In Ethiopia there are about 11 million children 0-3 years of age [1] of which the majority  are deprived of proper care. The psycho-social component of early child development, which is critical for proper cognitive, linguistic and social-emotional development and for adapting to new environmental situations, is largely ignored. About 44% of children in Ethiopia are stunted and 29% are underweight. [2] However, this is not due solely to the lack of available nutrition. The knowledge and skills of parents on child feeding practices and prenatal nutrition is generally very low.

The goal of the project is to improve holistic early childhood development (the health; physical, cognitive, linguistic and socio-emotional development) of 3,000 children 0-3 years of age in 2,500 households.

The project will use two complementary knowledge delivery approaches: Learning Through Play (LTP) and audio-visual early brain development education programs.  Pictorially illustrated LTP Calendars will be used by parents for stimulating the sense of self, motor, language, cognitive development of children 0 to 3 years of age. Audio-visual education (video messages) focusing on child nutrition,  immunization, sanitation, hygiene and prevention of harmful traditional practices and infections; and maternal health  will be locally produced and disseminated to rural low literacy families  in an interactive way using portable devices which are user-friendly. It will be delivered through the health extension packages of the Ministry of Health Extension Workers (HEWs), who are responsible for well-coordinated basic early childhood care services.

Funders

• Grand Challenges Canada

Key Partners

Implementers

• Christian Children’s Fund of Canada (CCFC)  (Ethiopia)
• Bole Bible Baptist Church Child Care and Community Development (BBBC) (Ethiopia)

Supporters

• The Hincks-Dellcrest Centre (HDC) (Canada)

Collaborators to Support Scale-Up and Sustainability

Health Office (Ethiopia) (collaborating organization for supporting the scaling up and sustainability of the project)

Existing Health Sector Infrastructure

The existing government’s health sector development plan and early childhood care and education policy framework, along with willingness of the local government to jointly work with CCFC, will facilitate the implementation, scale up, and sustainability of the program.

Challenges

Anticipated barriers to improving early childhood development through the program include:

Food Taboos

Existing food taboos that restrict pregnant women and children not to eat some food such as fruits with rich vitamins

Limited Father Involvement

Limited father involvement in caring for young children due to cultural norms

Lack of Parent Willingness

Lack of willingness of some parents to bring their young children to undertake anthropometric and psychometric measurement

Planned solutions for the challenges include:

Influential Community Members

The project will use influential community members such as leaders, elders and religious figures, to create awareness about existing harmful traditional practices and to convince parents of the importance of the program’s messages. These community members are well-respected and often sought for advice.

Trainings

Trainings for fathers and mothers will be conducted to eliminate harmful traditional practices and gender disparity in child rearing practices

The innovation features a participatory approach which involves experienced researchers, child development program practitioners, health extension workers, local government, influential community members and parents in its implementation processes to achieve the expected results and scale up of the project. It is attractive to poor rural parents and caregivers, and adaptable to low-literacy communities which means it can easily be expanded to other rural areas.

CCFC and the Hincks-Dellcrest Centre have experience in implementing Learning Through Play (LTP) in Ethiopia, Burkina Faso, and Ghana and other countries, demonstrating that it can be scaled up to reach larger populations.

The involvement of all concerned project stakeholders will be high in project implementation, monitoring and evaluation and sharing knowledge and experience to determine the best strategy to scale up the project based on the findings of the evaluation of the project. The local CCFC’s partner NGO and district Health Office will take over and scale up the innovative approaches in other areas.

The project will use a randomized control design by implementing the innovation and control arms in seven sub-districts of the Arsi Negele District each. The project will be evaluated for 1) improvement in  parents’/caregivers’ knowledge, and skills and behaviour in child-rearing, and for 2) change in physical, cognitive, language and socio-emotional development of children 0-3 years of age.

Quantitative and qualitative data collection methods (surveys, recording vital events, questionnaires, interviews, focus group discussions, children’s anthropometric and psychometric measurements) will be utilized at the baseline, post-intervention and 4-month follow-up both in the intervention and control areas.

The project will compare baseline and post-intervention child development assessments (Ages and Stages Questionnaires or Kilifi Developmental Inventory and MacArthur Child Communicative Development Inventory) to measure child growth and development.

Quantitative data: At the time of enrollment in the study, a background questionnaire will be administered to obtain demographic data such as parental age, marital status, parent education and number of children in the home. Household survey will be undertaken to collect data on child growth and development, child nutritional status, immunization and child illness, and maternal health.

Qualitative data: Focus Group Discussions will be held involving mothers and fathers with children 0-3 years to inquire about the use of LTP, change in parents’ knowledge, skills and practices in early brain development. In-depth interviews will be conducted with health extension workers, social workers, health development army, nurses and midwives at health facilities. The interviews will focus on the coverage and quality of maternal, newborn and child health services.

Data analysis: data entry, analysis and interpretation will be undertaken ensuring the quality and reliability of data with due diligence. SPSS and NVivo software or other better software will be used for quantitative and qualitative data analysis, respectively.

The innovation will have the potential to change the lives of children by improving their physical, mental and emotional health, and also to change the lives of their parents by creating strong attachments to their young children while improving child-rearing knowledge, skills and behaviour. This will subsequently have a positive and measurable change on development outcomes (physical, cognitive, language and socio-emotional) of children 0-3 years of age. It will reach 3,000 children 0-3 years of age in 2,500 households, enabling children to achieve normal development milestones.

Cost of Implementation

The innovation is based on the knowledge delivery model which is more effective, per dollar spent, and interactive in enabling parents to acquire knowledge and skills than the conventional, lecture-based, theoretical approach. The model uses local personnel by building their technical capacity (at a lower cost) through training on how to produce and disseminate audio-visual education instead of hiring external videographers (at a higher cost).

1. Central Statistical Agency (CSA). [Ethiopia]. The 2007 Population and Housing Census of Ethiopia. Statistical Summary Report at National Level. Addis Ababa, Ethiopia: Central Statistical, 2008 1:p.8-9.
2. Ethiopia Central Statistical Agency and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia, and Calverton, Maryland, USA, 2012. p. 18-19, 110-186.
3. Squires, J., & Bricker, D. (2009) Ages and stages questionnaires 3rd Edition: A parent-completed child monitoring system. Baltimore, MD: Paul Brookes Publishing.
4. Hao M, et al. Early vocabulary inventory for Mandarin Chinese. Behav Res Methods. 2008 Aug;40 (3):728-33.
5. Squires, J. et al. (2002) The ASQ: SE User’s Guide for the Ages & Stages Questionnaires®: Social-Emotional: A parent-completed, child-monitoring system for social-emotional behaviors. Baltimore, MD: Paul H. Brookes Publishing Co., Inc..
6. Cohen NJ, et al. (2012) Learning Through Play International Program: Early Childhood Development Resources and Training- Program Outcomes. Edmonton, AB.