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Early child development has been influenced directly and indirectly by the COVID-19 pandemic, and these effects are exacerbated in contexts of poverty. This study estimates effects of the pandemic and subsequent population lockdowns on mental health, caregiving practices, and freedom of movement among female caregivers of children 6-27months (50% female), in rural Bangladesh. A cohort (N=517) was assessed before and during the pandemic (May-June, 2019 and July-September, 2020). Caregivers who experienced more food insecurity and financial loss during the pandemic reported larger increases in depressive symptoms (0.26 SD, 95% CI 0.08-0.44; 0.21 SD, 0.04-0.40) compared to less affected caregivers. Stimulating caregiving and freedom of movement results were inconsistent. Increases in depressive symptoms during the pandemic may have consequences for child development.

Delivery of interventions through group sessions allows for in-depth discussions and creates opportunities for group members to work together to identify and solve common problems. However, low attendance may limit impact. We explored factors affecting attendance, active participation, and behavior change in an integrated group-based child development and maternal and child health intervention in Bangladesh. Community health workers (CHWs) facilitated two sessions a month including material on child stimulation; water, sanitation, and hygiene; nutrition, maternal depression, and lead exposure prevention. Sessions were conducted with 320 pregnant women and mothers with children younger than 24 months, in 16 villages in Kishoreganj district. After 4 and 9 months of intervention, we conducted focus group discussions and in-depth interviews with mothers (n = 55 and n = 48) to identify determinants of attendance and behavior change, and to examine potential for intervention scale-up. Recruiting family members to assist with childcare resulted in improved attention during sessions. Adopting a storytelling format for presentation of session materials resulted in more engaged participation during courtyard sessions. Session attendance and behavior change, especially purchasing decisions, were difficult for participants without the support of male heads of the household. Selecting a rotating leader from among the group members to remind group members to attend sessions and support CHWs in organizing the sessions was not successful. Facilitating self-appraisals and planning for water and sanitation allowed participants to identify areas for improvement and track their progress. Key determinants of a participant’s attendance were identified, and the resulting intervention shows promise for future implementation at scale.

In low- and middle-income countries, most latrines are not accessible to young children. We explored how to modify existing pit latrines to make them child friendly. We conducted four focus group discussions with mothers to explore barriers to child latrine use. We then enrolled 20 households with a child aged 3–7 years old to test six enabling technologies developed based on the identified barriers. Two to three weeks after installing the selected enabling technologies in each household, researchers conducted 19 in-depth interviews with caregivers to explore the technologies’ acceptance and feasibility. Common barriers included the discomfort of squatting on a large pan, fear of darkness, and fear of a slippery floor. Of the potential solutions, a ring to stabilize the child while squatting in the latrine was preferred by children and was affordable and available. A wooden board with a smaller hole than the usual pan reduced fears of falling and helped eliminate discomfort but was inconvenient to handle and clean. A transparent fiberglass roof tile was affordable, available, increased visibility, and kept the latrine floor dry. In conclusion, the fiberglass roof tile and stability ring were two affordable and locally available technologies that facilitated latrine use by children aged 3–7 years.

Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.

IntroductionIn low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.MethodsWe conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.ResultsIn July–August 2017, 621 pregnant women and primary caregivers of childrenConclusionOur findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.Trial registration numberThe trial is registered in ISRCTN (ISRCTN16001234).

Supporting caregivers&rsquo, mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar&ndash, April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children &lt, 24 months) (n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of &ldquo, unhealthy thoughts&rdquo, in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting.

(1) Background: Residents of Dhaka slums frequently lack clean and functional shared latrines. We explored the role of landlords and compound managers in promoting latrine cleanliness in the intervention arm of a randomized trial, (2) Methods: We conducted focus group discussions, key informant interviews, and in-depth interviews with community health promoters, landlords, and compound managers to better understand the decision-making process, barriers to contributing to sanitation, and cleanliness of shared latrines. (3) Results: Landlords&rsquo, and compound managers&rsquo, engagement in promoting clean and functional latrines depended, in part, on their own proximity to the properties they own and manage. The compound managers played a leadership role through engagement with health promoters, oversight of implementation of a cleaning schedule, and support for installation and maintenance of sanitation hardware, resulting in improved sanitation practices, (4) Conclusions: Interventions in slums in Bangladesh should consider engaging landlords and compound managers in efforts to bring about structural and organizational changes to support the adoption of improved water, sanitation, and hygiene practices.

OBJECTIVES: Many Bangladeshi women consume a diet that is low in nutrients, and in addition do not gain enough weight during pregnancy. We sought out to identify practices and perceptions that act as barriers to consuming both enough food and nutrient-dense foods during the pregnancy period. We also asked women where they received support and information regarding their pregnancy. METHODS: We randomly selected households in two villages of the Kishorganj district in rural Bangladesh and conducted purposive sampling to identify households with currently pregnant women. Women were invited to a central location to attend a focus group discussion (FGD) in a small group of other pregnant women. Discussion guides were created based on barriers to healthy eating that had been documented in the literature in similar settings. All interviews were conducted in Bengali with a trained field staff. Interviews were recorded and transcribed in Bengali. Data reduction was achieved by using an analytic questionnaire. RESULTS: Four focus group discussions were carried out with 40 pregnant women, of which the average age was 24 years. Data collection was done during the month of May 2017. Some women reported that they increased their food consumption during pregnancy, while others reported that they had trouble consuming enough food as fatigue and nausea decreased their desire to eat. Regardless of amount, most women reported consumption patterns of rice and vegetables daily, fish weekly, and meat fortnightly. However, many women reported the avoidance of certain foods such as specific fish, fruits, and vegetables according to the advice from the family members and/or health care providers. Additionally, we uncovered some knowledge gaps regarding recommended weight gain during pregnancy. Family members, neighbors, and health workers were found as part of the support system for pregnant women. CONCLUSIONS: Women overall have many positive dietary practices in this region of rural Bangladesh, but there is potential to increase both the quality and quantity with additional community-wide sensitization on nutrition. Community health programs may consider incorporating more messages on nutrition during pregnancy for all family members and rural health care providers. FUNDING SOURCES: Bill & Melinda Gates Foundation.