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Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015–2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world’s children with disabilities are unlikely to be realised.

IntroductionResearch spanning decades across fields such as psychology, education, and neuroscience consistently highlights the crucial role of social–emotional skills in various aspects of personal, academic, and professional development (1–3). The fact that UNESCO recognises social–emotional learning (SEL) as essential not just for meeting its educational objectives but also for accomplishing the Sustainable Development Goals highlights the crucial role robust social–emotional development plays in establishing sustainable societies. Whilst various studies highlight the importance of SEL, there is limited attention on how organizations can contribute to building such development by consciously including SEL in their work practice.Process/methodsOur case study presents the process of integrating SEL into organizational practice over a period of 9 months. The selected constructs of SEL were determined by the organisation’s needs and values. The Measurement for Change approach was used to frame and implement the intervention, with interactive discussions being the key methodology. Data were collected via surveys, reflective sharing, and observations.ResultsA shift in the selected constructs of SEL was recorded, with data highlighting individual differences.ConclusionThe process of co-design and continual reflective practice was key to achieving change within the subset of the organisation rather than the specific content of the materials used.

IntroductionChildren with disabilities in low- and middle-income countries face many challenges and lack adequate services, including access to rehabilitation professionals. To address this lack of access, Amar Seva Sangam Ayikudy (ASSA), a non-governmental organization (NGO) in India, designed a technology-leveraged rehabilitation program called Enabling Inclusion® (EI®), and implemented it in one state (Tamil Nadu, India) before scaling it. The model is supported by the EI® app, which enables organizations to screen, assess and monitor progress of children with disabilities via rehabilitation specialists and community rehabilitation workers, and to provide family-centered, goal-based interventions. An extensive monitoring, evaluation, and learning (MEL) framework is embedded into the program. This paper explores how this MEL system supported the scaling of the EI® model, reaching additional beneficiaries nationally and globally.MethodsThis paper describes ASSA’s MEL framework and demonstrates its use for decision-making in the process of scaling. It also explores how collaborations with various government departments, NGOs, and private partners contributed to the scaling of the EI® model and technology.ResultsScaling of the EI® program was achieved by (1) expansion of the program in rural Tamil Nadu (vertical scale-up) in partnership with the Tamil Nadu government and private partners, and (2) by licensing the EI® app and model to other NGOs in various states in India and globally (horizontal scale-up). Systematic examination of key program and performance indicators, as well as stakeholder feedback, informed decisions to modify the EI® app over time. This included further customizing to the needs of children and service providers, covering a greater range of age groups and contexts, and modifying service delivery models. Child functional independence, participation, and inclusion was further strengthened by mobilizing parent empowerment groups, community awareness programs, school advocacy, and entitlements from the government. Flexibility in the implementation model of the EI® app allowed for adaptation to local contexts and organizations, and facilitated its scale-up.ConclusionA dynamic, inclusive, and locally grounded MEL system, a flexible and collaborative approach, and an adaptive implementation model increased the accessibility of an early intervention and childhood rehabilitation program for children with disabilities and their families throughout the state of Tamil Nadu, across India, and internationally.

Background and objectivesEarly Childhood Development is high on the policy agenda in Côte d’Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how “MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale,” one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of “How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)?MethodsFive training approaches to improve caregivers’ knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD.ResultsThe evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation.ConclusionThe iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis.

IntroductionEarly childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described.MethodThis study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD.ResultsThe results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53–0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52–0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50–0.88).DiscussionAccording to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention.

