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EARLY CHILDHOOD NUTRITION, DEVELOPMENT AND HEALTH
The building blocks for a successful and productive life are needed early on, when children’s brains and bodies begin to grow. Delays are hard to reverse. A solid body of evidence shows that young children who receive appropriate nutrition, health care and emotional and cognitive stimulation are better prepared for school and learning. Investing in children returns big payouts both in the short term and later on. Children who get the right start in life, starting with good nutrition and health care during their mothers’ pregnancies, will become healthier and more productive adults and are will be prepared for raising their own healthy children. SIEF-supported researchers are working to find the best and most cost-effective ways to deliver a range of early childhood nutrition, health and development programs in low-income countries. Read more about early childhood development and impact evaluation in our Cluster Note.
PORTFOLIO OF IMPACT EVALUATIONS
Bangladesh: Is Child Development Helped by an Extra Year of Preschool?
- Principal Investigator - Shinsaku Nomura, World Bank
- Timeline: 2016 - 2019
- Evaluation: In Bangladesh, the government is considering extending preprimary school from one year for five year olds to two years started at age four. The evaluation of a Save the Children pilot preschool program aimed at four years olds will help build evidence about the usefulness of two years of preschool to improving children’s primary school readiness and the cost effectiveness of such a program.
- Principal investigators: Marjorie Chinen, American Institutes for Research; Johannes Bos, American Institutes for Research
- Timeline: Completed
- Evaluation: In Bangladesh, malnutrition among children in poor rural areas leads to high incidence of stunting and poor health, delaying development. Supporting mothers to help their children has shown some positive results, but less is known about how to engage fathers. Researchers evaluated low-cost integrated interventions that targeted pregnant women and parents with children under age three to improve nutrition and child stimulation.
- Results: Parents’ knowledge and practices of healthy development did not improve relative to the control group. However, families exposed to the pilot program were more likely to register for the existing national nutrition program.
- Principal investigator: Elise Huillery, Sciences Po
- Timeline: Completed
- Evaluation: In Bulgaria, the early learning gap between Roma and non-Roma children is a challenge for parents and policymakers. While more than 75 percent of all children aged three to six nationally are enrolled in school, the majority of Roma children are not. To address this challenge, the Trust for Social Achievement, a Bulgarian NGO supported by the America for Bulgaria Foundation, implemented a program in more than 150 poor communities to try to boost preschool participation in a variety of ways: encouraging active outreach to parents by local NGOs and authorities, offering free preschool for selected beneficiaries, and providing a conditional financial grant for some selected communities. Researchers measured the effectiveness of the components - jointly and independently - in order to help policymakers understand how they can increase the number of Roma children attending preschool and improve children’s cognitive and socio-emotional development.
- Principal investigator: Damien de Walque, World Bank
- Timeline: Ongoing
- Evaluation: Proper infant and early childhood development is critical to give children a healthy start to life. The challenge is especially profound in sub-Saharan Africa, where millions of young children are at risk of cognitive and physical delays because of poverty, poor nutrition and lack of stimulation. The Government of Burkina Faso, with World Bank support, is rolling out a social safety net program to improve food security and child development by giving very poor families direct cash transfers. The evaluation will look at the added benefit of interventions to improve parenting and health and nutrition practices. The results will help inform a government scale up the cash transfer program to serve as a cornerstone of the national safety net system for reducing long-term chronic poverty and building household resilience.
