Scaling Early Childhood Development – what to read this month | December 2024

‘What to read’ now has more than 700 readers from over 100 institutions across 4 different continents! As we reach the end of 2024, after 11 editions covering 100 studies, the newsletter’s lead editor Bet Caeyers has taken stock in two blog posts. In the first blog she provides an overview of all the evidence we have looked at over the course of the last year – what are the hot topics in scaling early childhood development (ECD) research? What types of research methods are being used? Which countries and regions are covered? By way of gauging research reach within the academic discourse, a second blog examines the impact of journals that are publishing research on scaling early childhood development.

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

Let’s kick off the last edition of this newsletter in 2024 with some exciting news. After many scientific contributions to the first 1000 days of a child’s life (the period from conception until age 2), The Lancet has launched a new series focusing on the ‘next 1000 days’, i.e. the period between a child’s second and fifth birthday. The series dives into factors that shape young children’s lives during this period, including care, risks and protective factors and the resulting developmental outcomes (see Figure 1). Short on time? Skip to page 2,107 for a comprehensive mapping of interventions promoting development over the next 1000 days. Although the number of interventions in this period has increased by 79% since 2010, high-income countries are driving this effort, with only 5% of interventions occurring in LMICs – highlighting a clear research gap. Coming soon: the follow-up paper on the cost of inaction and the implications of not investing in the next 1000 days.

Switching to nutrition, let’s look at the findings from Collishaw et al.’s. randomised control trial in rural Malawi, analysing how cash plus initiatives impact diet and food security. The Maziko intervention entails a social behaviour change component, implemented by Save the Children, and a cash transfer distributed by Give Directly. The cash component provided pregnant women and mothers of children under 2 with an unconditional transfer of either a lower amount (MWK 17,204  USD 10) or a higher amount (MWK 43,516 USD 25) delivered monthly for 30 months. Unsurprisingly, the higher cash transfer coupled with social behaviour change created the greatest impact on household food security, food consumption and behavioural changes. Interestingly, however, no impact was found when delivering either social behaviour change on its own or in conjunction with the smaller transfer amount. These findings are in line with evidence on other cash plus programmes (e.g. by Carneiro et al. in Nigeria and by Ahmedet al. in Bangladesh). This begs the question, how can policymakers remedy scalability and sustainability while ensuring cash transfer programme effectiveness?

Does integrating early childhood development (ECD) group sessions into existing health and nutrition programmes – a common approach to scaling ECD interventions – constrain caregiver time and detract from existing services? Not according to Hemlock et al. The authors assess this question in Madagascar where ECD group sessions were added to a nationwide maternal and child health and nutrition programme. Findings show that new services did not crowd out existing services. This aligns with previous work supporting the call to integrate ECD group sessions into existing health and nutrition services. The paper also discusses whether a combination of home- and group-based delivery could expand coverage to those caregivers who are most remote or time-constrained.

Pivoting to mental health, a new study by Fink et al. assesses the feasibility and impact of a culturally adapted community-based mental health intervention in Zambia, offered to mothers either by phone or in person. Results? It seems feasible and effective for health workers without formal training to deliver positive mental health outcomes in low-resource settings. Possibilities for scaling include enhancing community health worker training to encompass more severe mental health needs, including a telehealth element, and a train-the-trainer approach to develop the most capable community health workers into supervisors.

Moving to the importance of engaging caregivers other than mothers in ECD programming. Avornyo and Wolf’s recent study explores how mothers’, fathers’ and other caregivers’ engagement in cognitive and socioemotional stimulation impacts school readiness in Ghana. Caregivers (excluding fathers) were more likely to engage in activities such as reading or playing, and the involvement of the mother and other caregivers had the greatest effect on children’s readiness for school. No link was found between fathers’ cognitive or socioemotional stimulation and children’s school readiness. Conversely, Rothenberg and Bornstein’s study across 51 LMICs concludes that fathers’ engagement and stimulation at home were associated with higher levels of literacy and numeracy and greater overall socio-emotional development gains.

Quite a few new insights on the topic of intimate partner violence and violence against children this month. A qualitative study by McCool et al. confirms the feasibility and desirability of implementing SafeCare – an evidence-based parenting programme to prevent child neglect and physical violence – in Haitian birthing centres, bringing it one step closer to scale. A Lancet viewpoint piece by Meinhart et al. examines how gender transformative programmes can reduce gender-based violence in humanitarian settings. A pilot feasibility study by Desrosiers et al. in Sierra Leone highlights the transformative potential of the Family Strengthening Intervention for Early Childhood Development and Violence Prevention. Preliminary findings reveal improved parent-child interactions and a reduction in household violence, thanks in part to the active inclusion of male caregivers. The importance of including male caregivers alongside women to reduce intimate partner violence and violence against children is also emphasised in this new UNICEF evidence brief.

On financing, a recent World Bank report outlines five actions to bridge the financing gap in social protection. Recommendations include investing in delivery systems (e.g. targeting and digitalisation) to improve the accuracy and cost-effectiveness of services, repurposing fuel subsidies to finance social protection (also a win for the planet!), advocating for tax reforms to increase domestic resources, leveraging climate finance for social protection, and making the most of partnerships (including better coordination, for example, aligning humanitarian and social protection efforts in fragile settings).

Let’s end 2024 with the topic of measurement! A new scoping review by Rathod et al. examines the role of process evaluations in scaling up complex health interventions, emphasising the importance of context, structures, and external factors influencing scale-up. The authors call for continuous, systems-driven process evaluations that combine both qualitative and quantitative data, enabling real-time adaptations and identifying unintended consequences, which are vital for effective scale-up and ensuring interventions meet real-world needs.