School of Public Health, University of California Berkeley, Berkeley, CA, USA.
School of Public Health, University of Washington, Seattle, WA, USA.
BMC Public Health. 2024 Sep 27;24(1):2583. doi: 10.1186/s12889-024-20149-w.
In low-resource settings, introducing child health programs into community services may compete for caregiver time. We analyzed the impact of a new early childhood development (ECD) program in rural Madagascar on family attendance at other health services and of adding at-home play materials on program attendance.
We randomized 75 communities where community health workers (CHWs) implement an existing child health and nutrition program (Projet d'Amélioration des Résultats Nutritionnels or PARN), the status quo. We offered two 6-month cycles of 12 ECD sessions to eligible caregiver-child dyads (6-30 months) in 25 sites [T]; we added take-home play materials in Cycle 2 to 25 sites [T+]. We used differences-in-differences with administrative data to analyze the effect of offering ECD sessions on monthly PARN attendance (T+/T vs. C) among age-eligible children and the impact of toy boxes/libraries on monthly ECD session attendance (T + vs. T). We used random intercept models to analyze characteristics associated with program registration.
We analyzed data for 9,408 dyads; 30% and 32% registered for the program in Cycle 1 and 2 (respectively). On average, CHWs delivered 11.4 sessions (SD: 1.5). Children from wealthier households who already attended PARN sessions were more likely to register, and we found no effect of T or T + on PARN attendance. Adding play materials did not affect monthly ECD session attendance. Children from more populated sites were less likely to participate in both ECD and PARN sessions.
Integrating new services for ECD into the health system was feasible and did not reduce dyad participation in existing services. Investment in health services in more populated areas is needed to provide coverage to all eligible children. Novel strategies should be explored to engage the most vulnerable children in new and existing health services.
AEA Social Science Registry (AEARCTR-0004704) on November 15, 2019 (prospective registration) and ClinicalTrials.gov (NCT05129696) on November 22, 2021 (retrospective registration).
在资源匮乏的环境下，将儿童健康项目引入社区服务可能会与照顾者的时间产生竞争。我们分析了马达加斯加农村地区一个新的幼儿发展（ECD）项目对家庭参加其他卫生服务的影响，以及在家中提供游戏材料对项目参与的影响。
我们随机选择了 75 个社区，这些社区的社区卫生工作者（CHW）实施现有的儿童健康和营养计划（Projet d'Amélioration des Résultats Nutritionnels 或 PARN），作为现状。我们在 25 个地点为符合条件的照顾者-儿童对（6-30 个月）提供了两个为期 6 个月的 12 个 ECD 课程周期[T]；我们在第二个周期中为 25 个地点提供了家庭游戏材料[T+]。我们使用行政数据进行差异分析，分析在提供 ECD 课程后，在月龄符合的儿童中，PARN 参与率的变化（T+/T 与 C），以及玩具箱/图书馆对 ECD 课程参与率的影响（T+与 T）。我们使用随机截距模型分析与计划注册相关的特征。
我们分析了 9408 对儿童的数据；分别有 30%和 32%的儿童在第一和第二周期注册了该计划。平均而言，CHW 提供了 11.4 个课程（SD：1.5）。来自较富裕家庭且已经参加 PARN 课程的儿童更有可能注册，我们没有发现 T 或 T+对 PARN 参与率的影响。添加游戏材料并没有影响每月 ECD 课程的参与率。来自人口较多地区的儿童不太可能同时参加 ECD 和 PARN 课程。
将新的 ECD 服务纳入卫生系统是可行的，并且没有减少对现有服务的参与。需要在人口较多的地区投资卫生服务，为所有符合条件的儿童提供服务。应探索新的策略，使最脆弱的儿童参与新的和现有的卫生服务。
AEA 社会科学注册中心（AEARCTR-0004704）于 2019 年 11 月 15 日（前瞻性注册）和 ClinicalTrials.gov（NCT05129696）于 2021 年 11 月 22 日（回溯性注册）。
