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Evidence on the role of father involvement in children's development from low-resource settings is very limited and historically has only relied on maternal reports of father's direct engagement activities such as reading to the child. However, fathers can also potentially influence their children's development via greater positive involvement with the mother, such as by offering interpersonal support or sharing decision-making duties. Such positive intrahousehold interactions can benefit maternal mental health and wellbeing, and ultimately children's development. We use data collected from mothers, fathers and children in the context of the cluster randomized controlled trial evaluation of Msingi Bora, a responsive parenting intervention implemented across 60 villages in rural western Kenya, to explore the various pathways through which fathers may influence their children's outcomes. In an endline survey in Fall 2019 among a sample of 681 two-parent households with children aged 16-34 months, fathers reported on measures of their behaviors towards children and with mothers, mothers reported on their wellbeing and behaviors, and interviewers assessed child cognitive and language development with the Bayley Scales. In adjusted multivariate regression analyses we found that greater father interpersonal support to mothers and greater participation in shared household decision-making were positively associated with children's development. These associations were partially mediated through maternal wellbeing and behaviors. We found no association between fathers' direct engagement in stimulation activities with children and children's outcomes. Inviting fathers to the program had no impact on their involvement or on any maternal or child outcomes, and fathers attended sessions at low rates. Overall, our results show the potential promises and challenges of involving fathers in a parenting intervention in a rural low-resource setting. Our findings do highlight the importance of considering intrahousehold pathways of influence in the design of parenting interventions involving fathers.

BackgroundEarly childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya's network of community health volunteers.MethodsWe implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6-24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558.FindingsBetween Oct 1 and Nov 12, 2018, 1152 mother-child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5-Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21-0·83]), receptive language (0·42 SD [0·08-0·77]), and socioemotional scores (0·23 SD [0·03-0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05-0·62]) and socioemotional scores (0·22 SD [0·05-0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49-1·11]) and mixed-delivery villages (0·77 SD [0·49-1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes.InterpretationParenting interventions delivered by trained community health volunteers in mother-child groups can effectively promote child development in low-resource settings and have great potential for scalability.FundingEunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

Early childhood development (ECD) parenting interventions can improve child developmental outcomes in low-resource settings, but information about their implementation lags far behind evidence of their effectiveness, hindering their generalizability. This study presents results from an implementation evaluation of Msingi Bora ("Good Foundation" in Swahili), a group-based responsive stimulation and nutrition education intervention recently tested in a cluster randomized controlled trial across 60 villages in rural western Kenya. Msingi Bora successfully improved child cognitive, receptive language, and socioemotional outcomes, as well as parenting practices. We conducted a mixed methods implementation evaluation of the Msingi Bora trial between April 2018 and November 2019 following the Consolidated Advice for Reporting ECD implementation research (CARE) guidelines. We collected qualitative and quantitative data on program inputs, outputs, and outcomes, with a view to examining how aspects of the program's implementation, such as program acceptance and delivery fidelity, related to observed program impacts on parents and children. We found that study areas had initially very low levels of familiarity or knowledge of ECD among parents, community delivery agents, and even supervisory staff from our partner non-governmental organization (NGO). We increased training and supervision in response, and provided a structured manual to enable local delivery agents to successfully lead the sessions. There was a high level of parental compliance, with median attendance of 13 out of 16 fortnightly sessions over 8 months. For delivery agents, all measures of delivery performance and fidelity increased with program experience. Older, more knowledable delivery agents were associated with larger impacts on parental stimulation and child outcomes, and delivery agents with higher fidelity scores were also related to improved parenting practices. We conclude that a group-based parenting intervention delivered by local delivery agents can improve multiple child and parent outcomes. An upfront investment in training local trainers and delivery agents, and regular supervision of delivery of a manualized program, appear key to our documented success. Our results represent a promising avenue for scaling similar interventions in low-resource rural settings to serve families in need of ECD programming. This trial is registered at ClinicalTrials.gov, NCT03548558, June 7, 2018. https://clinicaltrials.gov/ct2/show/NCT03548558.

