Abstract
Objectives
Although a number of early childhood development (ECD) interventions in healthcare settings in low- and middle-income countries (LMICs) have been developed to improve parent-directed outcomes and support ECD, their impact have yet to be established. This review assesses the effectiveness of healthcare-based ECD interventions in LMICs on the following key evidence-informed parenting outcomes affecting ECD: (1) responsive caregiving (2) cognitive stimulation and (3) parental mental health. Impacts on parental knowledge regarding ECD and parenting stress were also assessed.
Methods
PubMed, PsycINFO, Scopus, CINAHL and Embase were searched. We included randomized controlled trials reporting effects of healthcare-based ECD interventions in LMICs on parent-directed outcomes in the first five years of life. Data extraction included study characteristics, design, sample size, participant characteristics, settings, intervention descriptions, and outcomes. Meta-analyses were conducted using random effects models.
Results
8 articles were included. Summary standardized mean differences demonstrated significant benefits of healthcare-based interventions in LMICs for improving: (1) cognitive stimulation (n = 4; SMD = 0.32; 95% CI: 0.08 to 0.56) and (2) ECD knowledge (n = 4; SMD = 0.44; 95% CI: 0.27 to 0.60). No significant effects were seen on maternal depression and parenting stress; only one study assessed parent-child interactions in the context of responsiveness. Limitations included small number of studies for moderation analysis, high heterogeneity, variability in measures used for outcomes and timing of assessments.
Conclusions for practice
Our results demonstrate statistically significant effects of healthcare-based interventions in LMICs on improving key evidence-based parenting outcomes and offers one promising strategy to support children reach their full developmental potential.
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Availability of Data and Material
(data transparency): The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.
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Funding
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K23HD086295. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Dr. Shah conceptualized and designed the study, conducted the moderator analysis, conducted and double-checked data extraction, drafted the initial manuscript, and reviewed and revised the manuscript. Andrea Camarena, Christen Park, and Aleah Martin conducted data extraction, double checked data extraction, developed tables/figures, and reviewed and revised the manuscript. Professor Clark developed the search strategy, performed the literature search, drafted the search strategy section, and reviewed and revised the manuscript. Dr. Atkins contributed to study design and provided critical revision of the manuscript. Dr. Schwartz contributed to study design, conducted the meta-analyses, edited the meta-analyses section, interpreted the data, reviewed and provided critical revision of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Institutional Review Board (IRB) approval was not sought as this study is an analysis of already published studies which have already obtained ethical approval. This article does not contain any studies with human participants performed by any of the authors.
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Shah, R., Camarena, A., Park, C. et al. Healthcare-Based Interventions to Improve Parenting Outcomes in LMICs: A Systematic Review and Meta-Analysis. Matern Child Health J 26, 1217–1230 (2022). https://doi.org/10.1007/s10995-022-03445-y
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DOI: https://doi.org/10.1007/s10995-022-03445-y