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Early Child Development (ECD) Program Evaluations

Numerous longitudinal studies on the benefits of early childhood programs for children living in poverty have been conducted in various countries.


BOLIVIA - Integrated Child Development Program (PIDI)

Bolivia has undertaken a large-scale home based early childhood development and nutrition program, Proyecto Integral de Desarrollo Infantil (PIDI), that provides day-care, nutrition and educational services to children which live in poor, predominantly urban areas. Under the program, children from 6 months to 6 years of age are cared for in groups of fifteen in homes in their own neighborhood. The community selects local women to become home day care mothers. These non-formal, home-based day care centers, with 2-3 caregivers, provide integrated child development services (play, nutrition, growth screening, and health referrals). The women receive child development training prior to becoming educators but are usually not highly trained. They come from similar socioeconomic backgrounds as the parents. The goals of PIDI are to improve health and early cognitive/social development by providing children with better nutrition, adequate supervision and stimulating environments. It is hoped that the program will also ease the transition to elementary school, improve progression through elementary grades, and raise school performance, all of which are expected to increase post-school productivity.

The study is based on two rounds of longitudinal household data for evaluation in 1995/96 and 1997/98. It analyzes the impacts of PIDI on child outcomes related to nutrition, health, cognitive development and psychosocial skills and provides some illustrative estimates of the benefit/cost ratio of the program.

Program Impact
  • Cognitive development: Children were tested on bulk motor skills, fine motor skills, language skills and psychosocial skills. Participating in PIDI shows to have a positive impact on all test scores for children age 37-54 months. Results for younger children are mixed. For the 37-54 months age group, the program is estimated to increase test score outcomes by roughly 5%. Average impacts on test scores generally increases as length of participation in the program increases. Impacts are almost always positive for children who have participated in the program for at least 13 months and roughly twice as high as the overall average impacts.
  • Height and weight: In terms of height, the estimated program impacts are positive at ages up to 36 months, but most negative for older children. However, findings do suggest a positive impact for the older age group in that the program is effective in keeping participating children out of the extreme lower left tail of the height distribution. For weight percentiles, estimated impacts are negative at ages younger than 36 months.
    It might be possible, however, that children in the program simply weighed less to begin with, for reasons not well captured by the model: no pre-program baseline data were available. This would be consistent with the primacy given to malnourishment in the initial program eligibility criteria. Moreover, the findings suggest a positive impact of the program on weight for children that have participated in PIDI for more than seven months. Again, positive impacts increase with duration.
Cost-Benefit Analysis

A monetary value was assigned to higher cognitive test scores and to improved anthropometrics outcomes by estimating their possible impact on earnings. Four channels through which PIDI can affect lifetime earnings where considered:

  • by increasing cognitive skills as an adult (conditional on grades of completed schooling) that directly affect earnings
  • by increasing physical stature as an adult that directly affects earnings
  • by increasing the grades of completed schooling that directly affect earnings and affecting the age of school completion (earlier entry in school and less grade repetition will decrease age, more grades completed will increase age)
  • by only changing the age of school completion without changing the grades of schooling completed.

These four channels are based on piecemeal empirical evidence for developing countries on:

  • the impact of adult cognitive achievement on wages
  • the impact of adult height on wages and/or productivity
  • the impact of early childhood nutrition and cognitive development on adult nutritional status and cognitive development
  • the impact of grades of schooling completed on wages
  • the impact of better child nutrition on progress through schooling
  • the impact of preschool child nutrition on age of starting schooling

If the multiple types of program impacts are considered together, the benefit-to-cost ratios are quite high and range from 1.7 to 3.7. Although these estimates are based on a number of assumptions regarding the respective impacts, they at least suggest the possibility that the benefit-to-cost ratios are fairly considerable for PIDI.

Conclusion
  • PIDI has been successful in reaching poorer children and households in poorer communities;
  • The impacts tend to be somewhat larger for the children enrolled in PIDI from better family backgrounds;
  • PIDI seems to have cumulative effects so the impacts increase considerably as duration in the program increases;
  • PIDI quite possibly has high benefit-to-cost ratios, ranging from 1.7 to 3.7 (though the estimates require a number of assumptions)
  • PIDI may be an effective mechanism for redistributing productive resources towards very poor members of society – young children in poor households.