IntroductionThe first three years of a child’s life are the most critical to child development and have an impact on the future achievement of the child. Young children’s healthy development depends on nurturing care that ensures health, nutrition, responsive caregiving, safety, and security. Parents & other adult caregivers play a critical role in moderating children’s early experiences, which has a lasting impact be it positive or negative on the children’s future. Parenting education programs are proven to improve parental skills, capacity, and efficacy in a way that supports improved child development outcomes. Yet, most parents in low-middle-income countries such as Rwanda lack access to information and skills on how to support their children’s holistic development. In response, Save The Children implemented the First Steps “Intera za Mbere” holistic parenting education project in Rwanda from 2014 to 2021. This paper reflects on how monitoring, evaluation, accountability, and learning (MEAL) approaches were applied throughout the project cycle and their impact on program improvement and national policy and advocacy. This paper explores how the aspirations for measurement for change, considerations for innovation uptake and frameworks for learning about improvement are reflected in this project.MethodsThe project utilized qualitative and quantitative MEAL across the program cycle. Action research at the start of the project identified promoters and inhibitors of high-quality nurturing care and program delivery modalities. The project utilized a randomized control trial to provide insight into components that work better for parenting education. Evidence from surveys done remotely via phones was used to inform COVID-19 adaptations of the program.ResultsThe application of MEAL evidence led to the successful development and improvement of the program. At the policy level, evidence from the project influenced the review of the 2016 National Integrated ECD policy and the development of the national parenting education framework.ConclusionThe regular use of evidence from MEAL is critical for program improvement, scale-up, and policy influence.

BackgroundKnowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4 years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4 years.MethodsWe used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4 years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally “on track”.ResultsThe findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children’s activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08–1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09–1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4 years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts.ConclusionHome environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study’s findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context.

This paper presents a community case study of how the Moments That Matter® (MTM) Program community-led monitoring, evaluation and learning (MEL) system contributes to a scalable model with quality and sustainable impact. With a faith-based approach, MTM is an early childhood development program partnership of Episcopal Relief & Development which is rooted in parenting empowerment and community ownership. MTM empowers Primary Caregivers, strengthening nurturing care of some 60,000 children aged under three since 2012. Launched in Zambia, MTM has expanded to five other countries. Based on MTM Zambia and Kenya, this paper examines how an innovative, community-led MEL system functions to drive sustainable impacts and scaling. Measurement for change has been critical to the community MEL system. MTM is people-centered with community leaders, early childhood development service providers, volunteers and Primary Caregivers all setting their specific goals. The program is inclusive with all stakeholders engaged in monitoring and making adjustments; interactive with relationship-based social and behavior change strategies; informative with continuous data gathering used for decisions and problem-solving; and dynamic with built-in flexibility and an adaptation process. The community-led MEL propels scaling up through two channels: (1) New communities for MTM program start up: As MTM communities graduate to community ownership, program staff and budget are then invested in new marginalized and underserved rural areas. (2) Deepening reach within MTM communities: Over the first two cycles, communities transition to community ownership, then continue independently of staff and budget. They identify a new set of vulnerable Primary Caregivers of children under three and carry out the caregiver parenting support and learning activities. The success of the program’s community-led MEL in achieving sustainable change and fueling the program scale up hinges on three factors: (1) Initiating the community-led MEL dimension at project start, gradually increasing the community role while reducing the staff role. (2) Provision of Community MEL capacity-building and effective, user-friendly tools to be tailored locally. (3) Three program stakeholder types leading MEL and collaborating closely with each other: ECD Committees with MTM-trained faith leaders, ECD Promoters, and Primary Caregivers of children under three.

In this review paper, we explore how on-the-ground Early Childhood Development (ECD) innovators are using monitoring, evaluation, and learning (MEL) systems to guide the design and implementation of ECD programs, as well as how MEL systems can influence policy and support the achievement of impact at scale. We reflect on articles in the Frontiers series “Effective delivery of integrated interventions in early childhood: innovations in evidence use, monitoring, evaluation, and learning.” The 31 contributions to the series reflect the breadth and depth of complexity that characterizes ECD, including global geographic spread, with studies from Asia, Europe, Africa, and Latin America and the Caribbean. Our synthesis finds that integrating MEL processes and systems into the fabric of a program or policy initiative can broaden the underlying value proposition. Specifically, ECD organizations sought to design their MEL systems to ensure programs fit the values, goals, experiences and conceptual frameworks of diverse stakeholders, so that participating makes sense to all. For example, formative, exploratory research identified the priorities and needs of the target population and frontline service providers, and informed the content and delivery of an intervention. ECD organizations also designed their MEL systems to support a shift of accountability toward broader ownership: They included delivery agents and program participants alike as subjects rather than objects, through active participation in data collection, and by providing opportunities for equitable discussion of results and decision-making. Programs collected data to respond to specialized characteristics, priorities and needs, embedding program activities into existing day-to-day routines. Further, papers pointed to the importance of intentionally involving a variety of stakeholders in national and international dialogues to ensure that diverse ECD data collection efforts are aligned and multiple perspectives are considered in the development of national ECD policies. And, several papers illustrate the value of creative methods and measurement tools to integrate MEL into a program or policy initiative. Finally, our synthesis concludes that these findings align with the five aspirations that were formulated as part of the Measurement for Change dialogue, which motivated the launch of the series.

