BIED has been exploring emerging areas in Early Childhood Development (ECD) through its research. This includes developing a comprehensive child development package and adapting for Bangladesh the Global Rating of Environments (GROE) rating scale through working with specialists from the Bank Street College of Education, New York, USA. Delving into the realms of psychosocial wellbeing, BIED has been involved in studying maternal mental health and infant stimulation and the emotional wellbeing of children (funded by the Aga Khan Foundation). Furthermore, with ECD in emergencies becoming a topic of growing importance, BIED has also broadened its research into issues with families and children in disasters.
MATERNAL MENTAL HEALTH STUDY
BIED began conducting a study on maternal mental health and its effects on infant growth and development, with an aim to developing a model that will support pregnant women with depression symptoms. The study was being conducted in the Kamrangirchar area of Dhaka where BRAC Health’s Manoshi Community Health Workers (CHW) is active. As per plan, the intervention began in July 2013 and training on mid-line data collection was completed in November to December 2013. The study has been published in Bangladesh Education Journal.
The purpose of the investigation was to determine the relative effectiveness of the Comprehensive Child Development Package (CCDP) on maternal, child and environmental components that will improve 3 to 5 year old rural children’s cognition, growth, school readiness, and general health and hygiene practices. A program delivered to disadvantaged children in three rural areas of Bangladesh during 2009 – 2011 was evaluated using a quasi-experimental pre-post design. In total 360 pre-school children, 180 in intervention group and 180 in control group, were assessed on above mentioned outcomes at baseline, midterm (12 months after start) and at the end (22 months after start). But the study could not assess 16.4% children in the final assessment, mostly due to out-migration. The regression analysis showed significant benefit of the CCDP programme on mothers’ early childhood development (ECD) and child care related knowledge scores, children’s home observation for measurement of environment (HOME) scores, Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) scores (both performance and vocabulary tests, and child’s school readiness scores. Among these findings, improvement in mothers’ knowledge, children’s WPPSI receptive vocabulary score and WPPSI performance (block design) score remained significant when further adjustment of all possible socio- demographic confounders were done in a multivariate adjusted linear regression analysis. These pilot findings highlight that implementing a comprehensive child development package through preschool infrastructure is beneficial for certain domains of early childhood development and could be a feasible means to make the programme sustainable. However, to get the optimum, sustained benefit in all domains of child development and to improve maternal child rearing practices, further modification of the package is required.
COMMUNITY BASED PSYCHOSOCIAL INTERVENTION IN REDUCING MATERNAL DEPRESSION AND IMPROVING INFANT’S DEVELOPMENT IN BANGLADESH: A RANDOMIZED CONTROL TRIAL
The study, published in IOSR Journal of Nursing and Health Science in the June 2016 issue, followed a prospective longitudinal approach with a randomized controlled design, and was located in Kamrangirchar, 14 km of Dhaka city. A total 830 pregnant women were screened for depression using BEPDS and enrolled in the third trimester of pregnancy and 299 women with depressive symptom (36%) identified Out of 299, 250 pregnant women aged between 15 and 40 years were randomly assigned into intervention and control group having 125 women in each arm. Women in the intervention group received the “Thinking Healthy (CBT based) program” at their home setting, from their last month of pregnancy till 10 months after delivery. Their children received psychosocial stimulation from birth till 10 months. Bangla version of Edinburgh Postnatal Depression Scale (BEPDS), Prenatal Attachment Inventory (PAI), Maternal Attachment Inventory (MAI), Bayley Scale of Infant Development-Third version (Bayley–III) and Family Care Indicator (FCI) were applied to get the outcome information. In addition, sever morbidity; breastfeeding, immunization, socio-economic and demographic information were collected. Data were collected at three time points’ viz. baseline, midline (6 months after delivery) and endline (12 months after delivery).
