Improving early childhood development in rural Nepal

Abstract

Early childhood development (ECD) provides a critical foundation for lifelong health, well- being, and productivity. The United Nations’ Sustainable Development Goals recognise ECD as central to achieving global targets to advance human development and socio-economic equality. Whilst nurturing care, including optimal nutrition, good health and adequate learning opportunities are essential to ECD, there is a scarcity of information about how to increase access to integrated health, nutrition and stimulation interventions for young children at a population level in Nepal. This thesis investigates early childhood development among children under three years of age in lowland Nepal and potential approaches to improving it. Methods This research employed mixed research methods. A systematic review and meta-analysis was performed to assess the effectiveness of integrated nutrition and stimulation interventions on children’s anthropometric, cognitive, motor and language development scores as well as to identify intervention components that might explain improved outcomes. Subgroup analyses and random meta-regression was conducted by baseline nutrition status of children and intervention characteristics (delivery strategy, intervention duration, behaviour change techniques and delivery personnel). Quantitative cross-sectional data for secondary data analyses were sourced from a large (N = 35,208) cluster randomised controlled trial in Dhanusha to estimate the prevalence of poor ECD and its predictors in lowland Nepal. Multivariable logistic regression models were used to determine independent associations between infant and young child feeding and cognitive and socioemotional caregiving indicators and potential explanatory household, parental and child-level variables. Qualitative data for secondary analysis was collected in July 2012 to understand caregivers’ perceptions of caregiving practices in lowland Nepal. Primary qualitative data were collected between February and April 2021 to explore the feasibility of integrating stimulation interventions into existing health and nutrition interventions within Nepal’s health system. A framework approach was applied to analyse semi-structured interviews with caregivers, health service providers, national and district level stakeholders and policymakers, and focus group discussions with caregivers, Female Community Health Volunteers, as well as health management and operation committee members. The findings were then triangulated to formulate recommendations for future work. Results The systematic review highlighted the benefit of integrated interventions for children’s cognitive, motor, and language developmental outcomes, especially in settings where child undernutrition was high. There was no association between the intervention characteristics and intervention effectiveness. The factors associated with poor feeding and caregiving practices included younger children, from poor households, whose mothers were young, whose mothers received less than three antenatal visits and who were delivered at home. In qualitative analyses, respondents did not perceive that children learn through play, but they highlighted several positive caregiving practices in the daily routine care of their children. Mothers had primary responsibility for childcare. However, they were occupied with household chores and duties and lacked sufficient time to play and communicate with their children. Respondents thought that stimulation activities could be integrated into many maternal and child health and nutrition interventions and early childhood development and education centres. They recommended using existing contact points between community members and frontline workers in health posts and outreach clinics, as well as group meetings to deliver integrated interventions.

Date of Award	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Dafna Merom (Supervisor)