AimThe provisions of the United Nation's Sustainable Development Goals (SDGs) for disability-inclusive education have stimulated a growing interest in ascertaining the prevalence of children with developmental disabilities globally. We aimed to systematically summarize the prevalence estimates of developmental disabilities in children and adolescents reported in systematic reviews and meta-analyses.MethodsFor this umbrella review we searched PubMed, Scopus, Embase, PsycINFO, and Cochrane Library for systematic reviews published in English between September 2015 and August 2022. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We reported the proportion of the global prevalence estimates attributed to country income levels for specific developmental disabilities. Prevalence estimates for the selected disabilities were compared with those reported in the Global Burden of Disease (GBD) Study 2019.ResultsBased on our inclusion criteria, 10 systematic reviews reporting prevalence estimates for attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental intellectual disability, epilepsy, hearing loss, vision loss and developmental dyslexia were selected from 3,456 identified articles. Global prevalence estimates were derived from cohorts in high-income countries in all cases except epilepsy and were calculated from nine to 56 countries. Sensory impairments were the most prevalent disabilities (approximately 13%) and cerebral palsy was the least prevalent disability (approximately 0.2–0.3%) based on the eligible reviews. Pooled estimates for geographical regions were available for vision loss and developmental dyslexia. All studies had a moderate to high risk of bias. GBD prevalence estimates were lower for all disabilities except cerebral palsy and intellectual disability.ConclusionAvailable estimates from systematic reviews and meta-analyses do not provide representative evidence on the global and regional prevalence of developmental disabilities among children and adolescents due to limited geographical coverage and substantial heterogeneity in methodology across studies. Population-based data for all regions using other approaches such as reported in the GBD Study are warranted to inform global health policy and intervention.

IntroductionThe Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.MethodsA search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.Results127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.ConclusionFindings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains.

Using a three-wave longitudinal survey conducted in 815 households in rural Western China, this study aims to examine the association between parental self-perception and early childhood development and the mediation effect of parental investment on the association between parental self-perception and child development when the sample children are at different ages in the early childhood (18–30, 22–36, and 49–65 months). The results demonstrate that parental self-perception are positively and significantly associated with child social-emotional development in all three ages of childhood (from 18 to 65 months). Positive and significant association between parental self-perception and child cognitive development is found in the ages from 22 to 65 months. In addition, findings of this study show that parental investment plays a mediating role in the association between parental self-perception and child cognitive development. The study calls on policymakers to help to strengthen parental self-perception and parental investment related to early childhood development, which should result in better child development in rural China.

Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015-2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world's children with disabilities are unlikely to be realised., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that BOO was an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decisio., (Copyright © 2024 Olusanya, Wright, Smythe, Khetani, Moreno-Angarita, Gulati, Brinkman, Almasri, Figueiredo, Giudici, Olorunmoteni, Lynch, Berman, Williams, Olusanya, Wertlieb, Davis, Hadders-Algra and Gladstone.)

