Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal control design.
Stimulation in early childhood can alleviate adverse effects of poverty. In a community-randomised trial, we implemented 2 home-based interventions, each serving as an attention control for the other. One group received an integrated household intervention package (IHIP), whereas the other group received an early child development (ECD) intervention. The primary objective of the study was to evaluate the effect of IHIP on diarrhoea and respiratory infections, the details of which are described elsewhere. Here, we present the impact of the ECD intervention on early childhood development indicators.



In this non-blinded community-randomised trial, an ECD intervention, adapted from the Peruvian government's National Wawa Wasi ECD programme, was implemented in 25 rural Peruvian Andean communities. We enrolled 534 children aged 6-35 months, from 50 communities randomised 1:1 into ECD and IHIP communities. In ECD communities, trained fieldworkers instructed mothers every 3 weeks over the 12 months study, to stimulate and interact with their children and to use standard programme toys. IHIP communities received an improved stove and hygiene promotion. Using a nationally validated ECD evaluation instrument, all children were assessed at baseline and 12 months later for overall performance on age-specific developmental milestones which fall into 7 developmental domains.



At baseline, ECD-group and IHIP-group children performed similarly in all domains. After 12 months, data from 258 ECD-group and 251 IHIP-group children could be analysed. The proportion of children scoring above the mean in their specific age group was significantly higher in the ECD group in all domains (range: 12-23%-points higher than IHIP group). We observed the biggest difference in fine motor skills (62% vs 39% scores above the mean, OR: 2.6, 95% CI 1.7 to 3.9).



The home-based ECD intervention effectively improved child development overall across domains and separately by investigated domain. Home-based strategies could be a promising component of poverty alleviation programmes seeking to improve developmental outcomes among rural Peruvian children.



ISRCTN28191222; results.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.|Instituto de Investigación Nutricional, Lima, Perú.|Universidad Peruana Cayetano Heredia, Lima, Perú.
Stella Maria
SM
Hartinger
Instituto de Investigación Nutricional, Lima, Perú.
Claudio Franco
CF
Lanata
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Jan
J
Hattendorf
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Jennyfer
J
Wolf
Instituto de Investigación Nutricional, Lima, Perú.
Ana Isabel
AI
Gil
Programa Nacional CUNA MAS, Lima, Perú.
Mariela Ortiz
MO
Obando
Pontificia Universidad Católica del Perú, Lima, Perú.
Magaly
M
Noblega
Instituto de Investigación Nutricional, Lima, Perú.|Universidad Peruana Cayetano Heredia, Lima, Perú.
Hector
H
Verastegui
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Daniel
D
Mäusezahl
D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D016000:Cluster Analysis; D003967:Diarrhea / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D010568:Peru; D011204:Poverty Areas; D012107:Research Design; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population
CHILD HEALTH; DEVELOPING COUNTR; ENVIRONMENTAL HEALTH; Lifecourse / Childhood Circumstances; RANDOMISED TRIALS