Cost-effective approach to supporting families with children in low-income countries

Cost-effective approach to supporting families with children in low-income countries
The first years of a child's life are crucial for the future. During these years, the brain develops rapidly, so the nutrition and stimulation a child receives is of great importance. However, in low- and middle-income countries, supporting child well-being and development can be challenging because such interventions are expensive. A study by our PhD student Akib Khan, among others, concludes that in countries with established support programmes, there is a cost-effective way to introduce assistance focusing on early education and stimulation. The programme studied, launched in Bangladesh, showed an internal rate of return of 18.9%.

• Children developed better when families were supported in both nutrition and early education.
• Parents became more involved in the child's physical, mental and social development during the intervention.
• The intervention was cost-effective because it could be incorporated into existing infrastructure.

Before the programme studied by the researchers started, more than 40% of children under five in Bangladesh were below their expected growth curve. Only 13% of children between 3 and 5 years old participated in any kind of childcare or early education activity. The researchers wanted to explore whether visiting families and providing educational materials for children between 3 and 18 months could improve their cognitive and social development.

To keep the cost of the programme down, this 'educational intervention' was linked to an already established government programme focusing on nutrition and health. During the intervention, the programme provided nutritional support and educational materials.

18,000 children were included in the 15-month study, which consisted of monthly visits by programme staff and a package of educational materials. Half of the families received educational tools and extra support, while the other half (the control group) received the usual visits with only nutritional information. The educational material consisted of cards with age-appropriate activities, two picture books, a book with information on child development, and a leaflet with guidelines for medical visits. In discussions with staff, families were given additional suggestions for activities and support in their use of the materials.

It was found that in the families that received counselling with a focus on both nutrition and education, children developed better cognitively, linguistically and emotionally than in families that did not have access to the educational material. To measure changes, the standard deviation (SD) measure was used, where a higher standard deviation (anything above 0) indicates measurable and positive improvements in child development and anything above 0.10 SD indicates a significant improvement. The intervention increased cognitive skills by 0.17 SD, language development by 0.23 SD and socio-emotional skills by 0.12-0.14 SD. Acute malnutrition and underweight were reduced by 40% and 8% respectively compared to the control group.

Parents, especially mothers, became more involved in the child's physical, mental and social development. This was evidenced, for example, by parents playing more varied games with their children and offering different types of activities. Mothers also became more confident in making decisions about their children's health. As a result, families were more likely to participate in growth monitoring and use other available support programmes. In addition, it was noted that older children in the household (aged 5-7 years) had started some form of educational activity to a greater extent than in the control group.

The fact that children showed positive development in cognitive, social, emotional and health aspects emphasises that when parents are helped, their children are better equipped for further learning and growth. The study shows that there are ways to introduce these tools and resources in a cost-effective way by utilising existing infrastructure.