Background: Over 250 million children in low- and middle-income countries are at risk of not achieving their fullest developmental potential due to co-occurring risks such as poor nutrition and inadequate learning opportunities. Early intervention programs integrating the aspects of nurturing care, that is, good health, adequate nutrition, safety and security, responsive caregiving, and learning opportunities, may ameliorate against the negative impact of these adverse conditions.Methods: This meta-analytic review updates the evidence base of parenting interventions comprising stimulation and responsive caregiving components on developmental outcomes for children under age 2 years in low- and middle-income countries. It also describes and assesses the moderation effects of population characteristics and implementation features on the intervention effectiveness. Studies were identified based on previous systematic reviews and an updated literature search in eight databases and the gray literature up to December 2020. A random-effect model was used to explore the pooled effect sizes accounted for by the intervention for developmental outcome of cognition, language, motor, and social-emotional capacities. Exploratory moderation analyses were also conducted.Results: Twenty-one randomized controlled trials representing over 10,400 children from 12 low- and middle-income countries and regions across three continents (Africa, Latin America, and Asia) were identified. The interventions showed overall small-to-moderate effects on children's cognitive development (ES = 0.44; 95% CI = [0.30, 0.57]); language development (ES = 0.33; 95% CI = [0.18, 0.49]); and motor skills (ES = 0.21; 95% CI = [0.10, 0.32]). The overall effect on social-emotional development was non-significant (ES = 0.17; 95% CI = [−0.01, 0.34]). Effect sizes (ES) varied significantly across the studies. Parenting programs that targeted vulnerable groups, including rural communities and caregivers with lower education levels, had more significant effects on children's development. Group sessions (vs. individual visits) and high program dose (≥12 sessions) were also associated with stronger effects on child development. Further research is needed to determine the effectiveness of the workforce and training on programmatic outcomes.Conclusion: The findings indicate that parenting interventions that encourage nurturing care are effective in improving the early development of children, especially among vulnerable populations. We discuss opportunities to strengthen the implementation of research-based parenting interventions in such contexts.

Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora (“Good Foundation” in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558.

Socioemotional learning (SEL) skills are the competencies that children need to be successful and accepted members of society. In this study, we built a SEL framework and a SEL measurement tool from the ground up that assess children's development of skills with communities of the Baka ethnic group in Cameroon. We conducted a participatory and interactive study to develop a SEL framework and measurement tool that is specific to the context of indigenous Baka communities in Cameroon. Using a quick ethnography methodology and an emic approach, a researcher team comprised mainly of Baka community members engaged parents, teachers, and others in iterative cycles of data collection, analysis, and reflection to develop the framework and assessments. The resulting Baka SEL framework includes skills and domains distinct from predominant SEL frameworks, underscoring the importance of drawing SEL priorities from communities themselves. Shared foundational constructs underlying the Baka SEL framework and other frameworks indicate possible universal human expectations for emotional and relational skills. Two SEL measurement tools were produced: a caregiver tool and a teacher tool, each using storytelling to elicit specific, honest, and detailed information about child behavior. These tools allow us to capture child behavior in the school and the home, and to collect data on all participating children within a specific time period. The described approach is a simple, practical, and culturally appropriate strategy for collaborating with rural communities to articulate their understanding of SEL. The resulting framework and tools illustrate the importance of rooting SEL in local culture, while the approach to developing them serves as a model for other early childhood care and education organizations and programs.

Adolescent mothers in Malawi face psychosocial challenges such as low resilience level, low self-esteem, poor maternal-infant interaction, and exposure to intimate partner violence (IPV). Children of adolescent mothers often face numerous risks such as low birth-weight, stunted growth, infant death, low school enrolment, increased grade repetition, and dropouts that put them at greater risk of poor developmental outcomes and socio-emotional problems. This study assessed the impact of components of a community project conducted by the Young Women's Christian association of Malawi in providing psychosocial support to adolescent mothers and their children. The goals of the project were; (1) to improve early childhood development in babies born to adolescent mothers; and (2) to enhance the psychosocial well-being of adolescent mothers (self-esteem, resilience stress, and parenting skills). This descriptive mixed methods evaluation study comprised an intervention and control groups of adolescent mothers respectively. The project had 3 centers in southern region districts of Malawi. Target population was adolescent mothers 18 years of age and below. At baseline we enrolled 267 mothers and at the end of the project we had 211 mothers. The project involved monthly meetings with adolescent mothers imparting knowledge and skills and early childhood education activities. From July 2017 to June 2019, 58 sessions were conducted. In the first year the control group had no meetings, however they received the intervention in the second year. Overall results in the intervention group showed statistically significant increase in knowledge on parenting skills (p < 0.01), nutritional practice (p < 0.01), motor skills and cognitive functions in children (p < 0.01) as well as expressive language and socio-emotional capacities in children (p < 0.01), while the change in confidence and psychosocial well-being was not statistically significant (p = 0.8823). Community projects such as these enhance parenting skills and improve development of children born to adolescent mothers. Improving psychosocial support is complex and requires further research and a more holistic approach.

