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Background: To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children., Methods: Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months., Findings: At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%., Interpretations: The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program., Funding: The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gaidhane, Khatib, Telrandhe, Patil, Kogade, Gaidhane, Choudhari, Holding, Saxena and Syed.)

Background: Effective and real-time data analytics plays an essential role in understanding gaps and improving the quality and coverage of complex public health interventions. Studies of public health information systems identify problems with data quality, such as incomplete records and untimely reporting. Effective data collection and real-time analysis systems for rapid-cycle learning are necessary to monitor public health programs and take timely evidence-based decisions. Early childhood development (ECD) programs are very diverse. Rapid-cycle evaluation and learning (REAL) guides the implementation process of such complex interventions in real time. Stepping stones was one such early childhood development program implemented in Central India., Objective: The objective was to improve the delivery of complex, integrated public health interventions for early childhood development in remote areas of rural India., Methodology: The program was developed according to the principles of inclusion and community-centeredness, which can be tested quickly and iteratively. To enhance the decision-making process and improve delivery and coverage, the core team implemented an information system for rapid-cycle learning. We developed performance indicators and a performance measurement matrix after defining the specific needs. Following that, we trained staff to collect complete data using electronic data collection tools and transfer it the same day to the server for quality review and further analysis. A variety of data/information was triangulated to address the gaps in intervention delivery, and those decisions were subsequently implemented., Results: We observed that the quality of data collection improved, and errors were reduced by 50% in the third quarter. The quality of the narrative was also enhanced; it became more elaborate and reflective. Sharing their field output in meetings and improving the quality of the narrative enhanced the self-reflection skills of field staff and consequently improved the quality of the intervention delivery. Refresher training and mentoring by supervisors helped to improve the data quality over time., Conclusion: Rapid-cycle evaluation and learning (REAL) can be implemented in resource-limited settings to improve the quality and coverage of integrated intervention in early childhood. It nurtures a reinforcing ecosystem that integrates providers, community, and family perspectives and guides interactions among stakeholders by integrating data from all available sources., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gaidhane, Telrandhe, Patil, Holding, Khatib, Gaidhane, Quazi Syed, Choudhari, Umate and Pathade.)

Background: Capturing real-life practices through photographs provides an opportunity to create awareness and focus discussions on relevant issues in community. Photographs and narratives also engage decision makers, inspiring changes in policy and practice. Objective: Paper describes development and adaptation of an integrated photostory approach documenting actions and stimulating positive change in Early Child Development (ECD). Methodology: The Photostory method was built through a cyclical process to describe and explore early-childhood practices in central-India through photographs and stories. A systematic format to capture, archive and evaluate photographic material was developed. A standardized rating system was established to monitor levels of, and change in, community practices. We integrated Photostory process into routine visits undertaken during implementation of Stepping-Stones, an ECD intervention program. This paper utilized collected data to explore utility of rating framework to describe and measure behavior and to track change. We explored role of Photostory approach in engaging community in process of stimulating positive ECD experiences. Results: We developed a systematic framework to support data capture, analysis, and data utilization using multistep iterative mixed method process. A total of 161 Photostories were collected (72 at baseline and 89 at endpoint). Using a rating system which measured both the structure of the tasks, and the emotional engagement of the child and parent, many activities and practices observed were evaluated as providing at least an adequate learning space. In exploring change over the implementation process, at endpoint children were more likely to be observed as more engaged in their play activities ( p < 0.05). Parental engagement levels remained stable, toward being less actively engaged. At endpoint we observed a trend toward activities being provided for children at a level of difficulty higher than child's level of developmental. The data provided the intervention team with local examples through which to engage parents in discussions on activities that stimulate effective child exploration and learning. We were also able to demonstrate the added value of photographs in stimulating detailed discussion amongst community members on early child development. Conclusion: Photostories can provide a systematic and rigorous methodology to stimulate engagement, monitor and measure change in community-based parenting interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Gaidhane, Holding, Shah, Patil, Telrandhe, Jadhav, Kogade, Chaudhari and Zahiruddin.)