BackgroundForty-three percent of children under five in low and middle-income countries (LMICs) experience compromised cognitive and psychosocial development. Early childhood development (ECD) interventions that promote parent-child psychosocial stimulation and nutrition activities can help remediate early disadvantages in child development and health outcomes, but are difficult to scale. Key questions are: 1) how to maximize the reach and cost-effectiveness of ECD interventions; 2) what pathways connect interventions to parental behavioral changes and child outcomes; and 3) how to sustain impacts long-term.MethodsMsingi Bora ("good foundation" in Swahili) is a multi-arm cluster randomized controlled trial across 60 villages and 1200 households in rural Western Kenya that tests different, potentially cost-effective and scalable models to deliver an ECD intervention in biweekly sessions lasting 7 months. The curriculum integrates child psychosocial stimulation with hygiene and nutrition education. The multi-arm study will test the cost-effectiveness of two models of delivery: a group-based model versus a mixed model combining group sessions with personalized home visits. Households in a third study arm will serve as a control group. Each arm will have 20 villages and 400 households with a child aged 6-24 months at baseline. Primary outcomes are child cognitive and socioemotional development and home stimulation practices. In a 2 × 2 design among the 40 treatment villages, we will also test the role of including fathers in the intervention. We will estimate intention-to-treat and local average treatment effects, and examine mediating pathways using Mediation Analysis. One treatment arm will receive quarterly booster visits for 6 months following the end of the sessions. A follow-up survey 2 years after the end of the main intervention period will examine sustainability of outcomes and any spillover impacts onto younger siblings. Study protocols have been approved by the Maseno Ethics Review Committee (MUERC) in Kenya (00539/18) and by RAND's institutional review board. This study is funded by the National Institute for Child Health and Human Development (R01HD090045).DiscussionResults can provide policymakers with rigorous evidence of how best to design ECD interventions in low-resource rural settings.Trial registrationClinical Trial NCT03548558 registered June 7, 2018 at clinicaltrials.gov; AEA-RCT registry AEARCTR-0002913.

OBJECTIVES: Two studies aimed to assess the provision of nutrition and psychosocial stimulation in the home and to examine associations between mental development and nutrition and stimulation using a validated measure of development milestones. METHODS: The first study consisted of secondary analyses on health and nutrition data from 1081 mother-child pairs (the children aged 0-12 months) and their households in Ghana's Eastern Region. For the second study, the Ghana Milestones Measure, consisting of items assessing cognitive and language development, was used to assess child development in a subsample (N = 330) of Study 1 participants one year later (children 10-24 months of age). This measure was mother-reported and had been validated in a separate community in Ghana. Correlation and linear regression analyses were used to analyze the data. RESULTS: Family assets and maternal education were identified as key factors of the family context. Both variables were positively associated with preventive health practices (r = 0.08 to 0.13, p < 0.0001 to 0.01), and dietary diversity (r = 0.15, p = 0.0001 to 0.0006), and negatively associated with maternal depressive symptoms (r = -0.19 to -0.12, p < 0.0001). Taller children had higher receptive (standardized beta = 0.16; p = 0.04) and expressive (0.21; 0.003) language, but not cognitive (0.15; 0.07) milestone scores, and psychosocial stimulation was positively associated with all three milestones (receptive = 0.13, p = 0.01; expressive = 0.21, p < 0.0001; and cognitive = 0.24, p < 0.0001). CONCLUSION: Our study provides the first validated measure of children's language and cognitive development in Ghana, finding associations with nutrition and stimulation. The Ghana Milestones Measure can be used to assess and help promote children's mental development. KEY WORDS: Child development; cognitive/language milestones; home environment; Ghana OBJECTIFS : Deux etudes ont evalue la nutrition et la stimulation psychosociale en milieu familial et ont examine les associations entre le developpement mental d'une part, et la nutrition et la stimulation d'autre part, a l'aide d'un indicateur valide des etapes de developpement. METHODE : Pour la premiere etude, des analyses secondaires des donnees de sante et de nutrition de 1 081 couples mere-enfant (les enfants etant ages de 0 a 12 mois) et de leurs menages ont ete menees dans la Region orientale du Ghana. La seconde etude a fait appel au Ghana Milestones Measure, un indicateur d'evaluation du developpement cognitif et de l'acquisition du langage, pour evaluer le developpement des enfants dans un sous-echantillon (N = 330) des participants de l'etude 1 un an plus tard (les enfants etant ages de 10 a 24 mois). Les elements de l'indicateur ont ete declares par les meres et valides dans une autre communaute du Ghana. Les donnees ont ete analysees par correlation et par regression lineaire. RESULTATS : L'actif familial et l'instruction maternelle ont ete juges etre les facteurs cles du milieu familial. Ces deux variables etaient associees positivement aux pratiques sanitaires preventives (r = 0,08 a 0,13, p < 0,0001 a 0,01) et a la diversite alimentaire (r = 0,15, p = 0,0001 a 0,0006), et associees negativement aux symptomes depressifs maternels (r = -0,19 a -0,12, p < 0,0001). Le langage receptif (coefficient normalise [beta] = 0,16; p = 0,04) et expressif (0,21; 0,003) des enfants de plus grande taille etait plus developpe, mais non leurs indices de developpement cognitif (0,15; 0,07), et la stimulation psychosociale etait associee positivement aux trois etapes (langage receptif = 0,13, p = 0,01; langage expressif = 0,21, p < 0,0001; et developpement cognitif = 0,24, p < 0,0001). CONCLUSION : Notre etude, qui offre le premier indicateur valide du developpement linguistique et cognitif des enfants au Ghana, etablit des associations avec la nutrition et la stimulation. L'outil Ghana Milestones Measure peut etre utilise pour evaluer et contribuer a favoriser le developpement mental des enfants. MOTS CLES : developpement de l'enfant; etapes cognitives et d'acquisition du langage; milieu familial; Ghana, Mental development refers to the cognitive, language, socio-emotional and fine motor maturity of children as they age. It is now acknowledged that 39% of children under 5 years of age [...]

