Suchergebnisse

Scaling up integrated nutrition programmes from small, targeted interventions or pilot studies to large‐scale government‐run programmes can be challenging, with risks of changing the nature and quality of the interventions such that effectiveness is not sustained. In 1999, the Government of Madagascar introduced a nationwide, community‐based, growth‐monitoring and nutrition education programme, which was gradually scaled up throughout the country until 2011. Data from three nationally representative surveys, administered pre‐ and post‐programme implementation, in participating and non‐participating communities, were used to evaluate the effectiveness of the programme to reduce malnutrition in children under 5 after two phases of expansion (1999–2004 and 2004–2011). In our analyses, we compared "original" communities, who had initiated the programme during the first phase, and "new" communities, who initiated the programme during the second phase. "Original" communities demonstrated a significant effect on mean weight‐for‐age and on the prevalence of underweight by 2004; this effect was sustained at a reduced level through 2011. In contrast, "new" communities showed no benefits for any childhood nutritional outcomes. An explanation for these findings may be that community health workers in the "new" communities reported lower motivation and less use of key messages and materials than those in the "original" communities. Frontline workers reported increased workload and irregular pay across the board during the second phase of programme expansion. Our findings underscore the risk of losing effectiveness if programme quality is not maintained during scale‐up. Key factors, such as training and motivation of frontline workers, are important to address when bringing a programme to scale.

AbstractOur objectives were to document and examine socioeconomic gradients across a comprehensive set of child development measures in a population living in extreme poverty, and to interpret these gradients in light of findings from the neuroscience literature. We assessed a nationally representative sample of 3–6‐year‐old children (n = 1332) from 150 communities of Madagascar using standard tests of development. We found that children whose families were in the top wealth quintile or whose mothers had secondary education performed significantly better across almost all measures of cognitive and language development and had better linear growth compared with children of women in the lowest wealth quintile or women with no education. These differences between children of low and high socioeconomic position were greatest for receptive language, working memory, and memory of phrases. The mean difference in the scores between children in the highest and lowest socioeconomic status categories doubled between age 3 and age 6, and the biggest gaps across socioeconomic position by age 6 were in receptive language and sustained attention. Our results suggest that even within the context of extreme poverty, there are strong associations between family socioeconomic status and child development outcomes among preschool children, and that the language and executive function domains exhibit the largest gradients.

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.

AbstractIn many low‐ and middle‐income countries, young children learn a mother tongue or indigenous language at home before entering the formal education system where they will need to understand and speak a country's official language(s). Thus, assessments of children before school age, conducted in a nation's official language, may not fully reflect a child's development, underscoring the importance of test translation and adaptation. To examine differences in vocabulary development by language of assessment, we adapted and validated instruments to measure developmental outcomes, including expressive and receptive vocabulary. We assessed 505 2‐to‐6‐year‐old children in rural communities in Western Kenya with comparable vocabulary tests in three languages: Luo (the local language or mother tongue), Swahili, and English (official languages) at two time points, 5–6 weeks apart, between September 2015 and October 2016. Younger children responded to the expressive vocabulary measure exclusively in Luo (44%–59% of 2‐to‐4‐year‐olds) much more frequently than did older children (20%–21% of 5‐to‐6‐year‐olds). Baseline receptive vocabulary scores in Luo (β = 0.26, SE = 0.05, p < 0.001) and Swahili (β = 0.10, SE = 0.05, p = 0.032) were strongly associated with receptive vocabulary in English at follow‐up, even after controlling for English vocabulary at baseline. Parental Luo literacy at baseline (β = 0.11, SE = 0.05, p = 0.045) was associated with child English vocabulary at follow‐up, while parental English literacy at baseline was not. Our findings suggest that multilingual testing is essential to understanding the developmental environment and cognitive growth of multilingual children.