SPRING- Kilkaari community early development intervention for India: Baseline findings and...
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SPRING KILKAARI(Sustainable PRogram Incorporating
Nutrition and Games)
Dr Gauri Divan , Sangath
IFPRI POSHAN, New Delhi 2016
Theoretical underpinning of the impact of promoting ECD on neural processes
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SPRING• Evaluating an innovative feasible, affordable and sustainable
intervention package delivered through home visits to mothers from pregnancy through the first two years of the life in order to maximize child growth and development in India and Pakistan.
• In India, the SPRING-Kilkaari intervention is being delivered by a new cadre of community based agents- the Kilkaari worker.
• District Rewari, State of Haryana in North India
SPRING KILKAARI
• To evaluate the effectiveness of the Kilkaari intervention through a cluster randomised control trial and assess its impact on stunting and cognition
• SPRING Kilkaari is informed by the • WHO-UNICEF Care for Child Development,
• WHO Infant & Young Child feeding guidelines
• Cognitive behaviour therapy.
SPRING CONCEPTUAL FRAMEWORK
Outcomes
Key Evaluations around at 12 and 18 months of age
Child growth and feeding patterns
Child cortisol levels to evaluate impact on early life stress
Child development ( cognition)
Maternal mental health, efficacy and decision making
Baseline findings of interest ( 2014)
• Eligible women (n=13, 431)• 35% finished high school
• 82% institutional deliveries
• 51% initiated breastfeeding within one hour ( n=2,771)
• 46% stunting (n=1,654: 17-35 months)
0%
10%
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30%
40%
50%
60%
70%
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100%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Age in months
Excl. BF Solids Or Semi-Solids
Feeding by age ( n=5405)
SPRING KILKAARI Intervention
• Delivered by program worker who shares similar characteristics to the current workers in government programs (ASHAs and Aangawadi Workers).
• 27 monthly visits are conducted at home from pregnancy until 2 years of age.
• A maximum of four key messages per visit.
• Messages are repeated and scaffolded across visits.
Kilkaari Intervention Booklet
I. FETAL GROWTH AND DEVELOPMENT
II. INFANCY
III. TODDLERS
Day 0
Day 1000
© Bill & Melinda Gates Foundation |
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SPRING KILKAARI Supporting growth to 2 years of age
SUPPORTIVE SUPERVISION
Individual Supervision Group Supervision
Once a month , field based Once a month, centre based
Used to track the quality and
performance of the individual KW
Addresses common issues and
challenges
Allows individual feedback to support
skill building
Supports peer group learning
Supervision adopts the Kilkaari principles of being empathetic to the workers’ issues,
helping them problem solve and supporting them with new strategies
Use of a checklist to monitor KW skills
LESSONS LEARNT DOMAIN LESSONS LEARNT
Worker Child Development worker is an acceptable and feasible delivery agent for ECD
messages
Characteristics may need to take into account cultural aspects for an
intervention which is delivered at home
Child development worker can be made responsible for developmental
surveillance to identify and support children with delays
Adaptation Need to understand cultural family dynamics - mother in law as key decision
maker
Content of messages e.g., acceptable foods
Integrate cultural roadblocks e.g., lack of access in early post-natal period
Training
Materials
Training manuals to be integrated into intervention manuals to increase
usability of resources
Training Workers need to understand not just the ‘why ‘of child stimulation but also the
‘how’
Next steps
• Long term follow up of this cohort
• Partnerships for implementation sites
• Design a package for 25-72 months to address the needs of SDG 4 Target 4.2
• By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education
Acknowledgements
Kamalkant Sharma, Reetabrata Roy, Neha Hooda, Neha Singhal, Ruchi Sareen
Partners in
Institute for Global Health, Faculty of Population Health Sciences, UK; Faculty of Epidemiology and
Population Health, London School of Hygiene and Tropical Medicine, UK; Institute of Psychology
Health and Society, University of Liverpool, UK