Stimulation Interventions and Parenting in Low- and Middle-Income Countries: A Meta-analysis.

CONTEXT

Early childhood stimulation interventions positively impact early child development (ECD) outcomes in low- and middle-income countries. However, trials have less comprehensively evaluated the effects of such parenting programs on caregivers' skills and capacities.

OBJECTIVE

We conducted a systematic review and meta-analysis to assess the effectiveness of stimulation interventions on improving parenting outcomes.

DATA SOURCES

Six electronic bibliographic databases.

STUDY SELECTION

Inclusion criteria included randomized controlled trials of stimulation interventions designed to improve ECD outcomes during the first 2 years of life that measured any maternal or parenting-related outcome after the start of the intervention.

DATA EXTRACTION

Two independent reviewers extracted data by using a structured form.

RESULTS

Fifteen studies representing 13 unique randomized controlled trials met the inclusion criteria. Pooled standardized mean differences (SMDs) based on random-effects models revealed medium-to-large benefits of stimulation interventions for improving the home caregiving environment ( = 10; SMD = 0.57; 95% confidence interval [CI], 0.37 to 0.77), mother-child interactions ( = 3; SMD = 0.44; 95% CI, 0.14 to 0.74), and maternal knowledge of ECD ( = 6; SMD = 0.91; 95% CI, 0.51 to 1.31). No significant difference was seen for maternal depressive symptoms ( = 9; SMD = -0.10; 95% CI, -0.23 to -0.03).

LIMITATIONS

Limitations include heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies.

CONCLUSIONS

Early childhood stimulation interventions improve several distinct aspects of maternal parenting. Improvements in parenting capacities may serve as key mechanisms by which these programs benefit ECD outcomes.