Reference:
Behrman, J.R., Y. Cheng & P. Todd (2000), "The Impact of the Bolivian Integrated 'PIDI' Preschool Program". Philadelphia: University of Pennsylvania

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BRAZIL - Costs and Benefits of Preschool Education in Brazil

This study first estimates the impact of preschool on the nutritional status of children from 4 to 6 years and on their future performance both in the educational system and in the labor market. Second, it estimates the costs of education per child served. Next, the authors compare the costs and benefits of preschool education to calculate the internal rate of return on investment in preschool education, as well as the willingness to pay for this service. Finally, the gap will be estimated between rich and poor in access to education for their children. The estimates are obtained on the basis of data from the Survey of Living Standards carried out between 1996 and 1997. These also contain retrospective data on preschool attendance by the current adult population, so that educational results and current performance in the labor market could be linked to time spent in preschool.

Impact of Preschool

The results show that attendance at preschool has a significant impact on the nutritional status of children and on their entire future educational performance. The impact of attending preschool on the child's height for age and weight for age has the expected sign and is statistically significant. The impact on weight for height is not statistically significant. Differences in nutritional status are influenced by sex (girls are better nourished), by region (southeast is favored), and mother's education (more years of education will reduce the probability of the child being malnourished).

The number of years of attendance at preschool has a positive and statistically significant impact on the schooling that people ultimately attain. The number of years of preschool attendance also has a positive and significant impact on the probability that people will reach a given grade at a specific age. Finally, an additional year of preschool reduces repetition. However, the magnitude of the impact is quite small: 3 to 5 percentage points.

These results imply that attendance at preschool has a significant impact on future income to the extent that better educational performance increases people's incomes An increase of one year of schooling raises income by about 11%, and preschool increases the level of schooling ultimately attained by 0.4 years.

In addition, the findings provide evidence that attendance at preschool has an independent and direct positive impact on income: an additional year of preschool will increase income with an extra 2% (using the lowest estimates).

The total impact of an additional year of preschool is equal to increasing income by about 6% (0.4*11% through increased schooling + 2% directly).

These estimates of the benefits of preschool do not include the potential gains due to improved nutritional conditions and reduction in repetition.

Cost-Benefit Analysis
  • Internal Rate of Return
    After an evaluation of the costs, the internal rate of return on the investment of an additional year of preschool for a child six years of age is estimated. Although the rate of return is slightly dependent on the family environment (parents' schooling, race, geographic location), all the values obtained are between 12.5% and 15%.The rate of return tends to be 1.5 % higher in the Southeast than in the Northeast and close to 1% higher among those whose fathers have more schooling. The rate of return also tends to be higher among whites and seems not to be affected by the mother's schooling. The reason why the father's schooling has a greater impact than the mother's schooling is because the father's schooling has a greater impact on the child's income.
  • Willingness to Pay for Preschool Services
    The difference between the present value of the income of someone who attends one year of preschool (minus the direct costs related to increased years of primary schooling) and someone who does not, can be interpreted as the social willingness to invest in preschool education. If the values obtained are higher than the cost of one year of preschool, it follows that investments should be made in preschool education.
    The estimates obtained show that, based on a discount rate of 10% per year, the willingness to pay for one year of preschool varies from R$ 900 to 1.600. The estimated cost for one year of preschool is R$ 480. This demonstrates that the willingness to pay is far higher than the estimated costs.
  • Gap between Poor and Non-Poor Children
    The study estimates that in order for the gap between poor and non-poor children to be eliminated, the percentage of poor children attending day care and preschool should be increased by 11 to 25%, depending on the age group and the data source used.

Reference:
Paes de Barros, R. and R. Mendonça (1999). "Costs and Benefits of Pre-school Education in Brazil." Rio de Janeiro: Institute of Applied Economic Research.

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COLOMBIA - Home-Based Community Day Care

"Home-based community day care" is an initiative for preschool day care in Colombia. Started in 1987, the initiative benefits approximately one million 2-to-7-year-olds in its sixth year (83% of all children living in poverty in Colombia). It is based on the idea that a woman, in her own home and assisted by a trained specialist, can provide day care for 15 children in her neighborhood. Parents and other local people participate actively in the operation of the day care "homes".

