Two-year impact of community-based health screening and parenting groups on child development in Zambia : Follow-up to a cluster-randomized controlled trial

Peter C. ROCKERA*, Arianna ZANOLINI, Bowen BANDA, Mwaba Moono CHIPILI, Robert C. HUGHES, Davidson H. HAMER, Günther FINK

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

25 Citations (Scopus)


Background: Early childhood interventions have potential to offset the negative impact of early adversity. We evaluated the impact of a community-based parenting group intervention on child development in Zambia. Methods and findings: We conducted a non-masked cluster-randomized controlled trial in Southern Province, Zambia. Thirty clusters of villages were matched based on population density and distance from the nearest health center, and randomly assigned to intervention (15 clusters, 268 caregiver–child dyads) or control (15 clusters, 258 caregiver–child dyads). Caregivers were eligible if they had a child 6 to 12 months old at baseline. In intervention clusters, caregivers were visited twice per month during the first year of the study by child development agents (CDAs) and were invited to attend fortnightly parenting group meetings. Parenting groups selected “head mothers” from their communities who were trained by CDAs to facilitate meetings and deliver a diverse parenting curriculum. The parenting group intervention, originally designed to run for 1 year, was extended, and households were visited for a follow-up assessment at the end of year 2. The control group did not receive any intervention. Intention-to-treat analysis was performed for primary outcomes measured at the year 2 follow-up: stunting and 5 domains of neurocognitive development measured using the Bayley Scales of Infant and Toddler Development–Third Edition (BSID-III). In order to show Cohen’s d estimates, BSID-III composite scores were converted to z-scores by standardizing within the study population. In all, 195/268 children (73%) in the intervention group and 182/258 children (71%) in the control group were assessed at endline after 2 years. The intervention significantly reduced stunting (56/195 versus 72/182; adjusted odds ratio 0.45, 95% CI 0.22 to 0.92; p = 0.028) and had a significant positive impact on language (β 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (β 0.11, 95% CI −0.06 to 0.29; p = 0.196), motor skills (β −0.01, 95% CI −0.25 to 0.24; p = 0.964), adaptive behavior (β 0.21, 95% CI −0.03 to 0.44; p = 0.088), or social-emotional development (β 0.20, 95% CI −0.04 to 0.44; p = 0.098). Observed impacts may have been due in part to home visits by CDAs during the first year of the intervention. Conclusions: The results of this trial suggest that parenting groups hold promise for improving child development, particularly physical growth, in low-resource settings like Zambia.

Original languageEnglish
Article numbere1002555
JournalPLoS Medicine
Issue number4
Publication statusPublished - Apr 2018
Externally publishedYes

Bibliographical note

Funding Information:
The first year of the study was funded through grants from Grand Challenges Canada (0349-03) and PATH (DFI.1836-672968-GRT). The second year of the study was funded through a grant from the Policy Research Fund at the Department for International Development (DFID), United Kingdom (55204321). At the time of the study, author RCH worked in the DFID Zambia office and was not part of the Policy Research Fund team. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2018 Rockers et al.


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