Cambodia: Challenges in Scaling-Up Preschool Programs
- Timeline: Completed (funded under SIEF 1)
- Evaluation: SIEF researchers worked with the Government of Cambodia to evaluate the impact of three early childhood development pilot programs being scaled up with assistance from the World Bank between 2008 and 2011. The randomized control trial found that expanding programs to improve access to and enrollment in preschool led to new challenges. Unforeseen implementation problems—some related to delays in building schools, problems paying teachers or weaknesses in promoting services—limited the programs’ reach and effectiveness. Parents who worked all day, or worked far from the village center, also found the part-time hours of the preschools difficult to manage, contributing to low use of the preschool services. The results of the evaluation highlight challenges governments can face as they move from pilot to scale up. Building on the lessons learned from this evaluation, the government of Cambodia included a revised approach in its 2014-2018 strategic education plan to strengthen the quality of preschools and ensure demand for these services. Journal of Human Resources | The new program for expanding preschool is now being evaluated by SIEF | Impact Evaluation of World Bank Policy Research Working Paper | CEPR Discussion Paper. Evidence to Policy Note: Cambodia: Challenges in Scaling Up Preschools | Baseline Report | Monitoring Report | Well-Designed Early Childhood Development Programs Can Pay Big Dividends | Researcher Interview
- Principal investigators: Deon Filmer, World Bank; Adrien Bouguen, University of Mannheim, Germany
- Timeline: 2015-2019
- Evaluation: In Cambodia, poverty, lack of access to improved water and sanitation, and limited early childhood development programs means that many young children aren’t getting the right start in life. The Government of Cambodia is implementing a program to improve access to and quality of early childhood eduction through preschool construction and refurbishment, door-to-door visits to inform parents of the value of early childhood education and monthly meetings on childhood development for parents with children under five. The evaluation will be carried out with the support of the Government of Cambodia, which will use the results to decide on next steps for its early childhood education programs.
Colombia: The Impacts of a Home-based Early Childhood Development Intervention in Colombia
- Principal investigator: Orazio Attanasio, University College London, Institute for Fiscal Studies
- Timeline: Completed
- Evaluation: In Colombia, researchers evaluated the medium-term effects of a home-based early childhood development intervention. The program sought to improve nutrition and development in the first two years of life through home visits to encourage children’s psycho-social development and use of micronutrient supplements. The findings can help policymakers and others understand the challenges around implementing at scale programs designed to improve nutrition and parental involvement.
Djibouti: Piloting the First Integrated Nutrition/Workfare Social Safety Net in Djibouti
- Principal investigators: Stefanie Brodmann, World Bank; Florencia Devoto, Abdul Latif Jameel Poverty Action Lab; Emanuela Galasso, World Bank
- Timeline: Completed
- Evaluation: In Djibouti, malnutrition, unemployment, and extreme poverty are key human development challenges. To address malnutrition among children younger than 24 months old, the Government of Djibouti piloted a safety net intervention that combines temporary employment (one beneficiary per household) with a component to promote better nutrition through informational classes. Researchers examined the effectiveness of linking child nutrition and workfare as a means of reducing malnutrition in young children.
- Principal investigators: J. Lawrence Aber, New York University; Sharon Wolf, University of Wisconsin-Madison
- Timeline: Completed
- Evaluation: In Ghana, the majority of kindergarten teachers are untrained, parents’ knowledge of the importance of quality early childhood education is limited and children’s readiness for primary school is generally low. To improve the quality of early childhood education, the Government of Ghana supported a low-cost, short duration in-service teacher training combined with a parental awareness intervention pilot in six disadvantaged districts in the Greater Accra Region. The evaluation findings are helping the government and stakeholders decide on future steps for strengthening kindergarten quality.
- Principal investigator: Betty Kirkwood, London School of Hygiene and Tropical Medicine
- Timeline: Completed (endline report pending)
- Evaluation: India and Pakistan both have an enormous number of children at risk for poor development because of malnourishment and lack of appropriate stimulation when they are young. The Sustainable Program Incorporating Nutrition and Games, or SPRING, uses home visits by community-based health workers to improve development. In both countries, SPRING is being implemented in concert with government programs that support child development, and the results of the evaluations will help policymakers better understand what is effective and scalable.
India: Early Childhood Development for the Poor: Evaluating the Impacts
- Principal investigator: Costas Meghir, Yale University
- Timeline: Completed (endline report pending)
- Evaluation: In India, stunting from malnutrition and ill health remains a big obstacle for health child development. In the Indian state of Odisha, where more than half of young children are stunted, this evaluation tested the impact of psychosocial stimulation and nutritional education for children around the ages of 9-15 months, providing evidence on the effectiveness of different approaches, including home visits and group meetings, for improving mother-child interaction and boosting nutrition.
India: Making Integration the Operative Concept in the Indian Integrated Child Development Strategy
- Principal investigators: Harold Alderman, World Bank; Jed Friedman, World Bank
- Timeline: Completed
- Evaluation: In India, researchers measured the cost and impact of nutrition services and child stimulation in low-income settings by evaluating a package of services currently being offered to the youngest children in a nationwide child development program.