This paper describes a creative and bold way in which a local NGO addressed increasing access and quality of ECED services in Colombia. This case study on Fundacion Carulla's aeioTU early childhood innovation in Colombia contributes to understanding the possibilities for the private sector to spark innovation, and the importance of an open and collaborative strategy in contributing to the ECED sector at large. The critical role of monitoring and evaluation in the provision of services is highlighted. This guided key decisions on different growth phases. After a decade of work, Fundacion Carulla-aeioTU has shown capacity to effectively support children's development in low-income settings through their participation in quality programming. Furthermore, this case study also describes how the organization, having proven its capacity to provide high-quality services directly to children, decided to innovate and bring about different solutions to reach and support other stakeholders in the early childhood development ecosystem.

In 2015, Romania took an important step toward increasing disadvantaged children's participation in early education programmes through the passage of legislation creating a nationwide conditional cash transfer programme linked to preschool attendance. The programme was modeled on the incentive component of a 5-year pilot project “Every Child in Preschool” (“FCG”) initiated by Asociatia OvidiuRo (“OvR”), a small non-governmental organization. This paper explores how OvR used evidence from its pilot, global research, a quasi-experimental evaluation, collaboration with local authorities, and an intensive advocacy effort toward the legislative and executive branches of the national government to achieve the national scale-up of an early education initiative designed to create equal access in kindergarten among Roma and other impoverished, marginalized children.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction: Children with disabilities in low- and middle-income countries face many challenges and lack adequate services, including access to rehabilitation professionals. To address this lack of access, Amar Seva Sangam Ayikudy (ASSA), a non-governmental organization (NGO) in India, designed a technology-leveraged rehabilitation program called Enabling Inclusion ® (EI ® ), and implemented it in one state (Tamil Nadu, India) before scaling it. The model is supported by the EI ® app, which enables organizations to screen, assess and monitor progress of children with disabilities via rehabilitation specialists and community rehabilitation workers, and to provide family-centered, goal-based interventions. An extensive monitoring, evaluation, and learning (MEL) framework is embedded into the program. This paper explores how this MEL system supported the scaling of the EI ® model, reaching additional beneficiaries nationally and globally., Methods: This paper describes ASSA's MEL framework and demonstrates its use for decision-making in the process of scaling. It also explores how collaborations with various government departments, NGOs, and private partners contributed to the scaling of the EI ® model and technology., Results: Scaling of the EI ® program was achieved by (1) expansion of the program in rural Tamil Nadu (vertical scale-up) in partnership with the Tamil Nadu government and private partners, and (2) by licensing the EI ® app and model to other NGOs in various states in India and globally (horizontal scale-up). Systematic examination of key program and performance indicators, as well as stakeholder feedback, informed decisions to modify the EI ® app over time. This included further customizing to the needs of children and service providers, covering a greater range of age groups and contexts, and modifying service delivery models. Child functional independence, participation, and inclusion was further strengthened by mobilizing parent empowerment groups, community awareness programs, school advocacy, and entitlements from the government. Flexibility in the implementation model of the EI ® app allowed for adaptation to local contexts and organizations, and facilitated its scale-up., Conclusion: A dynamic, inclusive, and locally grounded MEL system, a flexible and collaborative approach, and an adaptive implementation model increased the accessibility of an early intervention and childhood rehabilitation program for children with disabilities and their families throughout the state of Tamil Nadu, across India, and internationally., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Brien, Coutinho, Krishna, van der Haar, de Laat, Srinivasan and Venkatachalapathy.)

