Poor early childhood development in low-and middle-income countries is a major public health problem. Efficacy trials have shown the potential of early childhood development interventions but scaling up is costly and challenging. Guidance on effective interventions' delivery is needed. In an open-label cluster-randomized control trial, we compared the effectiveness of weekly home visits and weekly mother-child group sessions. Both included nutritional education, whose effectiveness was tested separately.METHODS: In Odisha, India, 192 villages were randomly assigned to control, nutritional education, nutritional education and home visiting, or nutritional education and group sessions. Mothers with children aged 7 to 16 months were enrolled (n = 1449). Trained local women ran the two-year interventions, which comprised demonstrations and interactions and targeted improved play and nutrition. Primary outcomes, measured at baseline, midline (12 months), and endline (24 months), were child cognition, language, motor development, growth and morbidity.RESULTS: Home visiting and group sessions had similar positive average (intention-to-treat) impacts on cognition (home visiting: 0.324 SD, 95% confidence interval [CI]: 0.152 to 0.496, P = .001; group sessions: 0.281 SD, 95% CI: 0.100 to 0.463, P = .007) and language (home visiting: 0.239 SD, 95% CI: 0.072 to 0.407, P = .009; group sessions: 0.302 SD, 95% CI: 0.136 to 0.468, P = .001). Most benefits occurred in the first year. Nutrition-education had no benefit. There were no consistent effects on any other primary outcomes.CONCLUSIONS: Group sessions cost $38 per child per year and were as effective on average as home visiting, which cost $135, implying an increase by a factor of 3.5 in the returns to investment with group sessions, offering a more scalable model. Impacts materialize in the first year, having important design implications. WHAT'S KNOWN ON THIS SUBJECT: In low-and middle-income countries millions of young children have poor development. Efficacy trials show that stimulation and nutritional interventions benefit children' s development but evidence on cost-effective methods of going to scale is urgently needed.WHAT THIS STUDY ADDS: Mother-child group sessions were as effective on average as home visits in improving child cognition and language in Odisha, India. Groups required 28% of the cost of home visits, substantially improving scalability of child psychosocial interventions.

We study the importance of maternal subjective beliefs about the technology of skill formation in determining parental investments on child development. We describe our framework in three steps. First, we discuss the construction of the survey instrument we used to elicit maternal subjective beliefs. Second, we show how to convert the answers to the survey instrument into estimates of maternal subjective beliefs. Finally, we correlate maternal subjective beliefs with maternal investments of child development. We apply our framework to a unique dataset collected as part of an 18-month-long parenting stimulation program in Colombia, whose target population were low-income households with children aged 12 to 24 months at baseline and lasted 18 months. In this program, home visitors paid weekly visits to randomly chosen households to improve mother-child interactions and other maternal behaviors that foster the development of children's cognitive and non-cognitive skills. We show that the vast majority of mothers believe that the technology of skill formation follows a Cobb-Douglas parameterization, but there is significant heterogeneity in coefficients of investments across mothers. In particular, mothers hold low subjective expectations, which means that mothers underestimate the returns to their investments. We also find that maternal subjective beliefs predict investments, but that the program did not affect maternal subjective beliefs.

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This paper studies two experiments of early childhood development programs in The Gambia: one increasing access to services, and another improving service quality. In the first experiment, new community-based early childhood development (ECD) centers were introduced to randomly chosen villages that had no pre-existing structured ECD services. In the second experiment, a randomly assigned subset of existing ECD centers received intensive provider training. We find no evidence that either intervention improved average levels of child development. Exploratory analysis suggests that, in fact, the first experiment, which increased access to relatively low quality ECD services, led to declines in child development among children