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The Chinese government has established a three‐tier maternal care system covering the entire country and providing integrated antenatal care (ANC) for pregnancies. This study aimed to analyze the direct and indirect effects of ANC services on early childhood development. A community‐based cross‐sectional survey was conducted for mothers' ANC visits and assessments of early childhood development in Shanxi and Guizhou provinces, China. A total of 1660 mother–child dyads were included in current analyses: 29.2% of mothers did not receive any ANC (ANC1), 23.3% of mothers received ANC three or fewer times (ANC2), and 47.5% of mothers received ANC four or more times (ANC3). Children whose mothers received ANC services had a significantly lower risk of overall developmental delay (OR = 0.60, 95% CI: 0.44–0.81 for ANC2; and OR = 0.44, 95% CI: 0.34–0.59 for ANC3) and social‐emotional developmental delay (OR = 0.68, 95% CI: 0.49–0.94 for ANC3). Furthermore, a significant pathway relationship mediated by maternal depression and nurturing care was found between ANC and developmental delay. This study showed ANC services significantly reduced the risk of developmental delay in offspring. We also suggest that a nationwide ANC system can be a good delivery platform for scaled‐up early childhood development interventions. [ABSTRACT FROM AUTHOR]

Reflecting a burgeoning political interest in supporting young children around the world, global demand for reliable, valid, and scalable assessments of early childhood development (ECD) is on the rise. One of the more popular sets of tools for measuring the ECD of children under age 3 is the Caregiver Reported Early Development Instruments (CREDI), which includes both a long form for research and evaluation and a short form for population-level monitoring. In this commentary, we describe the goals and limitations of the CREDI, research to support its use as a population-level ECD instrument, as well as the major gaps in its evidence base. We also discuss how the work of Alderman and colleagues (in this issue) addresses some of these outstanding gaps, highlighting several critical areas for future research. [ABSTRACT FROM AUTHOR]

Abstract: Small pilot studies of young children have frequently shown promise, but very few have been successfully scaled to the regional or national levels. How can we ensure that these promising approaches move from a suite of pilots to full‐scale implementation that can deliver sustainable impact for hundreds of millions of children? To elucidate concrete lessons learned and suggestions on accelerating the transition to impact at scale, we reviewed the Saving Brains portfolio to better understand three points: (1) the extent to which useful signals of impact could be extracted from data at the seed phase, (2) the ways in which innovators (project leaders) were approaching human resource challenges critical for scaling, and (3) the multisector diversity of the portfolio and the way innovators entered partnerships. The findings suggest key considerations for transitioning early childhood development interventions to scale and sustainability: strong entrepreneurial leadership, rigorous measurement and active use of data in support of adaptive learning, and champions acting at subnational levels. Together, these can enable flexible, iterative learning that can make the scaling process an opportunity to increase the level of benefit each child receives from an intervention. [ABSTRACT FROM AUTHOR]

Abstract: Research in early childhood development (ECD) has established the need for scaling‐up multisectoral interventions for nurturing care to promote ECD, for improved socioeconomic outcomes for sustainable societies. However, key elements and processes for implementation and scale‐up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. We discuss emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale‐up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. Effective implementation of nurturing care interventions is at the heart of achieving positive developmental outcomes for young children. It is pivotal to adapt and implement these interventions based on evidence for high impact, especially in low‐resource settings. [ABSTRACT FROM AUTHOR]

Abstract: Young children living in conditions of war, disaster, and displacement are at high risk for developmental difficulties that can follow them throughout their lives. While there is robust evidence supporting the need for early childhood development (ECD) in humanitarian settings, implementation of ECD programming remains sparse, largely due to the lack of evidence of how and why these programs can improve outcomes in humanitarian settings. In order to build the evidence base for ECD in humanitarian settings, we review the current state of implementation research for ECD programming (targeting children 0–8) in humanitarian settings, through a literature review and a series of key informant interviews. Drawing from existing frameworks of implementation research and the findings from our analysis, we present a framework for ECD implementation research in humanitarian settings and propose an agenda for future research. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we analyze the need for consistent and accurate cost data on early childhood development (ECD) interventions as a basis for increasing and improving the effectiveness of current spending on ECD. We establish the key components necessary in a costing model and present a new standardized costing tool intended for use across a broad range of stakeholders and contexts. Learnings from piloting the tool in Bangladesh, Malawi, Mali, Mexico, and Mozambique are shared. Providing a standardized methodology for costing ECD is an important contribution to the field and has the potential to improve both the volume and effectiveness of ECD financing. [ABSTRACT FROM AUTHOR]

Abstract: Meta‐analyses of interventions such as parenting, stimulation, and early childhood education have reported consistent medium‐to‐high effect sizes on early childhood development (ECD) and early learning outcomes. However, few effective interventions promoting ECD have achieved scale. In order to increase the access to effective or high‐quality services, greater focus on implementation research of interventions promoting ECD is necessary. In this paper, we describe the development of reporting guidelines for implementation research of nurturing care interventions designed to promote ECD following an expert consensus‐building process. The goal of these guidelines is to support a transparent and standard reporting of implementation evidence on nurturing care interventions designed to promote early childhood development. [ABSTRACT FROM AUTHOR]

Abstract: Political action and investment are critical to meet the development needs of vulnerable young children today. Early childhood development (ECD) has become a global priority: an ECD target and other ECD‐related targets are included in the sustainable development goals, over 75 countries have officially adopted multisectoral ECD policy instruments, and ECD is a programmatic focus in major global institutions (including UNICEF, UNESCO, the WHO, and the World Bank). However, lack of clear and strong ownership of and champions for ECD, operational and communication siloes of constituent sectors that constitute ECD, political pressures for investment in other arenas, and low international investment in ECD inhibit making a compelling and cohesive investment case for ECD. This commentary explores how a global ECD network can facilitate systematic alignment and action across sectors to support country systems, strengthen political will, and increase investment to deliver results for young children's development. The ECD Action Network is in formation and offers an opportunity for the field to share knowledge among countries and sectors, identify pathways for sectoral coordination and collaboration, and undertake advocacy to generate the scale of political and financial support necessary to ensure that every child receives the nurturing care he/she needs. [ABSTRACT FROM AUTHOR]

Abstract: As early childhood interventions move from small‐ to large‐scale programs, the partnerships among researchers, policymakers, communication experts, practitioners, and local communities become increasingly critical for successful implementation. The results from evaluations of programs need to guide policymakers so that they can make informed administrative and fiscal decisions. This commentary makes five recommendations for researchers to consider when designing early childhood programs for scale. [ABSTRACT FROM AUTHOR]

Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs. [ABSTRACT FROM AUTHOR]

A growing body of evidence supports the notion that integrated programs addressing nutrition and stimulation provide stronger impacts on nutritional and developmental outcomes than either intervention alone. When translating evidence into practice, several advantages and challenges for integration can be noted. Combined interventions may be more efficient than separate interventions, because they are intended for the same population and make use of the same facilities, transportation, and client contacts. In addition, for families, particularly for those most at risk, combined interventions can also lead to increased access to services. However, in order for integrated nutrition and early childhood development interventions to be successful, a variety of challenges must be addressed. These include workload of staff and supervisors, communication and coordination among different ministries and among staff in different sectors, and common language and measurement. It must be acknowledged at both the national and community levels that comprehensive, integrated care addressing both the physical and developmental needs of the child is key to promoting optimal health, growth, and development for children. [ABSTRACT FROM AUTHOR]