The overall goal of the day care homes is to offer extremely poor under-7-year-olds an opportunity to develop harmoniously. Children receive special care in health, nutrition, and psychological and emotional development and are supervised while their parents are at work. Parents and communities acquire a better understanding of child care. Several approaches have been adopted in the program:

  • Sound psychological and social development is encouraged in the child through educational activities designed to stimulate the child's awareness and foster understanding among the child, the family and the community.
  • Good nutrition among under-7-year-olds is spurred through the distribution of food supplements which supply 50 to 70 percent of the daily allowance of vitamins recommended for this age group; growth monitoring is encouraged and the program suggests alternatives for better diets.
  • Health care is bolstered by bringing children into programs of the national health system and other relevant agencies.
  • Day care is provided for the children of working parents, thus helping the latter become better integrated into the labor force.
  • The educational and social environment of children is reinforced by strengthening the family, raising the capacity of parents and the community in general to deal with the learning processes involved in activities in which children participate, improving the living conditions of the families associated with the program, supporting community participation and assisting families in boosting their incomes.
Results

Studies have demonstrated the program's positive effect on the physical, psychological and emotional well-being of children. The supervision provided through the community day care "homes" allows women to dedicate more time to jobs and thus augment the incomes of their families. The educational element of the program helps to enrich relationship between adults and children and generate a social and cultural environment more favorable to children:

  • Targeting: The program reaches the poorest parts of the population, which is very important: 76% of the beneficiaries of the program earn incomes per capita that represent less than one-third of the minimum wage. 37% of the heads-of-household are illiterate. Among the homes of all these families, 14,5% lack indoor plumbing, and 18% have dirt floors. The homes of 51% of the families are extremely overcrowded.
  • Child health: The most recent evaluation has found a relatively high morbidity rate among the children enrolled in the program. The high rate is clearly due to the difficult conditions in which poor families live. As the target population usually has no access to health care services of any type, the program may be remedying. However, the evaluations do not discuss the health status of the children prior to their enrollment in the day care homes, nor is there a control group.
  • Child nutrition: An earlier evaluation found that approximately one-half of the children interviewed had achieved progress in nutrition and social development. The underlying study reveals poor child development in terms of the height-to-age ratio. As measured in terms of the weight-to-height ratio, relatively fewer children in the program are suffering from acute malnutrition: 2.3% compared to a national average of 4.9%.
  • The socioeconomic position of their families is so critical to the nutritional status of children that the program cannot aim to correct all nutritional deficiencies. However, the day care homes have had a positive effect on the awareness of parents concerning the importance of their children's eating habits at home. Compared to 1990, the percentage of families involved in the program that were not preparing breakfast or dinner for those of their children who were attending a day care home, has dropped from 14% to 3%.
  • Psychological and social development: According to the 1989 evaluation, mothers felt that their children had made progress in social development: more spontaneity and self-assurance among the children, who were playing more and were more active. They were better playmates and more integrated into society, and had fewer arguments among each other.
    • A study in 1989 showed that 43% of the sample showed signs of greater psychological and social development. Some children were displaying better personal hygiene and health care habits and more learning ability. Relationships between children and adults improved. According to the children, the program had reduced the incidence of child abuse. Children had become more important to the community and as a result were being treated with more affection and respect.
    • The 1993 evaluation affirms these advances in psychological and social development: children who spend more time at the day care homes are exhibiting more evidence of normal development. They perform better on indicators like motor response, hearing, speech and social development than newcomers to the program of the same age and family situation. The proportion of children exhibiting slow psychological and emotional development is higher among children spending less time at the day care homes and among malnourished children.
  • Child care: The day care mothers interviewed for the 1989 evaluation felt that the most important result of the program was the fact that children no longer have to be locked up and left alone at home while their parents are at work. Communities expressed satisfaction with the additional supervision of children, which was leading to a reduction in the number of accidents and the number of minors on the streets. Mothers whose children are enrolled in the program have more free time and therefore more opportunities to earn income.
  • Learning and the social environment: All the efforts at training the day care mothers, auxiliaries and participating parents and the experience garnered through the program have led to changes in child raising and child care practices. The impact on the social environment is still limited but the program is encouraging the first steps towards a new approach to violence, playing with children etc.
  • Other effects: Home-based day care has made people more aware of neighborhood problems: participation of parents and communities in efforts to improve housing, sanitary conditions and child health have been important. The program is instilling people with a sense of pride and confidence in their ability to improve living standards for themselves and their children

