title: Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  96 municipalities in Colombia, located across eight of its 32 departments.
  
  
  METHODS
  1420 children aged 12-24 months and their primary carers.
  
  
  METHODS
  Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months.
  
  
  METHODS
  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.
authors.affiliation: Department of Economics, University College London, London, UK.
authors.forename: Orazio P
authors.initials: OP
authors.lastname: Attanasio
authors.affiliation: Mathematica Policy Research, Princeton, NJ, USA.
authors.forename: Camila
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Institute of Education, London WC1H 0AL, UK e.fitzsimons@ioe.ac.uk.
authors.forename: Emla O A
authors.initials: EO
authors.lastname: Fitzsimons
authors.affiliation: UCL Institute of Child Health, London, UK.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Grantham-McGregor
authors.affiliation: Department of Economics, Yale University, New Haven, CT, USA.
authors.forename: Costas
authors.initials: C
authors.lastname: Meghir
authors.affiliation: Centre for the evaluation of development policy, Institute for Fiscal Studies, London.
authors.forename: Marta
authors.initials: M
authors.lastname: Rubio-Codina
mesh_terms: D000328:Adult; D002657:Child Development / Q000502:physiology*; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D016000:Cluster Analysis; D003071:Cognition / Q000502:physiology; D003105:Colombia; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019587:Dietary Supplements; D005260:Female; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007223:Infant; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D009313:National Health Programs; D010988:Play and Playthings / Q000523:psychology; D011597:Psychomotor Performance / Q000502:physiology*; D012044:Regression Analysis
chemical_list: D018977:Micronutrients