Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial

Orazio P Attanasio, Camila Fernández, Emla O A Fitzsimons, Sally M Grantham-McGregor, Costas Meghir, Marta Rubio-Codina, Orazio P Attanasio, Camila Fernández, Emla O A Fitzsimons, Sally M Grantham-McGregor, Costas Meghir, Marta Rubio-Codina

Abstract

Objective: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels.

Design: Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control.

Setting: 96 municipalities in Colombia, located across eight of its 32 departments.

Participants: 1420 children aged 12-24 months and their primary carers.

Intervention: Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months.

Main outcome measures: Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention.

Results: Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels.

Conclusions: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: all authors had financial support from the Economic and Social Research Council, the Inter-American Development Bank, World Bank, the International Growth Center for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

© Attanasio et al 2014.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793830/bin/atto018159.f1_default.jpg
Flow of participants through study

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