Reference:

  • Castillo Cordona, C., Ortiz Pinilla, N. & González Rossetti, A. 1993 "Home-Based Community Day Care and Children's Rights: The Colombian Case", UNICEF International Child Development Centre: Innocenti Occasional Papers, Child Rights Series nr. 3, May;
  • Bogotá Study of Malnutrition, Diarrheal Disease, and Child Development Super: C.M., Herrera, M.G. & Mora, J.O. 1990 "Long-Term Effects of Food Supplementation and Psychosocial Intervention on the Physical Growth of Colombian Infants at Risk of Malnutrition" In Child Development, 1990, vol. 61, pp. 29-49.
  • World Bank 1983 "School Performance and Physical Growth of Underpriveleged Children: Results of the Bogotá Project at Seven Years", PHN Technical Notes res. 8, June 1983.

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INDIA - Early Childhood Education Project

In 1982 an Early Childhood Education Project was launched, with UNICEF assistance, in six states of the country, with four more states joining in the subsequent years (Bihar, Karnataka, Maharashtra, Orissa, Rajasthan, Tamil Nadu, Madhya Pradesh, Uttar Pradesh, Goa, Nagaland). The project established 65 ECE centers in each state which were administratively, and in most cases physically, attached to the primary schools. The centers were set up in the particularly underprivileged, underdeveloped regions of the states. The centers provided a development-oriented curriculum through play and activity. Every quarter they organized parents programs. These programs encouraged parents to participate and see their children's work and they were educated regarding the kind of environment and interactions that would be conducive to children's development. No medical or nutritional services were provided to the centers. The study was conducted with the objective of assessing the impact of the early Childhood Education provided under the project on the subsequent retention of children in the primary grades. The study was longitudinal and cross-sectional in design.

Results

The results show that exposure to early childhood education certainly facilitates retention in the primary grades. This impact is evident not only in the initial stages but, in a sustained way, right through the primary grades.

The percentage of children with ECE experience that drop out is lower than for the children without ECE experience. However, for both groups the maximum drop-outs (55 and 57%) occur between classes 1 and 2. While ECE experience does help reduce the total number of dropouts, its impact can be maximized by effective qualitative improvement in terms of child-centered, activity based pedagogy in the early primary stage to attract and retain children in elementary school.

Surprisingly, in Madhya Pradesh where the program was run by exceptionally well qualified and highly paid teachers, the impact of ECE on primary school retention was negative. Apparently, the program turned out to be counterproductive since the children found the primary school environment very dull and unattractive in comparison to their ECE experience. This could have led to a greater exodus from school at the early stage. The need, therefore, for ensuring extension of the ECE methodology to the early primary grades cannot be over emphasized.

The impact of ECE experience on retention in primary grades appears to be greater for girls as compared to boys, especially by class 4. This observation substantiates the significance of Early Childhood Education for not only helping girls tide over the initial adjustment difficulties (which is applicable to boys as well), but for surviving and continuing in primary grades up to class four or five. It may be that the family's utilization of the local ECE center helps spare the girls from the chore of looking after their younger siblings and thus leaves them free to continue in school.

Reference:
Kaul, V., C. Ramachandran & G.C. Upadhyaya 1993. "Impact of Early Childhood Education on Retention in Primary Grades: A Longitudinal Study". New Delhi: The National Council of Educational Research and Training.
Kaul. Integrated Child Development Services (ICDS) ChaChaturvedi, E., B.C. Srivastava, J.V. Singh, and M. Prasad 1987. "Impact of Six Years' Exposure to the ICDS Scheme on Psychosocial Development." Indian Pediatrics 24:153-64.

