||Dr. Megan McHenry
||Caregiver-focused intervention for neurodevelopmental delays in young children in western Kenya
||Infant and maternal health
||Children born in resource-limited settings face numerous risk factors for neurodevelopmental delays, such as malnutrition and extreme poverty. Nearly 250 million young children living in resourced-limited settings are at risk for having poor development. Long-term, these children have an estimated 20% deficit in adult income, impacting not only their own lives but also the economic stability in their communities and countries. Neurodevelopmental interventions are most effective if administered early, when the brain is growing rapidly and has the greatest plasticity. However, due to the overwhelmed healthcare systems in resource-limited settings, new interventions are often challenging to introduce and must be carefully evaluated to determine their benefits. Effective, sustainable interventions that can be integrated into the current models of care in resource-limited settings are critically needed to improve the neurodevelopmental outcomes of young children in these settings. Without such interventions, millions of children will be unable to reach their full developmental potential.
One promising intervention for neurodevelopmental delays in resource-limited settings is the Care for Child Development Intervention (CCDI) Program developed by UNICEF, in partnership with the World Health Organization. In the CCDI program, trained providers support families by promoting sensitive and responsive caregiver-child interactions and teaching them about cognitive stimulation and social support. The program is adaptable cross-culturally and has been used in over 40 countries. While few published evaluation studies look at the outcomes of implementing the CCDI program, one study performed in Pakistan showed that the program improved cognitive, language, and motor neurodevelopmental outcomes at 12 and 24 months of age, compared with a control group. The WHO/UNICEF’s Care for Child Development (CCDI) Program is the intervention for this study. This formal program provides education and coaching for caregivers in creating a nurturing and stimulating environment for their children. The curriculum of the program will be administered by a trained facilitator during 90 minute group sessions occurring every 2 weeks for a total of 10 sessions. The control group will follow current standard-of-care, which includes ad-hoc advice from clinical providers and being informed of the resources available at the MTRH child resource room.
||This intervention is being piloted in Kenya with support of the public health system run by the Kenyan Ministry of Health. The Indiana CTSI is developing a program focused on reciprocal innovation that seeks to support the identification, adaptation, implementation, and evaluation of promising interventions developed at LMIC partner sites for use in Indiana. This infrastructure provides funding and other resources to adapt interventions to a US context.
||The study population will include children aged 18-24 months and their caregivers, who will be recruited from the ongoing NEURODEV study of 225 young children to have a neurodevelopmental delay. In Kenya, to be eligible, a child must be 18-24 months old; speak either English or Kiswahili; and score <85 on one of the BSID-III subscales (mild/moderate/severe delay in cognitive, motor, or language). Exclusion criteria includes having a profound neurological impairment, such as severe cerebral palsy, deafness, or blindness, that would prohibit the child from fully engaging in the program. The caregiver must be primarily in charge of the child’s daily activities and speak either English or Kiswahili. Intervention is targeting low resource settings, and can easily be transferred .
|Process to Implementation
||This intervention has not yet been implemented in Indiana but is being piloted in Kenya. If the pilot findings show positive outcomes, potential exists to apply this intervention to low resourced clinical settings in Indiana and the US. Following identification of potential pilot sites in Indiana, this intervention could be adapted and piloted for use in the US clinical context using support from the Indiana CTSI and other health partners in Indiana, e.g. State Department of Health, IU Health, Eskenazi, and other public health centers.
||There were clinical partners, including doctors, nurses, etc. that helped with the intervention, patients, Ministry of Health stakeholders. We anticipate in transferring to the US that there would need to be similar stakeholders that would need to be engaged within the health systems.
|Scaled or Transferred?
||It has not been scaled yet, but we hope it will be
|Type of Research
||Subject-level randomization into groups within a 2×2 crossover design, with standard-of-care and intervention arms assessed at baseline, 6 month follow-up, and 12 month follow-up. For a scale up study in the future, implementation science frameworks will be used, such as RE-AIM.