Abstract
An estimated 43 percent of children under age 5 in low- and middle-income countries (LMICs) will not reach
their full developmental potential due to poverty, stunting, or inadequate psychosocial stimulation. Parenting
interventions that coach parents on responsive caregiving can effectively improve ECD outcomes in LMICs, at
least in the short-term. However, the very few programs that have examined their sustained effects find that early
program impacts tend to fade over time. To date, the only parenting interventions demonstrating sustained
impacts five or more years after the end of their programs from a LMIC are two small pilot studies, both featuring
weekly individual home visits over two years on a total of 134 stunted or low birthweight children from urban
Kingston, Jamaica. Such intensive delivery models are prohibitively expensive to scale in rural and resource-poor
LMIC settings. Community-based group meetings are a more cost-effective and scalable delivery model, and can
also allowforpeer-to-peer learning and the formation of social support networks. Though growing evidence from
LMICs shows that group meetings are at least as effective as individual home visits to improve ECD in the short-
term, evidence on their ability to sustain impacts over time, and the mechanisms underlying such impacts (e.g.,
social support), is still very limited.
With NICHD support (R01HD090045), we demonstrated that an 8-month, group-based ECD parenting
intervention delivered by CHWs in rural Kenya significantly improved short-term ECD outcomes and
parenting practices, and the program was highly cost-effective. In complementary work (R21HD098508),
immediately after the main intervention, in half of intervention villages, we added 9 bi-monthly “booster”
group meetings to reinforce key messages over two years. In a recent two-year follow-up assessment, we found
that early impacts from the original 8-month intervention were sustained when children were ages 3.5 to 5, and
the poorest families benefited the most. The booster extension, despite being severely disrupted by the COVID-
19 pandemic, had small additive effects on children’s socioemotional outcomes and parenting behaviors.
Building on these results, we now propose to follow-up our original study cohort roughly 5 years after the end
of the intervention to measure longer-term sustained impacts on our sample of targeted children who will be
roughly 6.5 to 8 years old, as well as their younger and older siblings to uncover potential spillover effects. We
will re-enroll households from our original sample across 60 villages to collect an additional survey wave to
measure children’s cognitive, language, executive function and socio-emotional skills, as well as parenting
behaviors, knowledge and beliefs, social networks, and social norms around parenting to examine potential
mediating pathways driving any sustained impacts and any spillover impacts onto siblings.
The goal of our study is to help fill a gap regarding evidence on the long-term effectiveness of ECD programs on
children’s outcomes from a scalable and cost-effective model of delivery to help inform policy.
