Institute for Fiscal Studies, London, UK
Department of Economics, Yale University, New Haven, Connecticut, USA.
BMJ Open. 2022 Oct 13;12(10):e061571. doi: 10.1136/bmjopen-2022-061571.
Many children in developing countries grow up in environments that lack stimulation, leading to deficiencies in early years of development. Several efficacy trials of early childhood care and education (ECCE) programmes have demonstrated potential to improve child development; evidence on whether these effects can be sustained once programmes are scaled is much more mixed. This study evaluates whether an ECCE programme shown to be effective in an efficacy trial maintains effectiveness when taken to scale by the Government of Ghana (GoG). The findings will provide critical evidence to the GoG on effectiveness of a programme it is investing in, as well as a blueprint for design and scale-up of ECCE programmes in other developing countries, which are expanding their investment in ECCE programmes.
This study is a cluster randomised controlled trial, in which the order that districts receive the programme is randomised. A minimum sample of 3240 children and 360 schools will be recruited across 72 district school cohort pairs. The primary outcomes are (1) child cognitive and socioemotional development measured using the International Development and Early Learning Assessment tool, the Strengths and Difficulties Questionnaire, and tasks from the Harvard Laboratory for Development Studies; (2) child health (measured using height/weight for age, height-for-weight Z scores). Secondary outcomes include (1) maternal mental health, (using Kessler-10 and Warwick Edinburgh Mental Wellbeing Scale) and knowledge of ECCE practices; (2) teacher knowledge, motivation and teaching quality (measured with classroom observation); (3) parental investment (using the Family Care Index and Home Observation Measurement of the Environment and the Child-Parent Relationship Scale); (4) water, sanitation, and hygiene (WASH) practices; (5) acute malnutrition (using mid-upper arm circumference). We will estimate unadjusted and adjusted intent-to-treat effects.
Study protocols have been approved by ethics boards at the University College London (21361/001), Yale University (2000031549) and Ghanaian Health Service Ethics Review Committee (028/09/21). Results will be made available to participating communities, funders, the wider public and other researchers through peer-reviewed journals, conference presentations, social and print media and various community/stakeholder engagement activities.
ISRCTN15360698, AEARCTR-0008500.
许多发展中国家的儿童在缺乏刺激的环境中长大，导致其早期发展不足。多项儿童早期保育和教育（ECCE）功效试验已证明其有改善儿童发展的潜力；但这些效果能否在项目推广后持续下去，证据则更为混杂。本研究评估了加纳政府（GoG）推广的一个已被证明有效的 ECCE 项目，在推广后是否仍能保持其有效性。研究结果将为 GoG 提供关于该项目有效性的关键证据，同时也为其他发展中国家设计和扩大 ECCE 项目提供蓝图，这些国家正在扩大对 ECCE 项目的投资。
本研究是一项整群随机对照试验，各地区接受项目的顺序是随机的。将在 72 对地区-学校队列中招募至少 3240 名儿童和 360 所学校。主要结局指标是：（1）使用国际发展与早期学习评估工具、长处与困难问卷和哈佛发展实验室任务测量儿童认知和社会情感发展；（2）儿童健康（用身高/体重年龄比、身高-体重 Z 分数测量）。次要结局指标包括：（1）母亲心理健康（用 Kessler-10 和华威爱丁堡心理健康量表）和 ECCE 实践知识；（2）教师知识、动机和教学质量（通过课堂观察测量）；（3）父母投资（用家庭关怀指数和家庭观察测量环境和儿童-父母关系量表）；（4）水、环境卫生和个人卫生（WASH）实践；（5）急性营养不良（用中臂围测量）。我们将估计未调整和调整后的意向治疗效果。
研究方案已获得伦敦大学学院（21361/001）、耶鲁大学（2000031549）和加纳卫生服务伦理审查委员会（028/09/21）的伦理委员会批准。研究结果将通过同行评议期刊、会议演讲、社会和印刷媒体以及各种社区/利益相关者参与活动，提供给参与社区、资助者、更广泛的公众和其他研究人员。
ISRCTN15360698，AEARCTR-0008500。