There was no significant difference between any of the socioeconomic and demographic variables at baseline. EPDS at baseline was not different between the groups (p=0.419), but there was a significant improvement at midline (p=0.027) and at endline (p=0.024) between the groups following the intervention. Home stimulation was significantly different between the groups at 6 month (p=.023) and 12 months (p=0.010). There was no significant effect of the intervention on maternal depression after controlling the confounders. The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months (-0.84vs-0.99, p=0·4 and -1.4 vs -1.3, p=0·7 respectively) and 12 months (-0.99vs -1.1, p=0·7 and -1·41vs -1·56, p=0·4, respectively). The group difference in developmental outcomes of infants were significant at 6 months (p=.008, p=016, p=.004 for cognitive, motor and language development respectively) and at 12 months (p=0.002, p=0.065, p=0.022, p=0.000 for cognitive, motor, language and socio-emotional development respectively). After controlling the confounders the effect size of the intervention on cognitive and social emotional development were 0.36 and 0.45 respectively.
LONGITUDINAL RESEARCH ON COMPREHENSIVE CHILD DEVELOPMENT PACKAGE (CCDP)
BIED took an initiative to develop a Comprehensive Child Development Package (CCDP) and implemented it as a pilot project in 30 centres spread across 3 districts in Bangladesh (Mymensigh, Tangail and Lalmonirhat). The CCDP, which was designed as a 2-year program for 3 to 4 year old children from disadvantaged backgrounds, addressed 4 major components: child development centre; parenting education, including child rearing and nutrition; community involvement, and; health referral services. The primary objective of the study was to determine the relative effectiveness of the CCDP on maternal, child and environmental components that will lead to improve 3 to 5 year old rural children’s cognition, growth, school readiness, and general health and hygiene practices.
A total 360 children – 180 in the intervention group and 180 in control group – were enrolled for the study. They were assessed at the programme’s baseline, midline (12 months after starting the programme) and endline (22 months after starting the programme). This study was conducted with the support of the Aga Khan Foundation (AKF), Bangladesh. The study findings indicate that the CCDP approach is feasible, could be sustainable and reasonably effective for important domains of Early Childhood Development. However, it needs to be tested and possibly revised further to ensure optimum child development in an ECD friendly environment. In particular the study indicated that the childcare service of the CCDP programme through parental involvement and monthly parental session had a significant improvement in the knowledge of mother in regards to ECD and childcare. In terms of the children, the study indicated that the CCDP had a positive impact on children’s language development. The CCDP study Report has been published and was submitted to AKF while also presented at the National ECD Conference, 2013.
GLOBAL RATING OF ENVIRONMENTS (GROE) FOR BANGLADESH
Global Rating of Environments (GROE) is a research tool, the purpose of which is to assess environments for early childhood care. BIED has been working to contextualise GROE for Bangladesh with the collaboration of international consultants from Bank Street College of Education, New York, USA. The objective of the research has been to create a culturally meaningful ECD environment scale to measure the quality of ECD programmes in Bangladesh. In the first phase of pilot testing (February 2013), the 2 consultants along with the advisory group members from BIED visited various NGO preschool programmes and childcare centres, along with the pre-primary programme of the Government’s Directorate of Primary Education (DPE). In the second phase of the pilot test (June 2013), team members visited the childcare centres of the Ministry of Women and Children Affairs (MoWCA) and Early Learning Centres and preschool programmes of various NGOs. To contextualise the tool every point was discussed and tested and changes were made. For example the issues of whether footwear is worn to use the washroom was added as this was determined to be an important hygiene issue in Bangladesh, while on the other hand it was not thought important that the childcare programme supplies food (as most childcare programmes do not do so in Bangladesh). Thus the pilot tests were used as a process of refining the tool for the Bangladeshi context.
RESEARCH ON ISSUES WITH FAMILIES AND CHILDREN IN DISASTERS: A QUALITATIVE PERSPECTIVE FROM RURAL BANGLADESH
The overarching goal of this research is to analyse the situations and aspects of vulnerable children (0-8 years) that are due to climate change, as well as exploring what would contribute to reduce vulnerability of children under those circumstances. The areas of Bhola, Shatkhira and Kurigram were selected for the study on the basis of severity of environmental disaster. Firstly, in order to identify the families in the vulnerable situation, a qualitative survey of 540 households was conducted. Thereafter, for qualitative inquiry a purposive sampling technique was followed and approximately 24 children were selected for expressing themselves through artwork and 09 Focus Group Discussions were conducted. Data analysis has already been completed and report-writing work is ongoing.