Background and Objectives: Early Childhood Development is high on the policy agenda in Côte d'Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how "MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale," one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of "How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)?, Methods: Five training approaches to improve caregivers' knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD., Results: The evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation., Conclusion: The iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Anago, Forzy, Guei, Pelras, Ramde, Tevenart, Vera Rueda and Macours.)

Introduction: Early childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described., Method: This study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD., Results: The results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53-0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52-0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50-0.88)., Discussion: According to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Liu and Chang.)

Introduction: The first three years of a child's life are the most critical to child development and have an impact on the future achievement of the child. Young children's healthy development depends on nurturing care that ensures health, nutrition, responsive caregiving, safety, and security. Parents & other adult caregivers play a critical role in moderating children's early experiences, which has a lasting impact be it positive or negative on the children's future. Parenting education programs are proven to improve parental skills, capacity, and efficacy in a way that supports improved child development outcomes. Yet, most parents in low-middle-income countries such as Rwanda lack access to information and skills on how to support their children's holistic development. In response, Save The Children implemented the First Steps "Intera za Mbere" holistic parenting education project in Rwanda from 2014 to 2021. This paper reflects on how monitoring, evaluation, accountability, and learning (MEAL) approaches were applied throughout the project cycle and their impact on program improvement and national policy and advocacy. This paper explores how the aspirations for measurement for change, considerations for innovation uptake and frameworks for learning about improvement are reflected in this project., Methods: The project utilized qualitative and quantitative MEAL across the program cycle. Action research at the start of the project identified promoters and inhibitors of high-quality nurturing care and program delivery modalities. The project utilized a randomized control trial to provide insight into components that work better for parenting education. Evidence from surveys done remotely via phones was used to inform COVID-19 adaptations of the program., Results: The application of MEAL evidence led to the successful development and improvement of the program. At the policy level, evidence from the project influenced the review of the 2016 National Integrated ECD policy and the development of the national parenting education framework., Conclusion: The regular use of evidence from MEAL is critical for program improvement, scale-up, and policy influence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dusabe, Abimpaye, Kabarungi and Uwamahoro.)

Background: Knowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4  years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4  years., Methods: We used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4  years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally "on track"., Results: The findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children's activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08-1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09-1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4  years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts., Conclusion: Home environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study's findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rahman, Tuli, Mondal, Sultana, Hossain, Kundu, Clara and Hossain.)

In this review paper, we explore how on-the-ground Early Childhood Development (ECD) innovators are using monitoring, evaluation, and learning (MEL) systems to guide the design and implementation of ECD programs, as well as how MEL systems can influence policy and support the achievement of impact at scale. We reflect on articles in the Frontiers series " Effective delivery of integrated interventions in early childhood: innovations in evidence use, monitoring, evaluation, and learning ." The 31 contributions to the series reflect the breadth and depth of complexity that characterizes ECD, including global geographic spread, with studies from Asia, Europe, Africa, and Latin America and the Caribbean. Our synthesis finds that integrating MEL processes and systems into the fabric of a program or policy initiative can broaden the underlying value proposition. Specifically, ECD organizations sought to design their MEL systems to ensure programs fit the values, goals, experiences and conceptual frameworks of diverse stakeholders, so that participating makes sense to all. For example, formative, exploratory research identified the priorities and needs of the target population and frontline service providers, and informed the content and delivery of an intervention. ECD organizations also designed their MEL systems to support a shift of accountability toward broader ownership: They included delivery agents and program participants alike as subjects rather than objects , through active participation in data collection, and by providing opportunities for equitable discussion of results and decision-making. Programs collected data to respond to specialized characteristics, priorities and needs, embedding program activities into existing day-to-day routines. Further, papers pointed to the importance of intentionally involving a variety of stakeholders in national and international dialogues to ensure that diverse ECD data collection efforts are aligned and multiple perspectives are considered in the development of national ECD policies. And, several papers illustrate the value of creative methods and measurement tools to integrate MEL into a program or policy initiative. Finally, our synthesis concludes that these findings align with the five aspirations that were formulated as part of the Measurement for Change dialogue, which motivated the launch of the series., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 de Laat, Radner, Holding, van der Haar, Slemming, Krapels, van der Harst, Raikes, Sanou and Dusabe.)

