title: Effectiveness of out-of-home day care for disadvantaged families: randomised controlled trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Tami
authors.initials: T
authors.lastname: Toroyan
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
authors.forename: Ann
authors.initials: A
authors.lastname: Oakley
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Laing
authors.forename: Miranda
authors.initials: M
authors.lastname: Mugford
authors.forename: Chris
authors.initials: C
authors.lastname: Frost
mesh_terms: 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*