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TURKEY - The Early Enrichment Project

In 1982 researchers at Bogazici University in Istanbul, Turkey instituted a randomized test to see whether educating poor mothers of three- and five-year-olds improved the children's learning abilities, and whether the effects were more lasting than programs that educated the children directly. The program was evaluated at the end of the project to see its immediate effects and once again nine years later. A series of assessments, tests, and interviews were used to establish a baseline for the project. Mothers were divided into groups: those with children in an educational preschool, those with children in a custodial daycare center; and those with children at home. Both treatment and control groups were established by random selection.

The original study was a 4-year longitudinal intervention project, utilizing a field experiment. It involved early childhood enrichment and mother training in the low-income areas of Istanbul. The effects of both center-based (educational and custodial) and home-based enrichment were studied, by selecting existing day care centers. Each enrichment group was subdivided in a 3-year old and 5-year old group. The extra intervention introduced by the project was mother training for a randomly selected number of the mothers of each of the 6 day care groups. They constituted the "experimental group" in the project design. The mothers not selected for mother training and their children constituted the "control group". The research design used was therefore 3x2x2 (context: educational, custodial, home care; age: 3 or 5; mother training or no mother training). All mothers in the project had similar socioeconomic and demographic characteristics (including low levels of education, income, mostly rural origin, rather young age, etc.)

Mother training was composed of two programs: the Cognitive Training Program (based on the Israeli HIPPY à a school preparation program including pre-literacy and pre-numeracy skills) and the Mother Enrichment Program (group discussions to sensitize mothers to the needs of the growing child and to develop effective communication skills of the mothers to promote better verbal interaction with the child à empowerment of the mothers in coping with problems and attending to their children's as well as their own needs). Assessments of the children and their families were conducted in four main areas: cognitive development, socio-emotional development, family context and day care context.

Short-Term Results (Results of the First Study)
  • Cognitive development: Overall, the results pertaining to cognitive development (IQ, analytical thinking, complexity of behavior, etc.) and school-related achievement in general (ability, mathematics and Turkish, school grades) show the positive effects of mother training and educational day care. The children trained by their mothers surpassed the control group on all measures of cognitive development and school achievement, significantly so on most. Similarly educational day-care context was found to be superior to custodial and home care on almost all of the cognitive measures. The effects of mother training and educational day care were additive.
  • Socio-emotional development (Child outcomes): The socio-emotional developmental outcomes are not as notable as the cognitive outcomes. The differences between the mother-trained and control groups of children on socio-emotional measures are all in the expected direction, showing some benefit from the mother training program. However, they barely reach significance. The mother-trained group of children was rated as less aggressive than the control group, less dependent, having higher self-concept and better school adjustment. The effects of child-care context are less clear-cut, though children cared for at home were found to be more dependent than children in day care and to exhibit more emotional problems.
  • Mother's orientation to the Child: The results showed a number of important differences in attitudinal and behavioral orientations between trained and non-trained mothers. Trained mothers were more attentive to the child, had more interaction while at home, read or told more stories, and helped more with homework. They had higher expectations for their children, especially regarding success in school, and on independency. Trained mothers had more positive and supportive interaction styles, involving encouragement, praise, positive feedback, reasoning instead of spanking. They communicated verbally with their children more often than non-trained mothers did.
  • Direct effect on mothers :The mother training program was also found to have direct effects on the mother herself. Trained mothers enjoyed higher intra-familiar status vis-à-vis their husbands (greater participation in decision-making, more role sharing and communication with their husbands). They also expressed greater satisfaction with their current life situation compared with 3 years earlier and had more positive expectations for the future, both in comparison to the control group.
Long-Term Follow-up Study

The project intervention (mother training) had a positive impact in the short term on both mothers and children. Educational preschool was also found to be beneficial for children. The effects of mother training in particular, were expected to be self-sustaining through time because they would entail a continuing supportive interaction with the immediate social environment. A "virtuous cycle" may underlie such sustained positive development. Hence, the follow-up study.

