Early intervention and caregiving 113 During the early years children make great strides across all domains of development

It was hypothesized that the World Bank assisted project on Nutrition and Early Child Development in Uganda would have an impact on parenting behaviors and attitudes about child development. This large-scale World Bank-assisted program operated in 35 districts during the period from 2000 to 2003. An experimental pre-post comparison group design (N=2250 families) was used to compare behaviors and attitudes of those who lived in the intervention area from those who did not. Results showed that at baseline there were few differences in attitudes and practices between groups. However at the final assessment, intervention mothers reported significantly more behaviors and positive attitudes supporting children’s learning and development compared to the control group. The intervention group was also more likely to report attitudes supporting father involvement. The data suggest that parenting behaviors and attitudes regarding stimulation and support for children’s development and learning can be changed through a program intervention at scale We would like to acknowledge the funding and support for data analysis provided by the World Bank. Correspondence concerning this article should be addressed to Pia Rebello Britto, Child Study Center, Yale University, 230 South Frontage Road, New Haven, CT 06520, Tel (203-785-3903); fax (203-785-7402) e-mail pia.britto@yale.edu Early intervention and caregiving 113 During the early years children make great strides across all domains of development (McCartney & Phillips, 2006; Shonkoff & Phillips, 2000). The near universal acceptance of the importance of caregiving cannot be disputed as parents and caregivers are the primary providers of stimulating and supportive experiences associated with these developments (Bradley & Corwyn, 2005; Britto, Fuligni, & Brooks-Gunn, 2002; Richter, 2004; Rogoff, 2003; Werner & Smith, 2001; Whiting & Edwards, 1988). Early childhood intervention programming has been fueled by the converging streams of knowledge that early childhood is a period of rapid growth and development, that both biological and social processes in the early years are critical, and that caregiving has a significant effect on children’s growth and development beyond the effects of socioeconomic status (Bradley et al., 2005). However much of this evidence has been garnered from developed countries (Barnett, 1995; Shonkoff & Phillips, 2000), with developing country data just emerging (Engle, Black, Behrman, et al., 2007). Engle et al (in press) in this journal outlined the significant associations between early learning and later development, and the size and extent of the loss of developmental potential in the developing world. The paper notes that even though nutritional deficiencies are being recognized, much less is known about strategies to improve children’s learning opportunities in the earliest years in resource-poor countries and early child development interventions are rarely evaluated. Existing data suggests that early childhood development (ECD) programs that provide comprehensive services, e.g., some combination of health care, nutrition, and early stimulation have pervasive and sustained beneficial impacts on children’s well-being, compared to single-service programs (Alderman, Behrman, & Hoddinott, 2004; Young, 1997). Albeit, how these programs should be combined and the best strategies for promoting early stimulation at scale are still unclear. Engle et al. (2007) identified what appeared to be characteristics of successful programming from 20 evaluations of early child development programs in developing countries. These included sufficient duration, provision of direct services to children, intensity, quality, comprehensiveness, targeting to disadvantaged children, and child’s age at beginning the project, but the evidence for the importance of each of these is still limited in developing countries. The evaluation of an integrated nutrition and early child development program supported by a World Bank loan to the Government of Uganda for five years, from 1998 to 2003, provides an opportunity to examine the effectiveness of a comprehensive large scale intervention on selected outcomes related to early child development. The Uganda Nutrition and Early Child Development (NECD) program, called the CHILD program, possibly the largest ECD initiative in East Africa. The intervention program was designed to enhance the capacity of families and communities to foster the learning and development of children under 6 years of age (preschool or at age of school entry) through enhancing growth and development. Specifically, communities were helped to organize services for children under 6 years through growth monitoring and promotion activities, strengthening the capacity of families and communities through sensitization, education and skills training on early childhood development, nutrition and health, enhancing access to child health services through six-monthly Child Health Days, and to providing support to communities through community grants for nutrition, savings groups, income generation, and early child development centers. The multi-site longitudinal evaluation of the NECD project was based on randomized experimental 114 Britto, Engle, & Alderman design. The present study is an investigation of one proposed outcome of the intervention -family caregiving behaviors and attitudes. Uganda is a challenging environment vis-à-vis for support early child development. While Uganda is approaching universal primary school initiation; there are questions of quality of schooling in many areas; additionally, there are many parts of the country that cannot ensure adequate health and nutrition of their children. For example, at the time of the study’s initiation, over one third of children were stunted, a rate above the global norm (UNICEF, 2006). Stunting is of particular concern because stunting has been shown to significantly affect cognitive development (Walker et al., 2007). Despite poverty and high rates of malnutrition, most Ugandan families’ value education; they want their children to attend school. To illustrate this interest, when, Uganda initiated a program of free primary education, the rates of attendance increased dramatically. Because the focus of the project was to help families support children’s early child development, formative research was conducted prior to the intervention design to assess family attitudes and practices toward “positive parental interaction” to support growth, learning and development, and to determine how best to phrase and communicate the messages of the intervention (Baume, Neema, Kibombo, & CabaneroVerzosa, n.d.). Some results of the intervention have been reported elsewhere. For instance, Alderman (2007) and Alderman and Engle (in press) report that there were improvements in growth but only for the youngest age group. They also report an increase in exclusive breastfeeding, as well as greater dietary diversity (Britto et al., 2005). Use of health services and coverage with deworming treatment also improved (Alderman, Britto, Engle, & Siddiqi, 2004). A few impacts of the intervention on children’s cognitive ability, based on the a Ugandan version of the British Ability Scales, for children 3.5 to 6 years of age have also been reported in an unpublished report (Alderman et al., 2004), and further work is underway. The focus of the present paper is the effects of the intervention on parenting behaviours and attitudes that support young children’s learning and overall development, behaviors that are important for and support the learning and development of young children (Bradley & Caldwell, 1995). Evidence that caregiver support and cognitive stimulation and provision of opportunities, materials and experiences will promote and further positive child development is strong, especially during the early childhood years (Bornstein, 2002; Richter, 2004). For example, stimulation of learning has been associated with better cognitive and behavior development in early childhood (Fuligni, Han, & Brooks-Gunn, 2004; Leventhal, Martin, & Brooks-Gunn, 2004). Positive parent children interactions and opportunities for development and learning are considered aspects of stimulating and supportive caregiving, e.g., parent and child book reading, playing, singing together (Britto, Fuligni & Brooks-Gunn, 2002; Custodero, Britto, & Brooks-Gunn, 2003). These effects continue to be seen even after controlling for socio-economic status (Klebanov, Brooks-Gunn & Duncan, 1996). For this intervention, based on the formative research and the developmental literature dimensions of caregiving included support and stimulation for children’s development (Bradley, 1994). Specifically 3 aspects of stimulation and parental support are assessed in the present study: daily routines; behaviors that support children’s learning and preparedness for school and children’s play and every day experiences. In Early intervention and caregiving 115 addition, father attitudes and involvement and with young children; and attitudes about the importance of these caregiving activities for young children’s learning and development are also assessed. The role of fathers in providing stimulating caregiving is important for young children’s development (Cabrera, Tamis-LeMonda, Bradley et al., 2000). Father involvement in child rearing has been considered from two perspectives, traditional and contemporary. Traditional approaches to understanding father involvement typically include the extent to which the father is the primary source of income for the child’s education and well-being, i.e., indirectly involved in the development of the child. Contemporary approaches to father involvement take into consideration the father’s direct role in caregiving, e.g., bathing, feeding, interactions, etc. fairly frequently (e.g., on a daily basis; Pruett, 2000). The second approach to father involvement i