Maternal stimulation and early child development in sub-saharan Africa: evidence from Kenya and Zambia.

BACKGROUND: Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings. METHODS: We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey. RESULTS: Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16). CONCLUSION: Our study findings suggest a strong positive link between maternal stimulation activities and children's developmental outcomes among communities in poor rural settings. TRIAL REGISTRATION: NA (not a clinical trial).

Scaling the Moments That Matter® early childhood development model: how communities' monitoring for change contributes to sustainable impact.

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.