In our systematic review, we searched databases including Psychinfo, PubMed, Google Scholar, Global Health, Econ Lit, ISI Web of Science, Academic Search Elite, the World Bank website, the UNICEF Evaluation Database, and the Brookings Institution website, and we used personal contacts to identify unpublished work in both English and Spanish. Our primary search was done between September, 2009, and December, 2010, and we limited our search to papers that had been published since July, 2006, when
SeriesStrategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries
Introduction
This report, the second in a Series, assesses the effectiveness of early child development intervention programmes in low-income and middle-income countries, calculates the cost of not investing in early child development, and builds on the 2007 Series in The Lancet on child development.1, 2, 3 The first report4 of the present Series identified social–cultural, psychosocial, and biological risk and protective factors that affect child development. The theoretical framework used in both reports, presented in the first figure of the first report, illustrates how children's developmental trajectories are affected by biological systems and by positive and negative risk and protective factors. The intensity of these effects relates to the developmental periods in which the risk factors happen (timing), the dose or extent of the risks (exposure), and the child's individual reactivity (temperament) to the risk and protective factors. Effective programmes, policies, and other interventions can protect children from the negative consequences of living in poverty.
Section snippets
Inequalities between and within countries
Social and economic differences, both between and within countries, contribute to inequalities in children's development. The WHO Commission on the Social Determinants of Health, in a World Health Assembly report,5 highlighted the social injustice of “avoidable health inequalities” and concluded that social and economic policies addressing early child development can affect whether children develop to their potential or experience a constrained life-course trajectory. Not only are there major
The challenge of sustainable improvement
Despite evidence of the potential effectiveness of interventions in early childhood, policy makers and planners are challenged by designing interventions that sustainably improve early child development at scale.9 In our previous review3 we reported that 18 of 20 early child development programmes in low-income and middle-income countries substantially affected early child development, with the largest effects in comprehensive programmes. Other recent reviews,10, 11 which included high-income
Promising directions for programming
Since poverty is a root cause of poor child development, some approaches to improving early child development are aimed at making those improvements through poverty alleviation. Cash transfer programmes are a popular approach to long-term poverty alleviation;55, 56 the expectation of conditional cash transfer programmes is that families use cash transfers both to help parents provide for their children's needs and as an incentive for parents to invest in their children's health and education.57
Children at risk of not reaching their potential
Substantial numbers of children experience risks to their development, in addition to poverty and malnutrition. These risks include physical and developmental disabilities, severe acute malnutrition, being small for gestational age and low birthweight (LBW), and being infected with HIV/AIDS (webappendix pp 18–20).
Programmatic implications
Most effectiveness studies that we have reviewed reported substantial and positive effects on child development, but results from assessments of scaled-up programmes were more variable. In panel 3 we list our conclusions and recommendations for the scale-up of early child development programmes. The Wolfensohn Center at Brookings Institution assessed issues in taking early child development to scale from 2005 to 2011.23, 90, 91 Expanding coverage while maintaining quality is a major issue for
Estimating potential benefits of preschool
Preschool is only one component of a comprehensive early child development agenda, but can serve as a proxy in an analysis of potential economic benefits of increasing investments. We estimated the effect of preschool enrolment on the gap between schooling attainment of the wealthiest quintile of youth (aged 15–19 years) compared with youth in the other wealth quintiles for 73 low-income and middle-income countries with a total population of 2·69 billion people (panel 4).98 Our estimates show
Trends in policies and funding
In the 2007 Series, there was a call for expanded early child development programmes, policies, and coordinating mechanisms at the national level. According to UNICEF annual reports, more than 40 countries are developing or have developed and received parliamentary approval for early child development policies, and several UN bodies have publicly supported early child development. WHO's Commission on the Social Determinants of Health made child development one of its key focus areas,5 the
Conclusions and future work
We have presented evidence for factors contributing to the effectiveness of interventions to promote early child development in low-income and middle-income countries (panel 2), recommendations for how programmes and policies can support early child development (panel 3), and we pose several future research questions (panel 6). The review from the previous Series3 reported that the most effective early child development programmes are those that provide direct learning experiences for children
Search strategy and selection criteria
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