The follow-up study was initiated 6 years after the completion of the original study (7 years after the intervention). The aim was to assess the overall condition of the children (experimental and control) who were now adolescents, and of their mothers and families, and to relate these findings to the original intervention

  • Cognitive Development and school performance:
    • School attainment (= still being in school at the follow-up study): a very significant 86% of the mother training group was still in school, compared to 67% of the children whose mothers had not been trained. No significant difference between educational, custodial and home care.
    • Academic performance in primary school: mother-trained children surpassed the control group in a very significant way on mathematics, Turkish and overall academic average. The difference is not significant after primary school à probably due to self-selection within the control group where only the more successful children continue with secondary school.
    • Retention: no difference between preschool context on academic performance but custodial day care children had significantly greater number of retention in grade.
    • Verbal cognitive performance: the mother-trained group significantly outperformed the control group. The educational day care group scored highest (47,06), followed by the custodial group (43,22) and the home-care group (40,11).
  • Adolescents' academic orientation:
    • Mother-trained adolescents compared with the control group, had higher self-esteem regarding academic performance, had a more positive attitude towards education, were more pleased with their school success en thought their teachers were pleased with them. They had less negative or external reasons to go to school.
    • The mother-trained children were also perceived by their parents in a more positive light regarding academic orientation than were the control children.
    • Preschool context made a difference mainly in terms of a negative effect from the custodial day care experience. Next, home care children were much less likely than the other groups to think they had been prepared for primary school (32% vs. 96% and 93% resp.).
  • Socio-emotional development and social integration of the adolescent:
    • The mother-trained adolescents showed better indicators of socio-emotional development and integration: greater autonomy (making their own decisions), better social integration and adjustment (being accepted by friends, mothers' approval of their friends, committing less (none) juvenile crime).
    • In the preschool context, again the negative effects of custodial day care are apparent: those adolescents had less self-confidence, they perceived themselves as less intelligent than their classmates and had less confidence in their ability to cope with different situations.
    • Compared with the four-year findings, where the socio-emotional outcomes were not very clear-cut, the long-term effects appear more notable.
  • Adolescents' perception of the mother:
    • Adolescents whose mother had been trained perceived her as more nurturing, more responsive. Compared to the control group they perceived their mother to talk with them, to console them, to help them, to be interested in them, to appreciate them more, and to spank them less.
    • Obviously, the trained mothers manifested a different style of parenting. This was probably the key difference between the human environments of the two groups of children.
  • Parent's Perception of child and Family Relations:
    • Significant differences between the two groups emerged in many basic family variables: In the experimental group, better parent-child communication, better adjustment of the child in the family, less physical punishment, and closer and better family relations were reported by both mothers and fathers.
    • The trained mothers still enjoyed a higher intra-family status, even 7 years after the intervention.
    • The mother-trained group performed better on indicators of educational orientation reflecting a home environment more likely to promote educational achievement.
Discussion of the Findings

With respect to the four-year results, and examining cognitive-school achievement outcomes, which are more clear-cut than the socio-emotional outcomes, both interventions are effective. Educational day care showed a significant superior performance on a lot of measures, the custodial group only on a few, and home-care never had the highest score. Likewise, the mother-trained group was superior on a lot of measures while the non-trained group was in no way superior to the mother-trained group. The gains of the educational day care show most significant differences.

When we move to the long-term effects, there is some reversal in the relative effectiveness of the two types of intervention. More of the gains from mother training are sustained compared with those from educational day care. This is the case for both school attainment, school achievement, academic orientation, and socio-emotional development and social adjustment/integration. A virtuous circle was apparently set into action by the mother training, which has proven itself to be self-sustaining. The dissipation of gains over the long-term from educational day care is in line with other research findings regarding the situation where parental involvement is lacking or minimal.

Reference:

  • Kağitçibaşi, Ç., "Family and Human Development Across Cultures: A View From the Other Side", New Jersey: Lawrence Erlbaum Associates, 1996.
  • Kağitçibaşi, Çigdem, Diane Sunar, and Sevda Bekman. 1993. "Long-term Effects of Early Intervention." Unpublished paper. Department of Education, Bogazici University, Istanbul, Turkey.

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TURKEY - The Mother Child Education Program

Since its implementation in 1982, the Early Enrichment Project has been revised thoroughly for application as a program in the community. The duration was shortened from 60 to 25 weeks, and the target group limited from both 4 and 5 year olds to only 5 year olds. A new cognitive training program was developed to replace the old HIPPY-based program in the original Project. The content of the Mother Enrichment component was revised and enlarged. And a new component was added: Reproductive Health and Family Planning. The program is utilized with only weekly group meetings instead of a combination of home visits and group meetings as it was in the original study. The whole Program was established in 1993 and named the "Mother-Child Education Program" (MOCEP).

