Really Important Papers on Child Development

Our CLAHRC has recently conducted an individually randomised trial of the effect of perinatal (before and after birth) support from lay health workers for women at high social risk. The results have been submitted for publication, but in the meantime the BMJ has reported a 2×2 factorial RCT of an integrated early child development intervention, consisting of micronutrient supplementation and weekly stimulation through local women. The study was conducted across 96 communities in Columbia.[1] While the supplementation yielded a null result, the additional psychosocial stimulation produced marked improvements in cognition and language over an 18 month intervention period. The results partly corroborate a similar recent study reported in the Lancet.[2] This study was also a 2×2 factorial design, again of nutrition (including micronutrients) and stimulation. This study involved 80 communities in Pakistan. They replicated the findings regarding stimulation, but also recorded a positive, albeit smaller, cognitive benefits from the nutritional intervention. Babies and toddlers are little learning machines who love to interact, and benefit themselves and others by doing so. The effect of nutrition may be more context dependent.[3] Our CLAHRC is considering conducting an overview, combining studies that examine antenatal and postnatal interventions, or both, and that compare interventions targeted mainly at the mother, versus those where the infant is the primary focus of attention. In the meantime, here are two excellent cluster factorial designs of similar interventions in two different continents, serendipitously published within weeks of one another.

— Richard Lilford, CLAHRC WM Director


  1. Attanasio OP, Fernandez C, Fitzsimons EO, Grantham-McGregor SM, Meghir C, Rubio-Codina M. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial. BMJ. 2014; 349: g5785.
  2. Yousafzai AK, Rasheed MA, Rizvi A, Armstrong R, Bhutta ZA. Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet. 2014; 384: 1282-93.
  3. Black MM & Hurley KM. Investment in early childhood development. Lancet. 2014; 384: 1244-5.

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