Supporting Child Development Through Parenting Interventions in Low- to Middle-Income Countries: An Updated Systematic Review

Abstract

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.

Toward complementarity: Specificity and commonality in social‐emotional development

“…Next, a more nuanced understanding regarding how specific contexts contribute to specificities in social-emotional growth is warranted, acknowledging the heterogeneity both within specific groups (Chen et al, 2021;Lin et al, 2021) and across cultural frameworks (Oh et al, 2021;Rothenberg et al, 2021), as well as considering moderators of cultural effects on socialemotional development (Davidov et al, 2021). Indeed, the transferability of parenting interventions aimed at nurturing child development across contexts depends on how well such interventions (including their curriculums and assessment tools) are adapted to the local context (Jeong et al, 2018;Zhang et al, 2021), as well as the extent to which bottom-up, community-based approaches (involving all stakeholders) are used to identify and prioritize the needs of a specific group (Abubakar et al, 2019;Speidel et al, 2021).…”

A community engagement approach for an integrated early childhood development intervention: a case study of an urban informal settlement with Kenyans and embedded refugees

“…Formative research was conducted to inform the community engagement and ECD intervention implementation processes. The formative research involved a systematic review of parenting interventions on stimulation and responsive caregiving for children under age 2 years in low- and middle-income countries [ 31 ]. Furthermore, between May and June 2018, a household survey was conducted among 458 Kenyan and 118 immigrant households on nurturing care among caregivers of children aged 0–2 years in Dagoretti’s informal settlements [ 32 ], and a qualitative study involving 14 focus group discussions with Kenyan and refugee caregivers on ECD practices and experiences [ 33 ].…”

“…The findings from the systematic review indicated that parenting interventions, which encourage nurturing care effectively improve children’s cognitive, language, motor, and social-emotional development. Moreover, these interventions are most beneficial when delivered in group sessions or group sessions combined with home visits, and are also feasible and effective when delivered by trained paraprofessionals [ 31 ]. These findings indicate that parenting interventions with nurturing care components are feasible for the promotion of early child development in low-income settings.…”

“…Insights from this systematic review were helpful in the justification of the intervention option and, more importantly, informed the intervention study process. The findings from the review are detailed in a separate publication [ 31 ].…”

The mental health of children and young people living in big cities in a revolving postpandemic world

“…For instance, cash-transfer programmes showed to have an impact in improving youth mental health and fostering development[131][132][133][134], and housing assistance programs also presented benefits[135,136]. Moreover, studies on community intervention revealed benefits at a group level, as shown by neighbourhood empowerment programs and parenting interventions delivered by community members[137][138][139][140][141][142]. In line with current recommendations, interventions should seek to be culturally sensitive and promote active involvement of participants[138,[143][144][145][146].…”