An eco-cultural approach to early childhood development
Authors: Pamela Akinyi Wadende, Henriette Zeidler
Journal: The Lancet Global Health (2020)

Quality early childhood development (ECD) programmes present an opportunity to drastically reduce early health and educational disadvantages for children in low-income and middle-income countries (LMICs). Studies have shown that interventions that build on existing and thus familiar community structures have a better chance of success. For instance, basing health and educational interventions on indigenous traditions such as the common African socialisation practices that assign pre-adolescent children to supervise and guide younger peers could enhance the acceptability and success of an intervention.1Serpell R Literacy and child development in a contemporary African society.Child Dev Perspect. 2020; 14: 90-96Crossref Scopus (1) Google Scholar, 2Serpell R Nsamenang AB The challenge of local relevance: using the wealth of African cultures in ECCE programme development.in: Marope PTM Kaga Y Investing against evidence: the global state of early childhood care and education. United Nations Educational, Scientific and Cultural Organization, Paris2015: 23-247Google Scholar In their Article published in The Lancet Global Health, Jill Luoto and colleagues3Luoto JE Lopez Garcia I Aboud FE et al.Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.Lancet Glob Health. 2020; (published online Dec 17.)https://doi.org/10.1016/S2214-109X(20)30469-1Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar address ways of improving the health of children in LMICs by assessing the effectiveness of ECD interventions that can be delivered cost effectively in group settings. Luoto and colleagues3Luoto JE Lopez Garcia I Aboud FE et al.Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.Lancet Glob Health. 2020; (published online Dec 17.)https://doi.org/10.1016/S2214-109X(20)30469-1Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar worked successfully with the established structure of the paraprofessional community health volunteers in Kenya to drive their intervention. An interesting add-on would be to test if the efficiency of the intervention could be further improved by integrating additional sociocultural structures, and how any number of them could be combined to maximise outcomes. In Kenya, there is renewed interest in early child development and especially in reducing early disadvantage as a means of achieving global (eg, Sustainable Development Goals), regional (eg, Global Partnership in Education), and national targets (eg, Kenyan Vision 2030). For this reason, Kenya is in the process of rolling out its new competency based curriculum, which aims to robustly seek and leverage a child's experience and competences in school instruction. The trial by Luoto and colleagues3Luoto JE Lopez Garcia I Aboud FE et al.Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.Lancet Glob Health. 2020; (published online Dec 17.)https://doi.org/10.1016/S2214-109X(20)30469-1Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar contributes to evidence for the importance of early childhood care, which shows that children who participate in quality ECD programmes progress more successfully through primary school than those without adequate preschool education.4Aboud FE Hossain K The impact of preprimary school on primary school achievement in Bangladesh.Early Child Res Q. 2011; 26: 237-246Crossref Scopus (36) Google Scholar, 5Berlinski S Galiani S Manacorda M Giving children a better start: pre-school attendance and school-age profiles.J Public Econ. 2008; 92: 1416-1440Crossref Scopus (91) Google Scholar Important questions that might still need to be addressed in effective ECD intervention include the effects that fathers have on the cognitive and socioemotional development of children in LMICs. Luoto and colleagues' trial could not find conclusive evidence of these effects due to low attendance by fathers. This low attendance of the intervention sessions was possibly a result of social norms restricting father contact with children outside of provision duties in the family; a factor that also emerged during pilot studies and post-intervention interviews with fathers. Although child-care duties in Kenya have largely been a preserve of women,6Cho Y Kalomba D Mobarak AM Orozco V Gender differences in the effects of vocational training: constraints on women and drop-out behavior. Working paper number 6545. World Bank, Washington, DC2013Crossref Google Scholar the country is rapidly urbanising7International Organization for MigrationMigration in Kenya: a country profile. International Organization for Migration, Geneva2018Google Scholar and traditional structures that endorsed a separation of duties are unravelling. Therefore, it is important to investigate if and how fathers can become more involved in child care, and subsequently in child-care interventions. A further valuable addition would be to assess how ECD interventions can be improved by harnessing the influence of non-parental caregivers such as baby sitters, friends and relatives, and particularly pre-adolescents who are commonly put in charge of younger peers in LMIC settings.1Serpell R Literacy and child development in a contemporary African society.Child Dev Perspect. 2020; 14: 90-96Crossref Scopus (1) Google Scholar Recent work on child development has focused on bridging the inequality gap created by early disadvantages in nutrition and education. Several studies have surveyed the opportunities inherent in local contexts that can be leveraged to improve child development (eg, cultural influence on dietary practices;8Chege PM Kimiywe JO Ndungu ZW Influence of culture on dietary practices of children under five years among Maasai pastoralists in Kajiado, Kenya.Int J Behav Nutr Phys Act. 2015; 12: 131Crossref PubMed Scopus (25) Google Scholar child-care subsidies for women's economic empowerment in Nairobi, Kenya;9Clark S Kabiru C The effects of child care subsidies on women's economic opportunities in the slums of Nairobi. The American Economic Association's Registry for randomised controlled trials.https://www.socialscienceregistry.org/trials/843/history/5276Date: 2015Date accessed: November 12, 2020Google Scholar early educational foundations for children;10Serpell R Mumba P Chansa-Kabali T Early educational foundations for the development of civic responsibility: an African experience.New Dir Child Adolesc Dev. 2011; 134: 77-93Crossref Scopus (12) Google Scholar and challenges of the local relevance of interventions2Serpell R Nsamenang AB The challenge of local relevance: using the wealth of African cultures in ECCE programme development.in: Marope PTM Kaga Y Investing against evidence: the global state of early childhood care and education. United Nations Educational, Scientific and Cultural Organization, Paris2015: 23-247Google Scholar). The study by Luoto and colleagues3Luoto JE Lopez Garcia I Aboud FE et al.Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.Lancet Glob Health. 2020; (published online Dec 17.)https://doi.org/10.1016/S2214-109X(20)30469-1Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar therefore fits well within the context of current research. Luoto and colleagues show that it is possible to deliver an ECD intervention cost effectively in large village settings with the help of available infrastructure, in this case the paraprofessional group of community health volunteers. It is equally important to devise ways to improve the participation of fathers in such interventions, despite social norms, and to account for other child-care givers in the community such as pre-adolescent children and other relatives. It was useful that the investigators in this instance worked with a team who already had an ongoing project in the community and this eased their recruitment and community entry activities. We declare no competing interests. Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trialParenting 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. Full-Text PDF Open Access