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A Holistic Approach to Promoting Early Child Development: A Cluster Randomised Trial of a Group-Based, Multicomponent Intervention in Rural Bangladesh


Pitchik, Helen O.; Tofail, Fahmida; Rahman, Mahbubur; Akter, Fahmida; Sultana, Jesmin; Shoab, Abul Kasham; Huda, Tarique Md Nurul; Jahir, Tania; Amin, Md Ruhul; & Hossain, Md Khobair, et al. (2021). A Holistic Approach to Promoting Early Child Development: A Cluster Randomised Trial of a Group-Based, Multicomponent Intervention in Rural Bangladesh. BMJ Global Health, 6(3), e004307. PMCID: PMC7970287


INTRODUCTION: In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.
METHODS: We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions ('group'); alternating groups and home visits ('combined'); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.
RESULTS: In July-August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July-August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, -0.07 to 0.54).
CONCLUSION: Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

BMJ Global Health


Pitchik, Helen O.
Tofail, Fahmida
Rahman, Mahbubur
Akter, Fahmida
Sultana, Jesmin
Shoab, Abul Kasham
Huda, Tarique Md Nurul
Jahir, Tania
Amin, Md Ruhul
Hossain, Md Khobair
Das, Jyoti Bhushan
Chung, Esther O.
Byrd, Kendra A.
Yeasmin, Farzana
Kwong, Laura H.
Forsyth, Jenna E.
Mridha, Malay K.
Winch, Peter J.
Luby, Stephen P.
Fernald, Lia C. H.



Data Set/Study

The Research on Integrated Nutrition, ECD and WASH (RINEW) Intervention