Improving early childhood care and development, HIV-testing, treatment and support, and nutrition in Mokhotlong, Lesotho: study protocol for a cluster randomized controlled trial.
Since 1990, the lives of 48 million children under the age of 5 years have been saved because of increased investments in reducing child mortality. However, despite these unprecedented gains, 250 million children younger than 5 years in low- and middle-income countries (LMIC) cannot meet their developmental potential due to poverty, poor health and nutrition, and lack of necessary stimulation and care. Lesotho has high levels of poverty, HIV, and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which provide a setting for inclusive, integrated Early Childhood Care and Development (ECCD) and HIV and nutrition interventions.



We are conducting a cluster randomised controlled trial in Mokhotlong district, Lesotho, to evaluate a newly developed community-based intervention program to integrate HIV-testing and treatment services, ECCD, and nutrition education for caregivers with children aged 1-5 years living in rural villages. Caregivers and their children are randomly assigned by village to intervention or control condition. We select, train, and supervise community health workers recruited to implement the intervention, which consists of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session 1 month later), followed by a locally hosted community health outreach day event. Group-based sessions focus on using early dialogic book-sharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. All children aged 1-5 years and their primary caregivers living in study villages are eligible for participation. Caregivers and their children will be interviewed and assessed at baseline, after completion of the intervention, and 12 months post intervention.



This study provides a unique opportunity to assess the potential of an integrated early childhood development intervention to prevent or mitigate developmental delays in children living in a context of extreme poverty and high HIV rates in rural Lesotho. This paper presents the intervention content and research protocol for the study.



The Mphatlalatsane: Early Morning Star trial is registered on the International Standard Randomized Controlled Trial Number database, registration number ISRCTN16654287 ; the trial was registered on 3 July 2015.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa. markt@sun.ac.za.
Mark
0000-0001-5846-3444
M
Tomlinson
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Sarah
S
Skeen
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Marguerite
M
Marlow
Department of Social Policy and Intervention, Oxford University, Oxford, UK.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Lucie
L
Cluver
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.|University of Reading, Reading, UK.
Peter
P
Cooper
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.|University of Reading, Reading, UK.
Lynne
L
Murray
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Shoeshoe
S
Mofokeng
Leadership Management and Governance Project, Management Sciences for Health, Pretoria, South Africa.
Nathene
N
Morley
Leadership Management and Governance Project, Management Sciences for Health, Pretoria, South Africa.
Moroesi
M
Makhetha
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Sarah
S
Gordon
Centre for Evidence-Based Health Care, Stellenbosch University, Stellenbosch, South Africa.
Tonya
T
Esterhuizen
University College London, London, UK.
Lorraine
L
Sherr
D000367:Age Factors; D017028:Caregivers / Q000523:psychology; D002652:Child Behavior; D002657:Child Development; D002662:Child Health Services; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003071:Cognition; D003150:Community Health Workers; D003159:Community-Institutional Relations; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007223:Infant; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D011203:Poverty; D011237:Predictive Value of Tests; D012107:Research Design; D012307:Risk Factors; D019035:Rural Health Services; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
Community health workers; Early childhood development; HIV; Lesotho; Maternal and child health; Nutrition; Paraprofessionals