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Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial
  1. Peter C Rockers1,
  2. Günther Fink2,
  3. Arianna Zanolini3,
  4. Bowen Banda4,
  5. Godfrey Biemba4,
  6. Cierra Sullivan5,
  7. Simon Mutembo6,
  8. Vichaels Silavwe6,
  9. Davidson H Hamer4
  1. 1Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  3. 3American Institutes for Research, Washington, District of Columbia, USA
  4. 4Zambia Center for Applied Health Research and Development, Lusaka, Zambia
  5. 5Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Colorado, USA
  6. 6Zambia Ministry of Health, Lusaka, Zambia
  1. Correspondence to Peter C Rockers; prockers{at}


Background Community-based programmes are a critical platform for improving child health and development. We tested the impact of a community-based early childhood intervention package in rural Zambia.

Methods We conducted a non-blinded cluster randomised controlled trial in Southern Province, Zambia. 30 clusters of villages were matched based on population density and distance from the nearest health centre, and randomly assigned to intervention (15 clusters and 268 caregiver–child dyads) or control (15 clusters and 258 caregiver–child dyads). Caregivers were eligible if they had a child aged 6–12 months at baseline. In intervention clusters, health workers screened children for infections and malnutrition, and invited caregivers to attend fortnightly group meetings covering a nutrition and child development curriculum. 220 intervention and 215 control dyads were evaluated after 1 year. The primary outcomes were stunting and INTERGROWTH-21st neurodevelopmental assessment (NDA) scores. Weight-for-age and height-for-age z-scores based on WHO growth standards were also analysed. Secondary outcomes were child illness symptoms, dietary intake and caregiver–child interactions based on self-report. Impact was estimated using intention-to-treat analysis.

Results The intervention package was associated with a 0.12 SD increase in weight-for-age (95% CI −0.14 to 0.38), a 0.15 SD increase in height-for-age (95% CI −0.18 to 0.48) and a reduction in stunting (OR 0.68; 95% CI 0.36 to 1.28), whereas there was no measurable impact on NDA score. Children receiving the intervention package had fewer symptoms, a more diverse diet and more caregiver interactions.

Conclusions In settings like Zambia, community-based early childhood programmes appear to be feasible and appreciated by caregivers, as evidenced by high rates of uptake. The intervention package improved parenting behaviours and had a small positive, though statistically insignificant, impact on child development. Given the short time frame of the project, larger developmental impact is likely if differential parenting behaviours persist.

Trial registration number NCT02234726; Results.

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  • Handling editor Sanni Yaya

  • Contributors PCR, GF, AZ, GB, SM, VS and DHH contributed to the conception and design of the study. PCR, GF, AZ, BB, GB, CS, SM, VS and DHH contributed to the organisation of the conduct of the study. PCR, GF, AZ, BB, GB, CS and DHH carried out the study, including acquisition of study data. PCR, GF, AZ and DHH analysed and interpreted the study data. PCR wrote the first draft of the manuscript. PCR, GF, AZ and DHH contributed important intellectual content to subsequent drafts of the manuscript. All authors have read and approved the final manuscript.

  • Funding Grand Challenges Canada provided funding for this study through the Saving Brains initiative (0349-03). After the project started, PATH provided additional funding through support provided by UK Aid from the UK Government as part of the Nutrition Embedding Evaluation Program (DFI.1836-672968-GRT). The views expressed do not necessarily reflect the UK Government's official policies.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Institutional Review Board at Boston University and from ERES Converge in Zambia. Additional approvals were obtained from the Zambia Ministry of Health and the Southern Province Medical Office.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.