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Abstract Background Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn—Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility. Methods EN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent–child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is “school readiness”, assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders’ perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Discussion This protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities. Trial registration The trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627).

Background : Vulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn—Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility. Methods: EN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent–child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is "school readiness", assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders' perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Discussion: This protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities. Trial registration: The trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627). [ABSTRACT FROM AUTHOR]

IntroductionAlmost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs.MethodsThe SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat.Results1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4–75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15–83%, p = 0.002) compared to children in the control groups.DiscussionThe lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

IntroductionIn the last decade, there has been increased global policy and program momentum to promote early childhood development. The Care for Child Development (CCD) package, developed by UNICEF and the WHO, is a key tool responding to the global demand. The CCD package comprises two age-specific evidence-based recommendations for caregivers to 1) play and communicate and 2) responsively interact with their children (0–5 years) and was designed to be integrated within existing services to strengthen nurturing care for child development. The aim of this report was to provide an up-to-date global review of the implementation and evaluation of the CCD package.MethodsIn addition to a systematic review of 55 reports, we interviewed 23 key informants (including UNICEF and WHO personnel) to better understand the implementation of CCD.ResultsThe CCD package has been or is being implemented in 54 low- and middle-income countries and territories, and it has been integrated into government services across the health, social, and education sectors in 26 countries. Across these contexts, CCD has been adapted in three primary ways: 1) translations of CCD materials (mostly counseling cards) into local language(s), 2) adaptations of CCD materials for the local context, vulnerable children, or a humanitarian/emergency setting (e.g., including local play activities, using activities that are better suited to children with visual impairments), and 3) substantive modifications to the content of CCD materials (e.g., expansion of play and communication activities, addition of new themes, creation of a structured curriculum). While there is promising evidence and examples of good implementation practice, there has been mixed experience about implementation of CCD with respect to adaptation, training, supervision, integration into existing services, and monitoring implementation fidelity and quality. For example, many users of CCD found difficulties with training the workforce, garnering buy-in from governments, and ensuring benefits for families, among others.DiscussionAdditional knowledge on how to improve the effectiveness, implementation fidelity and quality, and acceptance of CCD is needed. Based on the findings of the review we make recommendations for future efforts to implement CCD at-scale.

Introduction: Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs., Methods: The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z -score (HAZ), assessed at 18 months of age. Analyses were by intention to treat., Results: 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups., Discussion: The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation., 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 Kirkwood, Sikander, Roy, Soremekun, Bhopal, Avan, Lingam, Gram, Amenga-Etego, Khan, Aziz, Kumar, Verma, Sharma, Panchal, Zafar, Skordis, Batura, Hafeez, Hill, Divan and Rahman.)

The Early Development Instrument (EDI) is a measure of children's developmental health at school entry in five domains, developed in Canada. A shorter, 48-item version of the EDI covering the same domains, created based on Canadian population data was used. The present study examined the psychometric properties of the domains of the 48-item EDI and the invariance of the measurement models of the domains of the 48-item EDI by sex and across the two South Asian countries, the Philippines and Indonesia. Data for 946, 3 to 5-year-olds in the Philippines, and for 3244, four-year-olds in Indonesia were used. The Strengths and Difficulties Questionnaire (SDQ) subscales were used for purposes of testing concurrent validity. The internal consistencies of the domains of the EDI except for Physical Health and Wellbeing were acceptable. Concurrent validity of the EDI domains with the SDQ subscales was acceptable and associations were in the expected directions. Modifications to the measurement models for the domains were made, where necessary, to allow for cross-loading items across the domains and to improve fit indices without over-fitting. Multiple group analysis using categorical confirmatory factor analysis within the Structural Equation Modeling framework showed that the models for the social competence and emotional maturity domains fit very well across sex and across the two countries. The findings are discussed in the context of requirements and conditions for the validation in modification and application of measures in international contexts. [ABSTRACT FROM AUTHOR]

Abstract: A small but provocative literature suggests that neighbourhood socioeconomic conditions experienced by children early in life influence a variety of health and developmental outcomes later in life. We contribute to this literature by testing the degree to which neighbourhood socioeconomic conditions that children experience in Kindergarten influence their later language and cognitive outcomes in early adolescence, over and above current neighbourhood context and various child-level covariates including scores on a Kindergarten measure of school readiness. Cross-classified random effects modelling (CCREM) analyses were performed on a study population of 2648 urban children residing throughout the province of British Columbia, Canada, who were followed longitudinally from Kindergarten (age 5/6) to Grade 7 (age 12/13). Findings demonstrate that neighbourhood concentrated disadvantage experienced during Kindergarten has a durable, negative effect on children''s reading comprehension outcomes seven years later—providing evidence that early social contextual experiences play a critical role in the lives of children. Possible explanations and future directions are discussed. [Copyright &y& Elsevier]

This paper argues that many internationally financed literacy programs do not sufficiently take into consideration important daily life issues of the learners, including nutritional deficiencies that may hinder learning, or of children–parent–society interactions that may improve learning. As a result, many programs have become synonymous with increased supply of a low-quality education. Often, these programs address almost exclusively Education for All (EFA) international policy targets, without sufficiently addressing other poverty alleviation targets, as defined by the Millennium Development Goals (MDGs). This paper further contends that approaches that would generate the greatest effects within an EFA-perspective may not be the best way to alleviate poverty within a MDGs-perspective. Based on a case study of a women's literacy program in Senegal, this paper proposes to look at needs within an MDG perspective, and to use multi-pronged and integrated approaches to intervene in sectors where the poverty alleviation impact is the greatest. Current achievements against the MDG indicators show that significant efforts are needed to reduce maternal and child mortality, boost primary school enrollments, and remove obstacles so that a greater number of girls can attend school. One important target group for promoting greater achievements against these indicators would be young adults living in poverty, especially girls and young women. An approach that combines youth and family literacy, early child development (ECD), as well as health and nutrition interventions, could help to break a cycle of poverty that is fundamentally intergenerational in nature. Further, it is argued that integration of these different interventions, which are usually offered as separate services (but addressing essentially the same target group) could be more cost-effective than implementing each component as separate projects. Accordingly, this paper recommends the integration of such services as nutritional training for youth and adults; information and services for family planning; training on STD/HIV prevention and management; access to immunization for children and pregnant women; assistance to obtain antenatal registration and care as well as training and treatment of existing and non-complex conditions; and, if needed, micro-nutrient supplementation. [Copyright &y& Elsevier]