Integrated and holistic child development intervention (RINEW, Bangladesh)
Interventions to improve early child development outcomes that focus on responsive stimulation have improved short-term early child development outcomes in many different cultures and contexts globally. Water, sanitation, and hygiene, nutrition, caregiver mental health, and lead exposure are contributors to poor child development outcomes, though few interventions have delivered these components together with responsive stimulation. The aim of the RINEW project (Research on Integration of Nutrition Early child development and WASH) was to design and evaluate a multi-component early child development intervention and pilot its scale-up through the government health system in Bangladesh. We are currently building on the RINEW project with RINEW-G (RINEW components, but rolled out across an entire government district in Bangladesh). We have collected data that will allow us to evaluate the effectiveness of this massive roll-out and are currently preparing the results.
Findings:
In this project, we designed a multi-component early child development intervention that included contents on responsive stimulation, nutrition, water, sanitation, hygiene, caregiver mental health, and lead exposure prevention (protocol: International Journal of Environmental Research and Public Health). We evaluated the intervention using a cluster-randomized trial design in Kishorganj, Bangladesh, using two delivery methods: home visits and group sessions near participants’ homes. We found effects on stimulation in the home, child development, and multiple other risk factors for child development (BMJ Global Health, Environmental Research). We examined the experiences of delivery agents and participants to improve intervention delivery (International journal of environmental research and Public Health, American Journal of Tropical Medicine and Hygiene). We then adapted the multi-component intervention to be delivered by government health workers at community health centers in one sub-district of Bangladesh. We used data collected as part of this evaluation to examine the relationship between the COVID-19 pandemic and caregiving practices and caregiver mental health among caregivers more and less impacted by the pandemic (child development). We are currently using the quantitative data collected to evaluate the impact of the multi-component intervention on risk factors for poor child development, and using the qualitative data collected from delivery agents and participants to better understand the feasibility, acceptability and scalability of delivery agents (government health workers).
Collaborators:
Steve Luby (Stanford), Mahbubur Rahman (icddr,b), Fahmida Tofail (icddr,b), Peter Winch (Johns Hopkins), Jenna Forsyth (Stanford), Laura (Layla) Kwong (Berkeley), Christine Stewart (UC Davis).
Publications (sorted by recency):
Pitchik HO, Tofail F, Akter F, Sultana J, Shoab AK, Huda TMN, Forsyth JE, Kaushal N, Amin MR, Jahir T, Yeasmin F, Khan R, Das JB, Hossain K, Hasan MR, Rahman M, Winch PJ, Luby SP, Fernald LCH. Effects of the COVID-19 pandemic on maternal mental health and the child caregiving environment on families in rural Bangladesh. Child Dev 2021;92:e764–80
Jahir T, Winch PJ, Leontsini E, Hwang ST, Yeasmin F, Hossain K, Das JB, Amin R, Nurul Huda TM, Sultana J,Khan R, Akter F, Shoab A, Hasan R, Pitchik HO, Tofail F, Fernald LCH, Luby SP, Rahman M. Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh. Int J Environ Res Public Health. 2021 Jul 26;18(15). doi: 10.3390/ijerph18157891.
Pitchik HO, Tofail F, Rahman M, Akter F, Sultana J, Shoab AK, Huda TMN, Jahir T, Amin MR, Hossain K , Das JB, Chung EO, Byrd KA, Yeasmin F, Kwong LH, Forsyth JE, Mridha MK, Winch PJ, Luby SP, Fernald LCH. A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh. BMJ Global Health. 2021;6(3):e004307.
Yeasmin F, Winch PJ, Hwang ST, et al. Exploration of Attendance, Active Participation, and Behavior Change in a Group-Based Responsive Stimulation, Maternal and Child Health, and Nutrition Intervention. The American Journal of Tropical Medicine and Hygiene. 2021;104(4):1586–1595.
Akter F, Rahman M, Pitchik HO, Winch PJ, Fernald LCH, Huda TMN, Jahir T, Amin R, Das JB, Hossain K, Shoab AK, Khan R, Yeasmin F, Sultana J, Luby SP, Tofail F. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. International Journal of Environmental Research and Public Health. 2020;17(17):6233.
Funders: Bill and Melinda Gates Foundation