The Mother-Child Education Program targets both the child and the child's immediate environment rather than only the child. The aim is to foster cognitive and psychosocial development in the home environment. The mother is targeted as she is the significant person in the child's home context. By providing cognitive enrichment to children and by creating an environment that will provide optimal psychosocial health and nutritional development, the child will be better prepared to enter primary school. The role of the parents in the cognitive, social and emotional development of the child will be fostered. Child management methods and communication with the child, emotional security and self esteem of the mother, family planning and reproductive health are also targeted in the program. Thus, the program is an example of both adult education and child development

Short-Term Impact of the Program
  • Effects on Children: The program showed immediate and significant results both for pre-literacy and pre-numeracy skills. Girls gained more from the program than boys, maybe due to the fact that girls started at a lower level on these skills than boys. Thus, the participating children were more prepared to deal with the expectations of formal schooling than their counterparts who had not been in the program. Moreover, the program offers a chance to overcome initial inequality of gender differences.
  • Effects on Mother-Child Interaction (Child Rearing Practices)
    • Trained mothers were significantly less likely to display negative methods of discipline, such as beating their child, shouting at the child or not attending to him/her when the child is engaging in unwanted behavior.
    • Trained mothers were also more likely to practice positive methods of child rearing compared to the non-trained mothers. They were found to engage significantly more in behaviors like explaining why his/her behavior is wrong to the child, setting up rules of behavior beforehand, and distracting the child's attention to something else when involved in unwanted behavior. They were more likely to keep their promises to the child, and more likely to prepare an environment which allows the child to play.
    • The findings indicate a positive change in the child rearing practices of mothers in the trained group. The change reflects the presence of certain mother-child interactions which lead to more adequate growth and development of children. Also the results indicate an improvement in the relations between mother and child, and the coming about of an environment of healthy child development.
  • Effect on Mothers: A significant difference in self-esteem was found between the trained and the non-trained group. The self reports of the mothers indicated that the mothers who have been in training are significantly more likely to perceive themselves as better mothers, wives and individuals when they compare themselves with their acquaintances.
Longer-Term Impact of the Program

The follow-up research aimed to illustrate whether the acquisition of school readiness skills at preschool age gives an effective start at school and whether changes obtained with respect to the presence of a stimulating home environment leads to school success or not.

  • Effects on children:
    • The results indicate a significant differences in the performance of both groups, with significantly higher literacy and numeracy skills for the mother trained group of children. This illustrates that the positive effects of the program on the cognitive development of the child continued for a year after the termination of the program. As these children were better in pre-literacy and pre-numeracy skills, they were also better than non-participating children at the elementary school level.
    • A stimulating home environment (newspapers, magazines, TV, intensity of mother-child interaction) had a significant positive impact on children from the non-trained mother group, but no impact on the program children. This result for both groups was also found with regard to a stimulating study environment at home (place of study, presence of other people or TV at place of study, etc.). This shows the importance of early intervention programs in overcoming distressing effects of the home environment.
    • The mother trained group of children had significantly higher grades in the first grade and began to read significantly earlier than the non trained group, indicating that they were better prepared to enter primary school.
    • Finally, teachers expressed that the children from the mother trained group displayed more appropriate behaviors at school than the non trained group. Moreover, they evaluated the program children as more attentive, more creative, and more curious.
  • Effects on mothers
    • The self-reports indicated revealed that mothers from the trained group are significantly more interested in what happens at school than the non-trained mothers. Moreover, they make an extra effort to increase their child's success as school.
    • In addition to this better home environment for the child's academic success, the positive child rearing attitudes which mothers had at the termination of the program still continued after a year. They were more likely to engage in positive methods and less likely to use negative discipline methods.

Reference:
Bekman, S. (1998). "A Fair Start: An Evaluation of the Mother-Child Education Program". Istanbul: Mother-Child Education Foundation. Publication number 13.

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JAMAICA - The Long-term Follow-up of Severely Malnourished Children

Long term follow-up of the "Psychosocial stimulation program to severely malnourished children" at age 9 and 14.

