evaluation found that relatively more educated households and better off communities were able to translate gains in the behavioral indicators into gains in children’s nutritional outcomes (Galasso & Umapathi, 2007).

5.2.3 Early Stimulation and Early Learning Enhancement of children’s social, emotional, and cognitive development can be achieved through parenting interventions and center-based programs. Parenting information can be shared in the context of maternal and child health/growth monitoring visits (on-site at health facilities). Studies in Tajikistan, the Kyrgyz Republic, and Kazakhstan—where health staff used the UNICEF/WHO Care for Child Development<sup>25</sup> materials with specific behavioral recommendations about play, communication, and responsive feeding—found improvements in - - children’s language, gross motor, and social emotional development (Engle, 2010). Also, in Bangladesh, severely underweight hospitalized children who participated in play sessions and whose parents received parenting counseling at clinic visits benefited from improved mental development and weight gain (Nahar, Hossain, Hamadani, et al., 2012).

Alternatively, parenting education can be conveyed through home visits by existing health services. Although this is a higher-intensity approach, in terms of both human resources and logistics, it is supported by greater evidence of impact. In Jamaica, for example, weekly home visits by community health workers demonstrating play activities and discussing parenting issues improved both the children’s development outcomes and their mothers’ childrearing knowledge and practices (Powell, Baker-Henningham, Walker, Grantham-McGregor, & Gernay, 2004). Numerous other examples (including Jamaica, St. Lucia, and Brazil) show that home visits focusing on early stimulation and conducted by paraprofessionals can improve child development (Baker-Henningham & Lopez Boo, 2010).

On-site services can also be combined with home visits. Two studies in Bangladesh have found positive impacts using this approach. In one, severely malnourished children were provided with psychosocial stimulation both at rehabilitation centers and through home visits. Participants showed significantly better development scores than control children (Nahar, Hamadani, Ahmed, et al., 2009). In another, undernourished children participating in group meetings at nutrition centers and receiving home visits showed improved mental scores compared to controls (Hamadani, Huda, Khatun, & Grantham-McGregor, 2006).

In some cases, stand-alone parenting programs may be desirable. Recognizing that most young parents do not have the knowledge or skills to provide a stimulating home environment or promote social and emotional development, Jordan developed the Better Parenting project. The project targeted disadvantaged families and was implemented through partnerships between UNICEF and local nongovernmental organizations (NGOs). Topics covered included child development and the role of the family, positive discipline, and the importance of play. During its early years, the program struggled to reach fathers. Mosques were identified as an ideal place to connect with fathers and the community, and so the program reached out to the religious community. An Imam Guide on ECD was produced and used to train imams and khatibs (mosque preachers) on how to teach about better parenting during or after Friday prayers. The guide emphasized ways parents can actively support their children’s development, especially the

> 25 ‐ The Care for Development Module provides age based recommendations for parents on how to play (supporting cognitive development) and communicate (supporting language and social development) with their children from birth through age 2, as well as how to deal with problems that caregivers may bring up. See http://www.who.int/maternal_child_adolescent/documents/care_child_development/en/.

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