Due to their sociocognitive limitations, children between the ages of 4 and 8 years tend to resist antibias messages from others. The purpose of this study was to examine if children would be more responsive to an antibias message as a function of the race of the communicator, the strength of the antibias message, and their ability to reconcile different perspectives. As children's inferences of communicators' attitudes constitute an unintended message, we assessed children's inferences of communicators' Black and White attitudes before and after the intervention. Children's own attitudes and cognitive elaboration of the antibias message were assessed after the intervention. Very few children were able to reconcile different ethnic perspectives. Results further revealed that communicators were inferred to hold more positive attitudes after the intervention, but that this was largely due to an increase in the ingroup communicator's inferred White attitudes and when the message was weak. Moreover, no difference was observed for children's own attitudes and cognitive elaboration of the message. Results are discussed with respect to social cognitive barriers that result in children's distortion or dismissal of antibias messages. (Contains 4 tables and 2 figures.)

A randomized evaluation of a 9-month comprehensive math program for preprimary Bangladeshi school children addressed skills such as numbers, measurement, shapes, patterns, and space. Nine schools were randomly selected for the Intervention group and nine for the Control group, with 12 children randomly selected from each to participate in testing. Pre- and posttested scores on each unit's skills and a cumulative test at the end were subjected to analyses of covariance. Intervention children doubled their scores on almost all tests while control children increased only slightly. Reasons for the program's effectiveness were discussed. (Contains 2 tables.)

Evidence was collected regarding changes over 3 years in the quality of a preprimary program in rural Bangladesh and differences in school achievement of children who did and did not attend. The quality of 30 preprimary schools was evaluated using the ECERS-R (Early Childhood Environment Rating Scale-Revised) and ECERS-E (-Extension). Results indicated that the quality improved overall from 3.50 in 2006 to 5.24 in 2008. Samples of 180 graduates of these schools were annually followed into first and second grades and tested for five competencies: speaking, writing, reading, oral mathematics and written mathematics. Their achievement scores were compared with students in their classrooms and students in neighboring schools who did not have the opportunity to attend preprimary schools. First graders in 2008 performed significantly better than comparisons in all competencies, and better than earlier graduates. Second graders performed significantly better than comparisons on all but Reading. Qualities of the math preprimary program correlated with math achievement in Grade 1 only. Consequently the quality of the preprimary program improved over time along with higher achievement for its graduates. The findings support efforts to expand high-quality programs in developing countries to help children succeed in the early primary grades.

