Scaling Early Child Development- what to read this month | April 2025

Scaling Early Childhood Development – what to read this month is curated by Bet Caeyers (Lead Editor, Chr. Michelsen Institute), Meghan Taylor (Editor, Oxford Policy Management) and Daniel Munday (Editor, Oxford Policy Management).

Let’s start this April edition by featuring two new papers on the challenges of scaling programmes through community health workers in low-resource settings. Hemlock et al. examine a community-based nutrition programme in Madagascar and found that impacts on ECD trajectories depended on community health care worker and community characteristics. Notably, community health workers with additional income-generating jobs positively influenced service delivery and ECD outcomes, while limited access to transport and overall community infrastructure hindered progress. In related research, Tomlinson et al. analyse the significance of visit frequency and care quality in perinatal home visits by community health care workers in South Africa. Despite training and supervision, the workers struggled to meet the expected visit frequency, highlighting an underestimation of the resources required to build a high-quality workforce. Together, these papers emphasise the urgent need for policymakers to create tailored interventions that consider community infrastructure and logistics, and provide adequate support for community health care workers, particularly in rural areas.

Pivoting to nutrition, what does implementation research tell us about what complementary feeding programmes work, and why? An in-depth review of five large-scale complementary feeding models from Bangladesh, Ethiopia, Nepal, Nigeria and Vietnam by Sanghvi et al. finds that a combination of facility-based support, community engagement and mass media strategies effectively improves complementary feeding practices. The success of these programmes is attributed to several factors, including advocacy efforts, increased knowledge, improved social norms, and the active involvement of fathers and community leaders. Figure 1 presents a conceptual framework that outlines the key determinants and barriers to complementary feeding, the action domains or sectors that need addressing, and proposed interventions for operationalisation. This framework is based largely on common elements identified in implementation research and impact evaluations conducted over the past two decades within the examined programmes, aiming to facilitate the scaling up of successful complementary feeding initiatives.

New research by Tofail et al. assesses the long-term impact of integrated water, handwashing, sanitation and nutrition interventions in a seven-year follow-up study. The original randomised controlled trial, conducted in Bangladesh, focused on pregnant women over two years, and previously reported improvements in child developmental outcomes in 1 and 2-year-olds. The latest findings indicate that seven years later, the intervention continues to yield ‘small but significant sustained impacts’ on various domains of child development, the home environment and caregiver mental wellbeing. Specifically, children in the intervention groups showed improved cognitive development, more stimulating home environments and improved pro-social behaviours, while caregivers experienced fewer depressive symptoms. No sustained improvements were noted in fine motor skills, executive functioning or academic achievement. These results underscore the importance of integrating sanitation into ECD programming.

This month, we have an excellent write-up by Bah et al. on the long-term impacts of conflict on youth in Sierra Leone. The Intergenerational Study of War-Affected Youth (ISWAY) project in Sierra Leone — now supported by Thrive — has tracked 529 young Sierra Leoneans, including former child soldiers, over a 22-year period following the end of the conflict. It has identified the lasting effects of war on children and youth and highlighted factors influencing their health and wellbeing as well as reintegration efforts. The team emphasises the success of their Youth Readiness Intervention in improving mental health, arguing that it offers a valuable opportunity for scaling across Sierra Leone, enhancing school engagement and employment prospects for young people aged 15 to 24. For more insights on the ISWAY project and the experiences of former child soldiers in Sierra Leone, we highly recommend Dr. Betancourt´s recently released book, available here.

Research by Black et al. describes the scaling success story of the Sugira Muryango (SM) home visiting programme in Rwanda, designed to provide nurturing care to children under 3 and prevent violence in impoverished households. The study established a partnership with the Rwandan government and universities to scale the programme across three districts, reaching over 8,000 families. The programme improved nutrition for young children and led to a 66% reduction in harsh disciplinary methods, such as withholding food or toys. It also increased fathers’ involvement in child development and decreased instances of parental depression anxiety. The team found that scaling the programme through community volunteers and non-specialists did not reduce the impacts on parental engagement in ECD. Despite challenges like COVID-19, the programme was delivered on time and with quality to all eligible households, with a decreasing programme cost of US$199 per family at scale, compared to US$456 per family during the trial period. The research underscores that strong collaboration with government stakeholders was key to successful implementation and highlights the importance of stakeholder buy-in for future scaling efforts.

A new study by Altafim and Linhares offers promising insights into the potential to scale interventions addressing violence against children. The paper presents findings from an RCT evaluating the effectiveness of the ACT Action Program – Raising Safe Kids, currently being tested for scaling in Ceará, Brazil. This programme provides group training and support to strengthen positive parenting practices and reduce violence against children in low-income families. At scale, it significantly improved emotional and behavioural regulation and increased the use of positive discipline among participating parents. The programme proved to be low-cost and easily implementable in new regions through the development of quick training manuals and delivery systems. While the authors note that medium- to long-term studies of the ACT programme are lacking to assess its lasting effects, the initial results highlight its effectiveness and potential for national scaling as a positive parenting intervention.

On measurement, Yibeltal et al. share their experience in adapting and implementing the World Health Organization (WHO) Global Scales for Early Development (GSED) tool in Ethiopia. This tool assesses children under 3 on various developmental milestones, including cognitive, motor, socio-emotional and language. The team assessed nearly 400 children using trained nurses, who received instruction from GSED master trainers. They found the tool user-friendly and the training straightforward. Cultural adaptations were essential, such as adjusting terminology in Amharic translations and modifying cognitive tests to align with local norms, a point echoed in Wen et al.´s article below. Overall, the GSED´s adaptability to cultural contexts proved effective in Ethiopia, demonstrating that necessary modifications can be introduced relatively easily for successful implementation. Further information on the GSED tool and its rollout can be found here.

Wen et al. present a compelling argument regarding the challenges and considerations essential for conducting cross-cultural developmental research. They emphasise that, with the increasing prevalence of cross-cultural research in ECD and related fields, there has also been a rise in methodological issues. These include insufficient cultural and contextual knowledge, the creation of culturally inappropriate methods and tools, and the establishment of superficial, short-term partnerships, all of which jeopardise the validity and ethical integrity of the research. The authors offer a variety of suggestions for designing culturally grounded and methodologically sound research methods tailored to the specific cultural context of the study. These recommendations include the development of ethnographic and observational techniques, the creation of flexible causal frameworks that adapt to contextual evidence, and the cultivation of community-engaged and collaborative research environments.

To wrap up this month´s newsletter,  we feature an insightful article by Baek et al. that presents a cost-benefit analysis of a transformative ECD intervention in Vietnam. This initiative, centred around community-based ‘Learning Clubs’, aims to enhance maternal and new born health. The team monetised the programme´s benefits by evaluating wage increases associated with improved cognitive development over a lifetime. The results? When implemented at scale, the programme is projected to yield a benefit-cost ratio of 5.52 (averaged across both boys and girls), meaning for every dollar invested in the Learning Club programme, US$5.52 would be returned. On a national scale, the authors estimate that the total benefit could reach a staggering US$2.28 billion per birth cohort throughout their working lifetime, factoring in enhanced educational outcomes, better job prospects and reduced healthcare costs. The authors strongly advocate for conducting systematic cost-benefit analyses to showcase the economic advantages of scaling ECD interventions globally.