Community-based infant massage: from saving bones to saving brains

In this project

Organization:

Community Empowerment Lab

Country of Implementation:

India

Sites:

Shivgarh, Uttar Pradesh

Rural/Urban/Peri-Urban:

Rural

Target Beneficiary:

0-2 years

Delivery Intermediaries:

Caregiver; Non-Medical Professionals

Objective:

To improve infant neurodevelopment through a holistic stimulation package layered on traditional massage practice.

Innovation Description:

The integration of a package of early child development interventions into the existing socio-cultural practice of infant massage in India, Bangladesh and Nepal.

Stage of Innovation:

Proof of Concept

Community-based infant massage: from saving bones to saving brains

Organization

Community Empowerment Lab

Sites

Shivgarh, Uttar Pradesh

Rural/Urban/Peri-Urban

Rural

Target Beneficiary

0-2 years

Delivery Intermediaries

Caregiver; Non-Medical Professionals

Objective

To improve infant neurodevelopment through a holistic stimulation package layered on traditional massage practice.

Innovation Description

The integration of a package of early child development interventions into the existing socio-cultural practice of infant massage in India, Bangladesh and Nepal.

Stage of Innovation

Proof of Concept

Innovation Summary

0068 CEL_logoGlobally, over 200 million children fail to fulfill their developmental potential, manifested as poor skill development, lower educational attainment and reduced earnings, contributing to the  intergenerational transmission of poverty. India accounts for more than 30% of the global burden, and the state of Uttar Pradesh (UP) is home to a quarter of India’s children at risk. [1] Of the 25 million under-5 children in UP, 24.4% are moderately stunted and 32.4% are severely stunted. [2]

The traditional practice of infant massage in India has been sustained at scale over millennia through the underlying socio-cultural system. Caste-role based workers such as ‘nauns’ are the repositories of this practice, and provide massage to infants and mothers in the first few weeks post birth. This innovation aims to integrate a holistic early child development intervention package into this universally accepted practice. The existing network of such community massage specialists will be leveraged to deliver the intervention to families and transfer skills to mothers to ensure continuity of the intervention over the first six months of life. Besides direct benefit to the infants’ development outcomes, the innovation will lay a strong foundation for future life course interventions.

Impact

  • 100 community massage specialists will receive training on early childhood development.
  • 1000 mothers will receive early childhood development counseling and support from community massage specialists.
  • 15% expected reduction in the proportion of at-risk children in intervention vs. control group.

At Community Empowerment Lab, we believe that transformation lies at the confluence of science and local wisdom. This innovation has the potential to unify, empower and transform.
-- Dr. Vishwajeet Kumar

Innovation

The final challenge for any social innovation is its adoption by its users. This innovative idea circumvents this barrier by leveraging existing accepted practices to integrate a comprehensive package of early childhood development (ECD) interventions.

Community-based infant massage is an integral part of the socio-cultural operating system across South Asia. Infant massage is believed to strengthen bones and muscles. This practice is so integrated that there is a cadre of traditional service providers called nauns, who provide massage to newborns and mothers in the first few weeks after birth, a practice then continued by the family for 1-2 years.

Nauns (community massage specialists) are highly regarded across the caste hierarchy for their skills and services. Thus, nauns are community-based social entrepreneurs in their own right, providing a sustainable framework to the program. The practice of massage has multiple neurodevelopmental benefits of which the community is as yet unaware. Massage therapy for preterm infants has proven effective in stimulating weight gain, and accelerating brain maturation. [3, 4]

Infant massage has also proven effective in improving mother-child interaction in depressed mothers. [5] Therefore, given its deep cultural roots, universal acceptability, and pre-existing neurodevelopmental benefits, the practice of infant massage is an excellent platform for integrating a comprehensive package of evidence-based ECD interventions involving visual, auditory, motor and cognitive stimulation to infants in the first 6 months of life.

The perceived benefit of massage amongst the community will therefore expand from the current “saving bones” paradigm, which was valuable in an agrarian economy, to include the “saving brains” paradigm, which has increasing value in the knowledge economy. This idea involves rebranding the nauns as “saving brains” service providers, and empowering them to deliver and train mothers to provide a holistic ECD intervention woven into the massage routine, created both by ECD experts and nauns.

Collaboration

Funders

Grand Challenges Canada

Key Partners

Community Empowerment Lab (India)

Implementation

Key Drivers

  • Capacity building of community massage specialists to deliver intervention package.
  • Design of intervention.
  • Design of a community-centric early childhood development intervention layered on infant massage.
  • Coverage of intervention.
  • High & equitable coverage of the intervention.

Continuation

The innovation is highly scalable as: (a) It is layered on an existing socio-cultural platform at scale; (b) it is financially sustainable as it is being layered on a pre-existing social entrepreneurial model. The potential scale of our innovation is at the minimum the entire Indian sub-continent, including India, Pakistan, Bangladesh and Nepal, that is also home to almost half of disadvantaged children globally. Due to the pervasive nature of this practice in culturally entrenched regions, it may also be possible to scale it up in parts of Africa and other parts of Asia.

Evaluation Methods

The innovation will be evaluated through a cluster randomized controlled trial in Shivgarh, India. Thirty two villages (population ~ 3000 each) will be randomized equally to intervention or control. Child outcomes will be measured through child developmental scores at 1,3,6,9,12 and 15 months. The tool requires parent interview coupled with direct observation of the child.

The project team will also evaluate whether or not the intervention reduces environmental risks to child development, such as quality of the home environment, nutrition including complementary feeding, maternal mental health, improved caregiver-child attachment, caregiver efficacy, etc. These covariates will also be measured as secondary outcomes alongside child developmental scores.

References

  1. Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. The Lancet, 369(9555), 60-70.
  2. The situation of children in India: A profile. United Nations Children’s Fund, 2011.
  3. Dieter, J. N., Field, T., Hernandez-Reif, M., Emory, E. K., & Redzepi, M. (2003). Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology, 28(6), 403-411
  4. Guzzetta, Andrea, et al. “Massage accelerates brain development and the maturation of visual function.” The Journal of Neuroscience 29.18 (2009): 6042-6051.
  5. Glover, V., Onozawa, K., & Hodgkinson, A. (2002). Benefits of infant massage for mothers with postnatal depression. Seminars in Neonatology,7(6),495-500.

Resources

  • Instruments & Batteries

    • Developmental Milestone Checklist-II (DMC-II). Language. Gross/Fine Motor. [Dr. Elizabeth Prado].

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Saving Brains is a partnership of

Saving Brains is a partnership of