive as well as survive, meeting their full developmental potential. Unfortunately, children most at risk include those with neurodevelopmental delays and developmental disabilities like cerebral palsy, who are less likely than their peers to access pre-primary and primary school education. Whilst 48% of low- and middle-income countries (LMIC) countries have policies to address pre-primary education, there remain major gaps in provision, and major gaps for evidence-based, feasible approaches that are inclusive of children with NDD/D. OPPORTUNITY: 'Reach Up' (a Jamaican home visiting programme) is one of the most evidence-based parenting programmes to support early child development and educational outcomes. Effects have been seen into adulthood, including increased earning power. Up until now 'Reach Up' has focused on children under 3 years of age and has not included those with severer developmental delays and disabilities. Effects on pre-school readiness children at the age of 5 years, an important factor in longer term educational achievement, have not to date been examined and is the focus of the 'Every Newborn-Reach Up Early Education Intervention For All Children' (EN-REACH) researchPARTNERSHIP: Our proposal builds on a well-established, equitable partnership since 2015 between three leading research institutions in Bangladesh, Nepal and Tanzania and the UK. We have a cohort of 2,000 children, now aged 2-3 years, in these three countries to compare accuracy and feasibility of range of early child development (ECD) assessment tools, known as the EN-SMILING study. EN-SMILING is partnering with the World Health Organization and UNICEF, to contribute to accurately measuring ECD and detecting disability early in children in LMICs and provides. It provides a timely opportunity to rigorously test more feasible ways to improve educational outcomes for all children, including those with disabilities. OBJECTIVES:The EN-REACH study has 3 objectives:Objective 1: INNOVATIONTo adapt the existing "Reach Up" parenting package to include those with disability and additional materials to support pre-school readiness for all children.Objective 2: IMPACT EVALUATIONTo conduct a 'quasi-experimental' research study to compare early child development markers for school readiness and other important development, health and well-being outcomes for children and their families between those receiving the adapted "Reach-Up" package, and those who did not. Objective 3: IMPLEMENTATION: To improve our understanding of important factors in implementing the new adapted 'Reach up' package to support integration of the package into routine child health systems if it is found to be effective. IMPACT EXPECTED: EN-REACH could have significant impact for children in these three high priority countries, both for education and care of children at risk of poor developmental outcomes, with strong links to national and global policy including MoHs WHO, UNICEF and many stakeholders. Direct research benefits will include identification and roll-out of testing tools to screen children for developmental delay and disability to ensure early detection of difficulties. This research would enable understanding of acceptability of the parenting package to be inclusive of children with disability more widely across Africa and Asia. Since the team have a 5-year track record of collaborative work, with strong site teams and have proven ability to deliver outputs and joint publications throughout 2020, ongoing effective work can be anticipated despite the COVID19 pandemic.