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Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia : cluster randomized controlled trial

Attanasio, Orazio P and Fernández, Camila and Fitzsimons, Emla O A and Grantham-McGregor, Sally M and Meghir, Costas and Rubio-Codina, Marta (2014) Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia : cluster randomized controlled trial. BMJ (Clinical research ed.), 349. g5785. ISSN 1756-1833. DOI UNSPECIFIED

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Abstract

OBJECTIVE: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels. DESIGN: Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. SETTING: 96 municipalities in Colombia, located across eight of its 32 departments. PARTICIPANTS: 1420 children aged 12-24 months and their primary carers. INTERVENTION: Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. MAIN OUTCOME MEASURES: Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. RESULTS: Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. CONCLUSIONS: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160.

Item Type: Article
Additional Information: © Attanasio et al 2014.
Controlled Keywords: Adult, Child Development, Child Health Services, Child, Preschool, Cluster Analysis, Cognition, Colombia, Delivery of Health Care, Integrated, Dietary Supplements, Female, Home Care Services, Humans, Infant, Male, Micronutrients, National Health Programs, Play and Playthings, Psychomotor Performance, Regression Analysis
Depositing User: Atira Pure
Date Deposited: 25 Nov 2014 14:11
Last Modified: 29 Jan 2015 09:13
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