Conclusion

Severely malnourished children maintained poorer levels of development than their peers who were hospitalized in the same early childhood period but without malnourishment. This developmental lag exists even 14 years after the acute malnutrition episode, after controlling for social background and hospitalization. However, those malnourished children who participated in the intervention program showed sustained benefits compared to the malnourished control group. The implications are that psychosocial stimulation should be an integral part of the treatment of severely malnourished children. In countries where PEM is common and famine is frequent, the implications for human development are overwhelming.

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JAMAICA - Nutritional supplementation, and psychosocial stimulation combined

It is estimated that 40% of children under 5 years of age in developing countries are stunted (low heights for age). Several cross-sectional observational studies have shown that stunting is associated with poor developmental attainment in young children (Lasky et al., 1981; Powell & Graham-McGregor, 1985) and poor school achievement or intelligence levels in older children (Jamison, 1977, Moock & Leslie, 1986). But observational studies do not control for other factors. Therefore, this experimental intervention study was undertaken:

The effects of nutritional supplementation, with or without psychological stimulation, of growth-retarded (stunted) children aged 9-24 months were assessed in a study in Kingston, Jamaica. 129 children from poor neighborhoods were randomly assigned to four groups: control, supplemented only, stimulated only, and supplemented plus stimulated. A group of matched non-stunted children was also included.

Results

The children's mental development (DQ) was assessed on the Griffiths mental development scales. Initially the stunted groups' DQs were lower than those of the non-stunted group, and those of the control group declined during the study, increasing their deficit. Stimulation and supplementation had significant independent beneficial effects on the children's development. The treatment effects were additive, and combined interventions were significantly more effective than either alone. These findings suggest that poor mental development in stunted children is at least partly attributable to under-nutrition.

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JAMAICA - Psychosocial stimulation to severely malnourished children

The development of 16 children who were hospitalized for severe malnutrition and participated in a home-visiting program of psychosocial stimulation was compared with that of two other groups who were also hospitalized but received standard medical care only: a severely malnourished group and an adequately nourished group. All groups were assessed regularly on the Griffiths test and the Stanford Binet test (both mental development / IQ).

Short-Term Results

Both groups of malnourished children were markedly behind the adequately nourished group on admission to the hospital and the group that received no intervention showed little sign of catching up. The intervention group caught up in 2 years.

Long-Term Follow-up Study

A follow-up study has been undertaken 3 years after the cessation of the intervention. The intervention group showed a decline in three of the five Griffith subscales since the end of the second year of intervention. However, they retained a marked advantage over the nonintervention group of malnourished children on the Stanford-Binet test until the end of follow-up, showing no further decline in the last year. For height, both malnourished groups failed to catch up to the adequately nourished group. It was concluded that a relatively simple intervention can benefit the mental development of severely malnourished children. It is possible that greater improvements would have occurred if nutritional supplementation had also been given.

References:

  • Graham-McGregor, S.M., Schofield, W. & Powell, C., "Development of Severely Malnourished Children Who Received Psychosocial Stimulation: Six-Year Follow-Up", in: Pediatrics, February 1987, Vol. 79 (2), pp. 247-254.
  • Graham-McGregor, S.M., Powell, C.A., Walker, S.P. & Himes, J.H., "Nutritional supplementation, psychological stimulation, and mental development of stunted children: the Jamaican Study", in: The Lancet, 1991, vol. 338, pp. 1-5.
  • Jamison, D.T., "Child malnutrition and school performance in China", in: Journal of Development Economics, 1977, vol. 20, pp. 299-309.
  • Lasky, R.E., et al., "The relationship between physical growth and infant behavioral development in rural Guatemala", in: Child Development, 1981, vol. 52, pp. 220-226.
  • Powell, C.A. & Graham-McGregor, S.M., "The ecology of nutritional status and development in young children in Kingston, Jamaica", in: American Journal Clin. Nutrition, 1985, vol. 41, pp. 1322-1331.
  • Grantham-McGregor, Powell, C., Walker, S., Chang, S. &Fletcher, P., "The Long-Term Follow-up of Severely Malnourished Children Who Participated in an Intervention Program", in: Child Development, 1994, vol. 65, pp. 428-439