Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial.
OBJECTIVE
To assess the effects of providing daycare facilities for young children on the health and welfare of disadvantaged families.


METHODS
Randomised controlled trial. Eligible children from the application list to a daycare facility were randomly allocated to receive a daycare place or not.


METHODS
Early Years daycare centre in Borough of Hackney, London.


METHODS
120 mothers and 143 eligible children (aged between 6 months and 3.5 years).


METHODS
A place at the centre, which provided high quality day care. Control families used other child care that they secured for themselves.


METHODS
Maternal paid employment, household income, child health and development.


RESULTS
At 18 months' follow up, 67% of intervention group mothers and 60% of control group mothers were in paid employment (adjusted risk ratio 1.23 (95% confidence interval 0.99 to 1.52)), but were no more likely to have a weekly household income of above pound 200 (risk ratio 0.88 (0.70 to 1.09)). Intervention group children had more otitis media with effusion (risk ratio 1.74 (1.02 to 2.96)) and used more health services (1.58 (1.05 to 2.38)), but both estimates were imprecise.


CONCLUSIONS
The provision of child day care may have increased maternal employment, but it did not seem to increase household income. The results suggest that providing day care may be insufficient as a strategy to reduce poverty. The study shows how random allocation can be used to ration and evaluate interventions where demand exceeds supply.
Toroyan
Tami
T
Public Health Intervention Research Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1B 3DP. tami.toroyan@lshtm.ac.uk
Roberts
Ian
I
Oakley
Ann
A
Laing
Gabrielle
G
Mugford
Miranda
M
Frost
Chris
C
D002656:Child Day Care Centers / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004651:Employment / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008131:London; D009035:Mothers / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D035862:Vulnerable Populations / Q000706:statistics & numerical data*