The purpose of the study was to examine the efficacy of a 4-week dialogic reading intervention with rural Bangladeshi preschoolers with the intention of increasing their expressive vocabulary. Eighty preschoolers randomly selected from five preschools participated in the 4-week program. Their expressive vocabulary, measured in terms of definitions, was tested on 170 challenging words before and after the program and compared with that of control children who participated in the regular language program. Both groups were read in Bangla eight children's storybooks with illustrations, but the dialogic reading teacher was given a set of "wh" and definitional questions to enhance children's verbal participation. The mean vocabulary scores of dialogic program children increased from 26% to 54% whereas the control children remained at the same level. Results are discussed in terms of the successful application of dialogic reading to low-resource preschools. (Contains 1 figure and 2 tables.)

An important goal of education in developing countries is to implement and improve early childhood education. A pre-post intervention-control design was used to compare a piloted-revised versus a regular preschool program offered by an organization in rural Bangladesh. After 7 months in operation, the quality of the piloted-revised program was higher than the regular program, though the regular program had also improved. Children attending pilot preschools made greater gains than children attending regular preschools on most outcome measures. Action research was conducted alongside the quantitative evaluation to study the process of the implementation and to identify areas for further improvement.

This evaluation research compares the first-grade competencies of two cohorts of Bangladesh children who attended "Succeed" preschools, with a control group who did not attend preschool. Testing of these groups occurred in 2006, 2007, and 2005, respectively. The Succeed program aims to improve children's learning and children's school success by developing and testing an affordable, sustainable preschool model that can be implemented in school, community and home settings. Researchers assessed the quality of school- and home-based preschool environments using the Early Childhood Environment Rating Scale (ECERS) plus two curricular subscales that tap program quality. An independently developed test based on government-defined competencies assessed school achievement of Grade 1 children. Results showed that children who attended Succeed preschools performed better in four of the five competencies relating to reading, writing, and oral math, compared with children without any preschool experience. Better quality preschool environments were positively associated with children's competencies in Grade 1. There were no statistically significant differences in first-grade performance between children from home-based preschools compared with school-based preschools, both using the same Succeed program. (Contains 3 figures and 3 tables.)

A cross-sectional design was used to inquire about peer relations of 85 second and fifth grade students in two integrated Anglophone and Francophone schools in Montreal, Canada. Data on same- and cross-ethnic identification, interactive companions and mutual best friends were collected for each student. Overall findings were that students had more companions from their own than the other ethno-linguistic group, but equivalent numbers of mutual best friends. Same- and cross-ethnic mutual friends were rated similarly in terms of friendship quality (as assessed by the McGill Friendship Questionnaire). Exploratory in-depth interviews with 16 students indicated that cross-ethnic relationships ran into two barriers. One was that they were limited to only a few activities and locations and so did not become personalized. The second was that in-group and out-group friends did not always mix well. (Contains 4 tables.)

A preschool program in rural Bangladesh was evaluated in terms of cognitive and social outcomes of children. The preschools provided a half-day program, 6 days a week, with free play, stories, and instruction in literacy and math. Four hundred children between 4.5 and 6.5 years were assessed, half in preschools and half in villages where there were no preschools. After controlling the differences in child's age, nutritional status, mother's education, and assets: preschool children performed better than the comparison children on measures of vocabulary, verbal reasoning, nonverbal reasoning, and school readiness. On some indicators of social development during play, preschool children performed better, though not on the cognitive aspects of play. They were less likely to be stunted but did not differ on most other health variables. The mean quality score from the ECERS-R was 3.5, and this correlated with the group averages of verbal and nonverbal reasoning. Results were discussed in terms of implementing a high-quality program in rural sites of developing countries, where there was a mix of play and teacher-directed instruction.

