PMID- 29689045 OWN - NLM STAT- MEDLINE DCOM- 20190204 LR - 20240314 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 15 IP - 4 DP - 2018 Apr TI - Two-year impact of community-based health screening and parenting groups on child development in Zambia: Follow-up to a cluster-randomized controlled trial. PG - e1002555 LID - 10.1371/journal.pmed.1002555 [doi] LID - e1002555 AB - 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 (beta 0.14, 95% CI 0.01 to 0.27; p = 0.039). The intervention did not significantly impact cognition (beta 0.11, 95% CI -0.06 to 0.29; p = 0.196), motor skills (beta -0.01, 95% CI -0.25 to 0.24; p = 0.964), adaptive behavior (beta 0.21, 95% CI -0.03 to 0.44; p = 0.088), or social-emotional development (beta 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT02234726. FAU - Rockers, Peter C AU - Rockers PC AD - Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America. FAU - Zanolini, Arianna AU - Zanolini A AD - American Institutes for Research-Zambia Office, Lusaka, Zambia. FAU - Banda, Bowen AU - Banda B AD - Zambia Center for Applied Health Research and Development, Lusaka, Zambia. FAU - Chipili, Mwaba Moono AU - Chipili MM AUID- ORCID: 0000-0002-0272-9589 AD - Department of Psychology, University of Zambia, Lusaka, Zambia. FAU - Hughes, Robert C AU - Hughes RC AUID- ORCID: 0000-0002-1345-3063 AD - UK Department for International Development, London, United Kingdom. FAU - Hamer, Davidson H AU - Hamer DH AUID- ORCID: 0000-0002-4700-1495 AD - Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America. AD - Zambia Center for Applied Health Research and Development, Lusaka, Zambia. AD - Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America. FAU - Fink, Gunther AU - Fink G AD - Swiss Tropical and Public Health Institute, Basel, Switzerland. AD - University of Basel, Basel, Switzerland. LA - eng SI - ClinicalTrials.gov/NCT02234726 SI - Dryad/10.5061/dryad.3340hc4 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20180424 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM CIN - PLoS Med. 2018 Apr 24;15(4):e1002557. PMID: 29689056 MH - Adolescent MH - Adult MH - Child Development/*physiology MH - Child Health Services/standards MH - Community Health Services/standards MH - Female MH - Follow-Up Studies MH - Humans MH - Infant MH - Male MH - Mass Screening/*methods MH - *Parenting MH - Public Health MH - Young Adult MH - Zambia PMC - PMC5915271 COIS- The authors have declared that no competing interests exist. EDAT- 2018/04/25 06:00 MHDA- 2019/02/05 06:00 PMCR- 2018/04/24 CRDT- 2018/04/25 06:00 PHST- 2017/08/07 00:00 [received] PHST- 2018/03/19 00:00 [accepted] PHST- 2018/04/25 06:00 [entrez] PHST- 2018/04/25 06:00 [pubmed] PHST- 2019/02/05 06:00 [medline] PHST- 2018/04/24 00:00 [pmc-release] AID - PMEDICINE-D-17-02745 [pii] AID - 10.1371/journal.pmed.1002555 [doi] PST - epublish SO - PLoS Med. 2018 Apr 24;15(4):e1002555. doi: 10.1371/journal.pmed.1002555. eCollection 2018 Apr.