India: Testing the Effect of Self-Help Groups to Improve Mother-Child Development
- Principal investigator: Neha Kumar, International Food Policy Research Institute (IFPRI)
- Timeline: 2014-2016
- Evaluation: Maternal and child undernutrition rates are exceptionally high in Bihar, India, with 56 percent of children stunted, 45 percent of women underweight, and 67 percent of women anemic. Current programs to boost nutrition are not always successful, often due to poor implementation or utilization. This evaluation will measure the impact of a multisectoral pilot self-help group mode, called Jeevika-Multisectoral Convergence, implemented by the World Bank-funded Bihar Rural Livelihoods Program.
- Principal investigator: John Strauss, University of Southern California
- Timeline: Completed
- Evaluation: In 1989, Indonesia began a program to expand access to midwives in villages. By the time the program reached scale in 1998, 54,000 nurses had been trained in midwifery and placed in communities. Researchers evaluated the effects of the midwife program on the educational decisions and outcomes, cognitive abilities, employment, and life satisfaction of the children (who are now young adults) of mothers who had access to midwives.
- Principal investigators: Menno Pradhan, University of Amsterdam, VU University and Amsterdam Institute for International Development; Amelia Maika, University of Gajah Mada; Sally Brinkman, University of Western Australia; Haeil Jung, Indiana University Bloomington
- Timeline: 2015-2018
- Evaluation: In Indonesia, large numbers of children don’t have access to improved water and sanitation, health services and early childhood education, especially in rural areas. The Government of Indonesia is seeking effective, sustainable ways to increase access to early childhood education to improve child development outcomes and learning. As part of its Early Childhood Education and Development project, the Government provides teacher training, community facilitation and village block grants to encourage communities in rural areas to establish and support playgroup centers. The evaluation team will examine if the project has an impact on development and learning outcomes by the time children are eight years old, and whether community-based playgroup centers provide a sustainable delivery model in rural areas.
Jamaica: 30 Years Later, Does an Early Childhood Program Still Have Impact?
- Principal investigator: Christel M. J. Vermeersch
- Timeline: 2016-2018
- Evaluation: For more than two decades, a group of stunted children whose mothers were taught how to play and talk to them have been tracked by researchers. The findings have shown that these children have done better in measures of education, employment and socio-emotional development. The children, now nearing 30 years old, will be re-evaluated to measure continuing effects, including on risk of risk of later cardiovascular diseases.
Jamaica: Can an Hour a Week Change a Child’s Life?
- Timeline: Complete (Funded under SIEF 1)
- Evaluation: Researchers assessed the long-term impact of a special program to help mothers learn how to use play and talk to stimulate their children. The children were between the ages of nine months and 24 months when the two-year program was launched in the late 1980s in a slum in Jamaica’s capital Kingston, and they already were stunted, a sign of severe malnutrition that can harm cognitive development. Researchers went back almost 20 years later to measure how well the original participants, who were now young adults, were doing. They found that children whose mothers took place in the weekly meetings were now less likely to have engaged in violent behavior, and more likely to be employed and to have finished school, when compared with children who didn’t receive the program. In adidtion, their earnings were about 25 percent higher than children not in the program, which put them on par with a comparison group of non-stunted children from the same area. The results have aparked numerous new programs around the globe, as governments and development organizations seek to learn how to replicate the results through cost effective programs at scale. See our special Jamaica impact page for more details.
- Principal investigators: Lia Fernald, University of California at Berkeley; Pamela Jakiela, University of Maryland; Owen Ozier, World Bank
- Timeline: 2015 - 2019
- Evaluation: Kenya is one of the best-educated low-income countries in sub-Saharan Africa and yet many primary school students read below grade level. Reasons include poor quality of teaching and the fact that many children start primary school without having been introduced to reading and books beforehand. Researchers are evaluating a low-cost program that produces and distributes children’s storybooks to households with children between ages two and six, to increase school readiness.
Kenya: Evaluation of Bridge Schools
- Principal investigators: Anthony Keats, Wesleyan University; Michael Kremer, Harvard University; Isaac Mbiti, University of Virginia; Owen Ozier, World Bank
- Timeline: 2015-2019
- Evaluation: The last several decades have seen large increases in the number of students attending and completing primary school in Sub-Saharan Africa. In some countries, including Kenya, there has also been rapid growth in enrollment in private schools. While many private schools are independently operated, some firms now operate multiple schools. As the number of these schools increase, it is important to evaluate their impact on children’s learning.
