Date of Award

10-6-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr Jai K Das

Second Advisor

Dr Zahra Hoodbhoy

Third Advisor

Dr Sidra Kaleem Jafri

Department

Community Health Sciences

Abstract

Introduction: While neonatal mortality has declined in low- and middle-income countries, the number of children at-risk and with developmental disability remains unaffected. The early child period can be defining for children and can have effects throughout the individual’s life. Home and community are the child’s primary environment and provide the settings where learning and development are first stimulated. These make an extremely effective point of intervention when focusing on child development and long-term outcomes, particularly in low resource settings.
Methods: Studies that were published from 1990 to July 2022 and reported findings on developmental outcomes (cognitive, motor, speech and socioemotional development) in at-risk and developmentally disabled children after a home or community-based intervention to promote development were systematically reviewed. Experimental studies, including both randomized controlled trials and quasi experimental trials, were included and meta-analysis was performed in accordance with the standard methodology described in the Cochrane handbook.
Results: We included 37 studies in this review which were subsequently pooled in the meta-analysis. Pooled analysis of the outcomes showed significant improvements in cognitive development (SMD: 0.56, 95% CI: 0.28, 0.84), motor development (SMD: 0.43 95% CI: 0.18, 0.69) and language development (SMD: 0.38, 95% CI: 0.07, 0.70). A significant decrease was also observed in socio-emotional problems in children (SMD: 0.44, 95% CI: 0.07, 0.80). Subgroup analysis has shown similar impacts with more pronounced impact in children at-risk as compared to those diagnosed with a developmental disability for each outcome assessed. Similarly, the effect was more significant in children aged 0 to five years as compared to those above 5 years.
Conclusion: Community and home-based interventions are effective for child development and have the potential of larger impacts if scaled up especially in low- and middle-income countries, as evidence suggests significant improvement in cognition, motor, speech and socio-emotional development. More trials are needed with standardized interventions and standardized tools to further strengthen the findings for scale up.

First Page

1

Last Page

61

Download

Share

COinS