Despite documented efficacy of early interventions to treat neurodevelopmental delay (NDDs), the challenge for low-resource settings is to find a way to feasibly and effectively deliver evidence-based interventions to the vast population in need. In settings of poverty and limited health infrastructure, scalable solutions are difficult since children at greatest risk for NDD are often the least likely to access healthcare and specialized care to treat NDDs is limited.

The goal of the innovation is to demonstrate feasibility and efficacy of a community-based intervention that seeks to reduce NDD among children in the context of poverty and limited health infrastructure.

Community health workers will identify and treat children at-risk of NDDs and assist their caregivers. The intervention includes 1) coaching parents on how to stimulate their child to promote development, and 2) providing parents with social support and encouragement.

The children and their primary caregivers will be randomly assigned to one of three interventions: monthly nutritional support alone; nutritional support plus 3 months of the intervention in the home; or nutritional support plus 3 months of the intervention in group settings.

Funders

• Grand Challenges Canada

Key Partners

• Socios En Salud Sucursal Peru

Key Drivers

Multi-sector Partnership

Socios En Salud Sucursal Peru engages with the Peruvian Ministry of Health as well as civil, social, and community-based organizations to ensure projects are sustainable at the community and municipal level.

Mutual Health Priority Amongst Invested Partners

Recent trends in Latin America toward decentralization of health services have shifted resources and leadership from Ministry of Health programs to local municipalities. Municipalities, such as Carabayllo, have resources and infrastructure to implement health programs, yet lack necessary expertise to execute programs effectively. Responding to this mandate, Rafael Alvarez Espinoza, Mayor of Carabayllo, identified the impact of child labor and social inequality on NDDs. As a result, he requested our organization to lend our expertise in community-based interventions to improving early neurodevelopment through a scalable, relatively low-cost program. Thus, this program represents a mutual health priority among invested partners and the collective resources necessary to leverage pilot findings towards in meaningful programmatic implementation.

Policy leaders, clinicians, and CHWs in Pisco/ Chincha and Carabayllo, Peru and similar stakeholders from two sister organizations (in Rwanda and Haiti) will be interviewed to explore how the intervention can be adapted to the different cultures, health systems, and socioeconomic characteristics of these diverse sites. The results will inform future development of a “core CBI package” with clear guidelines on adaptations for local populations.

Among the outcomes to be measured and evaluated:

• Changes in child development.
• Changes in parenting behaviour.
• Child, caregiver, and household characteristics that predict who benefits most from the intervention.
• Effectiveness of each delivery mechanism (one-on-one or group settings).

The project will compare the change in developmental status among children and the change parenting behavior among caregivers across the control and intervention groups. Once enrolled, CHWs will administer the HOME questionnaire to evaluate parenting and home influences on child development, and they will conduct a brief assessment of the child’s birth history, health and nutritional status (clinical and psychosocial data). Videotapes of parent-child interactions will be taken at baseline, 3, and 6 months, and reviewed using standardized assessments adapted for Peru. The project team will compare changes in home influences, parent responsiveness, parental involvement, cognitive stimulation, and parent-child interactions (number & quality) across the control and intervention groups. Data will be collected at baseline, at 3 months into the intervention, and at 3 months post-intervention. The team will perform subgroup analyses to assess for heterogeneity of treatment effects due to caregiver, home, and child characteristics.

To assess the role of the delivery setting, the project will compare outcomes of each modality (group and individual lessons) in addition to qualitative data to compare the potential assets and limitations of each.

Process evaluations will include verbal caregiver surveys after each session and final focus groups for stakeholders, to improve the intervention through lessons learned.

To identify which aspects of the intervention are essential for scale and sustainability, the project team will interview policy leaders, clinicians, and CHWs in Peru, Rwanda and Haiti to explore how the intervention can be adapted to the contexts of these diverse sites.

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