Madagascar: Evaluation of a Behavioral Approach to Improve Outcomes in Early Childhood
- Principal investigators: Laura Rawlings, World Bank; Saugato Datta, ideas 42
- Timeline: 2016-2019
- Evaluation: Improving early childhood development parenting practices and nutrition is a critical first step in preparing children for school and productive working lives. With nearly 80 percent of Madagascar’s population of 22 million living below $1.25 per day, around half of Malagasy children are chronically malnourished. As part of the roll out of a World Bank supported social safety net project that gives cash transfers to the poorest households, SIEF researchers will test the impact of adding in community meetings on healthy development with behavioral “nudges” to boost mothers’ self-esteem and help them take positive steps for their children’s future.
Madagascar: Addressing Chronic Malnutrition in Madagascar
- Principal investigator: Lia Fernald, University of California, Berkeley; Emanuela Galasso, World Bank; Christine Stewart, University of California, Davis; Ann Weber, University of California, Berkeley
- Timeline: Completed
- Evaluation: Madagascar has one of the highest rates of childhood stunting in the world. Over half of children are chronically malnourished, and more than one-fourth are severely malnourished. Researchers will evaluate the impact and cost-effectiveness of combining different nutrition and child development interventions to help the government of Madagascar optimize the impact of its community-based nutrition program on nutritional and child development outcomes.
- Principal investigators: Lia Fernald, University of California, Berkeley; Berk Ozler, World Bank
- Timeline: Completed
- Evaluation: Children’s social and cognitive readiness for school is crucial for later success. In Malawi, the government seeks to improve child development outcomes through better preschools. Researchers studied the effects of teacher incentives and training, parental education, and learning materials for children on their physical, emotional, and cognitive development and their readiness for primary school. The evaluation found that teachers who were trained did more learning activities in the classroom, and when teachers also received a stipend or parents attended classes on child development, teachers did even more in the classroom with the children. However, initial cognitive gains, seen among children in the group that received both teacher training and parenting classes, dissipated.
- Principal investigators: Siân Clarke, London School of Hygiene and Tropical Medicine; Natalie Roschnik, Save the Children
- Timeline: Completed
- Evaluation: Mali is one of the world’s least developed countries and suffers from some of the highest rates of anemia and malaria in the world. In Sikasso region in southern Mali, where this evaluation took place, 45 percent of children under the age of five are stunted, over 80 percent are anemic and malaria is rampant. Save the Children supports Early Childhood Care and Development centers to help prepare young children for primary school, but many children already arrive malnourished or stunted from chronic disease and nutritional deficiencies. The evaluation measured the impact and cost effectiveness of home fortification with micronutrient powders combined with seasonal malaria chemoprevention and parenting education delivered through the childcare centers on children’s health, nutrition and child development.
Mozambique: Can Community Preschools Improve Children’s School Skills?
- Timeline: Completed (Funded under SIEF 1)
- Evaluation: Researchers conducted a randomized experiment to evaluate the impact of a community-based preschool program on children's physical, cognitive, linguistic, and socio-emotional development. The program, created and run by Save the Children, was implemented in 30 rural communities in the Gaza province of Mozambique over a two year period between 2008-2010. The evaluation found that attending preschool led to significantly higher primary school enrollment and school readiness, with positive spill-over effects on older siblings, who were more likely to go to school, and on caregivers, who were more likely to engage in income-generating activities. The results led the Government of Mozambique to partner with the World Bank on a scale-up of the community preschool model, and this is now being evaluated by SIEF. For more details, see our Mozambique impact page.
- Principal investigators: Sophie Naudeau, World Bank; Marie-Helene Cloutier, World Bank
- Timeline: 2013 - 2019
- Evaluation: In Mozambique, researchers will measure the effectiveness of two related programs that provide nutrition, early child stimulation, and parenting information sessions to children, pregnant women, and parents of young children. The project builds on a successful small-scale pilot intervention and will help experts in this field determine the scalability, cost-effectiveness, and sustainability of such projects, and the usefulness of integrating early childhood development and nutrition programs rather than pursuing them separately.
Nepal: Can Information and Cash Make a Difference in Children’s Development?