Aim: The provisions of the United Nation's Sustainable Development Goals (SDGs) for disability-inclusive education have stimulated a growing interest in ascertaining the prevalence of children with developmental disabilities globally. We aimed to systematically summarize the prevalence estimates of developmental disabilities in children and adolescents reported in systematic reviews and meta-analyses., Methods: For this umbrella review we searched PubMed, Scopus, Embase, PsycINFO, and Cochrane Library for systematic reviews published in English between September 2015 and August 2022. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We reported the proportion of the global prevalence estimates attributed to country income levels for specific developmental disabilities. Prevalence estimates for the selected disabilities were compared with those reported in the Global Burden of Disease (GBD) Study 2019., Results: Based on our inclusion criteria, 10 systematic reviews reporting prevalence estimates for attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental intellectual disability, epilepsy, hearing loss, vision loss and developmental dyslexia were selected from 3,456 identified articles. Global prevalence estimates were derived from cohorts in high-income countries in all cases except epilepsy and were calculated from nine to 56 countries. Sensory impairments were the most prevalent disabilities (approximately 13%) and cerebral palsy was the least prevalent disability (approximately 0.2-0.3%) based on the eligible reviews. Pooled estimates for geographical regions were available for vision loss and developmental dyslexia. All studies had a moderate to high risk of bias. GBD prevalence estimates were lower for all disabilities except cerebral palsy and intellectual disability., Conclusion: Available estimates from systematic reviews and meta-analyses do not provide representative evidence on the global and regional prevalence of developmental disabilities among children and adolescents due to limited geographical coverage and substantial heterogeneity in methodology across studies. Population-based data for all regions using other approaches such as reported in the GBD Study are warranted to inform global health policy and intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer CS declared a past co-authorship with the author BO to the handling editor., (Copyright © 2023 Olusanya, Smythe, Ogbo, Nair, Scher and Davis.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction: The Nurturing Care Framework (NCF) describes "nurturing care" as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues., Methods: A search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains., Results: 127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0-3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains., Conclusion: Findings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abboah-Offei, Amboka, Nampijja, Owino, Okelo, Kitsao-Wekulo, Chumo, Muendo, Oloo, Wanjau, Mwaniki, Mutisya, Haycraft, Hughes, Griffiths and Elsey.)

Using a three-wave longitudinal survey conducted in 815 households in rural Western China, this study aims to examine the association between parental self-perception and early childhood development and the mediation effect of parental investment on the association between parental self-perception and child development when the sample children are at different ages in the early childhood (18-30, 22-36, and 49-65 months). The results demonstrate that parental self-perception are positively and significantly associated with child social-emotional development in all three ages of childhood (from 18 to 65 months). Positive and significant association between parental self-perception and child cognitive development is found in the ages from 22 to 65 months. In addition, findings of this study show that parental investment plays a mediating role in the association between parental self-perception and child cognitive development. The study calls on policymakers to help to strengthen parental self-perception and parental investment related to early childhood development, which should result in better child development in rural China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wang, Wang, Li, Guo, Hu, Zhang and Rozelle.)

Socioemotional learning (SEL) skills are the competencies that children need to be successful and accepted members of society. In this study, we built a SEL framework and a SEL measurement tool from the ground up that assess children's development of skills with communities of the Baka ethnic group in Cameroon. We conducted a participatory and interactive study to develop a SEL framework and measurement tool that is specific to the context of indigenous Baka communities in Cameroon. Using a quick ethnography methodology and an emic approach, a researcher team comprised mainly of Baka community members engaged parents, teachers, and others in iterative cycles of data collection, analysis, and reflection to develop the framework and assessments. The resulting Baka SEL framework includes skills and domains distinct from predominant SEL frameworks, underscoring the importance of drawing SEL priorities from communities themselves. Shared foundational constructs underlying the Baka SEL framework and other frameworks indicate possible universal human expectations for emotional and relational skills. Two SEL measurement tools were produced: a caregiver tool and a teacher tool, each using storytelling to elicit specific, honest, and detailed information about child behavior. These tools allow us to capture child behavior in the school and the home, and to collect data on all participating children within a specific time period. The described approach is a simple, practical, and culturally appropriate strategy for collaborating with rural communities to articulate their understanding of SEL. The resulting framework and tools illustrate the importance of rooting SEL in local culture, while the approach to developing them serves as a model for other early childhood care and education organizations and programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Anziom, Strader, Sanou and Chew.)

Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora ("Good Foundation" in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Luoto, Lopez Garcia, Aboud, Singla, Zhu, Otieno and Alu.)

This paper describes a creative and bold way in which a local NGO addressed increasing access and quality of ECED services in Colombia. This case study on Fundacion Carulla's aeioTU early childhood innovation in Colombia contributes to understanding the possibilities for the private sector to spark innovation, and the importance of an open and collaborative strategy in contributing to the ECED sector at large. The critical role of monitoring and evaluation in the provision of services is highlighted. This guided key decisions on different growth phases. After a decade of work, Fundacion Carulla-aeioTU has shown capacity to effectively support children's development in low-income settings through their participation in quality programming. Furthermore, this case study also describes how the organization, having proven its capacity to provide high-quality services directly to children, decided to innovate and bring about different solutions to reach and support other stakeholders in the early childhood development ecosystem., Competing Interests: NM has had the following roles in Fundacion Carulla-aeioTU: Executive Director (2008-2016), Chairperson (2016-2018), Member of the Board (2018-2020), and President of the Board of Fundacion Carulla-aeioTU (Q1/2020), Bogotá, Colombia. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mesa, Nores and Vega.)

Adolescent mothers in Malawi face psychosocial challenges such as low resilience level, low self-esteem, poor maternal-infant interaction, and exposure to intimate partner violence (IPV). Children of adolescent mothers often face numerous risks such as low birth-weight, stunted growth, infant death, low school enrolment, increased grade repetition, and dropouts that put them at greater risk of poor developmental outcomes and socio-emotional problems. This study assessed the impact of components of a community project conducted by the Young Women's Christian association of Malawi in providing psychosocial support to adolescent mothers and their children. The goals of the project were; (1) to improve early childhood development in babies born to adolescent mothers; and (2) to enhance the psychosocial well-being of adolescent mothers (self-esteem, resilience stress, and parenting skills). This descriptive mixed methods evaluation study comprised an intervention and control groups of adolescent mothers respectively. The project had 3 centers in southern region districts of Malawi. Target population was adolescent mothers 18 years of age and below. At baseline we enrolled 267 mothers and at the end of the project we had 211 mothers. The project involved monthly meetings with adolescent mothers imparting knowledge and skills and early childhood education activities. From July 2017 to June 2019, 58 sessions were conducted. In the first year the control group had no meetings, however they received the intervention in the second year. Overall results in the intervention group showed statistically significant increase in knowledge on parenting skills ( p < 0.01), nutritional practice ( p < 0.01), motor skills and cognitive functions in children ( p < 0.01) as well as expressive language and socio-emotional capacities in children ( p < 0.01), while the change in confidence and psychosocial well-being was not statistically significant ( p = 0.8823). Community projects such as these enhance parenting skills and improve development of children born to adolescent mothers. Improving psychosocial support is complex and requires further research and a more holistic approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Kachingwe, Chikowe, van der Haar and Dzabala.)

In 2015, Romania took an important step toward increasing disadvantaged children's participation in early education programmes through the passage of legislation creating a nationwide conditional cash transfer programme linked to preschool attendance. The programme was modeled on the incentive component of a 5-year pilot project "Every Child in Preschool" ("FCG") initiated by Asociatia OvidiuRo ("OvR"), a small non-governmental organization. This paper explores how OvR used evidence from its pilot, global research, a quasi-experimental evaluation, collaboration with local authorities, and an intensive advocacy effort toward the legislative and executive branches of the national government to achieve the national scale-up of an early education initiative designed to create equal access in kindergarten among Roma and other impoverished, marginalized children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gheorghiu, Hawke, de Laat and Papari.)