Two studies examined in-group favoritism and out-group prejudice among two samples of white 4- to 7-year-olds. Findings indicated that the two attitudes were reciprocally correlated in the sample from a racially homogeneous school but not in the sample from a mixed-race school. In-group favoritism did not appear until 5 years of age and was strongly related to developing social cognitions. Out-group prejudice was consistently low but significant among 5-year-olds only. (Author/KB)

Examined the cross-racial validity of friendship qualities and the value of reciprocity in friendship with 40 white and black fifth graders in a multiracial elementary school. Found that reliable alliance was considered significantly more important as a friendship quality by black than by white students, with 10 qualities, including reciprocity, considered important by all students. (KB)

Responsive complementary feeding, whereby the mother feeds her child in response to child cues and psychomotor abilities, is low in some countries and likely contributes to malnutrition. Interventions are needed to evaluate whether promoting responsive feeding would add any benefit. Using a cluster-randomized field trial, we evaluated a 6-session educational program that emphasized the practice of child self-feeding and maternal responsiveness. A total of 108 mothers and their 8- to 20-mo-old children in 19 clusters were randomly assigned to the intervention group and 95 in 18 clusters were assigned to the informational control group. Outcomes were assessed at pretest, postintervention, and follow-up. Research assistants, who were unaware of group assignment, observed and coded mother and child midday meal behaviors. At follow-up, the percent of self-fed mouthfuls was 47.8 [+ or -] 42.4 (mean [+ or -] SD) in the responsive feeding group children compared with 32.2 [+ or -] 41.0 in the controls (P = 0.01); likewise, the number of responsive verbalizations was 6.55 [+ or -] 5.9 in the responsive feeding mothers and 4.62 [+ or -] 4.5 in controls (P = 0.01 ). Intervention mothers recalled more messages. Mouthfuls of food eaten by children and weight were equivalent in the 2 groups. Lack of change in foods eaten and small quantities may explain the similarly low levels of weight gain. These results provide evidence that self- feeding and maternal verbal responsiveness, two developmentally important behaviors, can be increased by targeting specific behaviors with appropriate behavior change strategies of modeling and coached practice. Weight gain may require more nutritional input, especially in areas of high food insecurity.

It is now widely recognized that malnutrition can partly be attributed to caregiver--child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother--child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding. Keywords: Responsive feeding; Feeding practices; Malnutrition; Child development; Bangladesh

Forty children between the ages of 16 and 42 months and their mothers, living in an Ethiopian rural village, participated in the study. The objective was to determine the mental development of the children using the Bayley Scale of Mental Development, and to examine its relation to nutritional status and mother-child interaction. Forty-eight percent of the children were mildly or moderately malnourished; 7.5% severely so. The child's weight for age was significantly related to the child's scores on the Bayley scale. Mother-child interaction was assessed through a 30-60 min observation of the pair in a naturalistic setting around the home. The number of verbal, gestural and motor actions spontaneously initiated by the mother and child, as well as responses made by each to the others' behavior were recorded and coded separately. The rate of a mother's verbal responses to the child positively predicted the child's verbal score. In contrast, the mother's spontaneously initiated motor actions toward the child correlated negatively with the child's performance score. The mother's responsiveness was unrelated to the child's nutritional status, age or sex, but was best predicted by a fussing/crying child and by her expectations about the ages when specific social-cognitive abilities would be acquired by a child. Key words - nutrition, child development, developing country

A cross-sectional survey was conducted on 1000 adult Ethiopians living in rural communities to determine firstly the prevalence of mental illness and secondly its association with stress and demographic variables. The Self-Reporting Questionnaire developed by WHO experts was used as the meausre of mental illness. A modified version of the Holmes-Rahe Social Readjustment Scale was the measure of stress. Respondents were interviewed in their homes. Those experiencing 11 or more of the 20 neurotic symptoms and 3 or more of the 4 psychotic symptoms were considered mentally ill. Despite the use of high cut-off points for identifying potential cases, the prevalence of mental illness was 17.2% -- neurotic 11.2% and psychotic 6.0%. This is higher than earlier reports for Ethiopia, but comparable to rates found in other African countries. Mental illness scores were most strongly associated with stress in that the odds of experiencing 6 or more stressful life events in the past year were 2.7 times greater for neurotics and 2.1 times greater for psychotics. In addition, neuroses and psychoses were significantly associated with a family history of mental illness and with being divorced, separated or widowed. Neurosis alone was also associated with chronic illness, females, those between the ages of 35 and 44, and illiteracy. These findings were discussed in terms of their relevance for identifying high stress groups and thus for preventing mental illness through community activities.