- Principal investigator: Gayatri Acharya, World Bank; Prashant Bharadwaj, University of California, San Diego
- Timeline: Completed
- Evaluation: Children under the age of five in Nepal suffer from one of the highest rates of malnutrition and stunting in the world. Moreover pregnant women tend to have sub-optimal weight gain during pregnancy. The Government of Nepal sought to rectify these problems by removing two barriers to good nutrition: lack of knowledge about nutrition and lack of income needed to make better nutritional choices. Researchers evaluated the effectiveness of providing information alone, or information and cash, on improved nutrition for pregnant women and young children.
Nicaragua: Can Adding a Parenting Program Boost Children’s Development?
- Timeline: Completed (Funded under SIEF 1)
- Evaluation: More than one in five children in Nicaragua are stunted and preschool access is limited, so that many children don’t receive the nutrition or stimulation they need during critical stages of development. In Nicaragua, the government has at times implemented cash transfer programs to support better health and education for children. One such program was Atención a Crisis, which ran from November 2005 through December 2006, targeting areas affected by a severe drought. The program, implemented with assistance from the World Bank, sought to improve children’s health and education with conditional cash grants, along with special training and grants for parents to help them with work opportunities. In 2009, a parenting program consisting of community workshops for parents of young children and biweekly home visits by trained educators was implemented in the same region, using the same randomization system that was applied to study the impact of the conditional cash transfer program (that study was not supported by SIEF, but papers related to it can be found on this page under Atención a Crisis publications). The program ran for a year with community workshops and then for a second year with the home visits. This evaluation focused on the impact of the parenting program in areas where a prior evaluation had already found sustained behavioral changes in families that received conditional cash transfers through Atención a Crisis. The evaluation of the parenting program, which was supported under SIEF 1, found positive changes in parenting practices and significant improvements in the cognitive, motor and socioemotional development of children in the areas where the cash transfer program had been. A working paper is pending. SIEF is currently funding a follow-on evaluation that will measure the longer-term impact of the home-visit parenting training program on parenting practices and early childhood development outcomes. SIEF Brief (2016) | "Conditional Cash Transfers : Reducing Present and Future Poverty", World Bank Book (2009) | JPAL video part 1: Cash Transfers and Early Cognitive Development in Nicaragua | JPAL video part 2 | JPAL video part 3 | JPAL video part 4 | Early Childhood Magazine | Encouraging Early Childhood Parenting through Home Visits in Nicaragua | Social Interactions | "After the Transfers Stop", JPAL Policy Briefcase (2014)
- Principal investigators: Karen Macours, Paris School of Economics; Renos Vakis, World Bank; Patrick Premand, World Bank
- Timeline: 2015-2019
- Evaluation: In Nicaragua, children in poor rural areas frequently don’t have access to adequate nutrition and early childhood stimulation, and begin primary school without adequate preparation. The Government of Nicaragua has made substantial efforts to promote early childhood development and in 2008-09, piloted a low-cost home-visit program to improve parenting practices through bi-monthly home-visits, community workshops and provision of toys and children’s books. This evaluation will measure the program’s impact on parenting practices and children’s development and learning outcomes nine years after participation in the program.
NIGER: Using Behavioral Change Activities to Improve Early Childhood Development
- Principal investigator: Patrick Premand, World Bank
- Timeline: Completed
- Evaluation: In Niger, a large share of the population suffers from chronic food insecurity and 45 percent of children under age five are stunted. The Office of the Prime Minister of the Government of Niger is implementing a large-scale safety nets project. As part of the project, poor rural women receive a regular cash transfer, while also participating in accompanying measures that aim to improve a range of parenting practices. A team of researchers worked with project implementers to evaluate the effectiveness of the cash transfers and the value-added of the parenting training on nutrition, health and cognitive development of children under the age of five.
- Principal investigators: Theresa S. Betancourt, Harvard University; Laura Rawlings, World Bank; Robert T. Brennan, Harvard University
- Timeline: 2016-2019
- Evaluation: In Rwanda, large numbers of children are stunted and lack access to early childhood education and stimulation and start primary school without skills critical for learning. The Government of Rwanda is strongly committed to reducing poverty and promoting early child development and is seeking to develop models that can deliver early childhood services effectively and sustainably. This evaluation will test the effectiveness of a Government-led home-visit family-strengthening intervention that includes parenting coaching, nutrition education, early learning and stimulation activities, in improving parenting practices and children’s development outcomes.