A global call to action for early childhood

Our global responsibility: The developmental potential of over 200 million young children
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are aware of their children’s abilities,
they are more responsive and their
children do better in the short term.
Risk factors often co-occur or
cumulate. Exposure to multiple risks
has a much larger impact on children’s
development than exposure to single
risks. These cumulative risks contribute
to a developmental trajectory that
includes poor health, immature
behaviour, lack of readiness for
school, poor academic performance,
limited preparation for economic
opportunities, and perpetuation of
the intergenerational cycle of poverty.
Because many young children from
developing countries experience
multiple risks, integrated interventions
that address several of these identified
risk factors are the most effective.
Such interventions are discussed below.
Paper 3. Strategies to Avoid the Loss
of Developmental Potential in more
than 200 Million Children in the
Developing World (Engle et al., 2007)
Based on the conclusions from the
previous papers in the series, paper 3
evaluates programmes that promote
child development and either prevent
or ameliorate the effects on child
development of stunting, iodine
deficiency, iron-deficiency anaemia,
and inadequate stimulation.
The evidence from industrialised
countries is clear that there are shortand
long-term effects of quality
programmes to improve disadvantaged
young children’s cognitive and socialemotional
functioning; these effects
have been shown to last through to
age 40, and cost-effectiveness has
been demonstrated. However, the
applicability of these findings to a
developing country context has been
questioned. For this reason, paper 3
reviewed evaluations of programmes
to improve children’s cognitive
and social-emotional development
exclusively from developing countries,
representing all regions.
There has been increasing interest in
early child development (ECD) from
both the health and educational
sectors within developing countries.
For example, by 2005, the World
Bank had financed loans to fiftytwo
developing countries for ECD
programmes, for a total of 1.6 billion
dollars. In addition, at least thirty-four
developing countries had policies on
ECD, and UNICEF was supporting
parenting programmes in sixty
countries. However, there have been
relatively few systematic evaluations of
ECD programmes.
Through an extensive search, we
identified twenty ECD programmes
that have been implemented in
developing countries that had an
adequate comparison group, measured
children’s outcomes, and occurred
prior to age 6. The programmes fall
into three groups: (1) centre-based
early learning; (2) parenting or parentchild
interventions; and (3) communitybased
interventions. All include
health and nutrition interventions.
As noted in the earlier papers,
strong evidence exists of an additive
or synergistic effect of stimulation
and improved nutrition on a child’s
development. This is illustrated by
studies showing the combined effect
of initial malnutrition and improved
The challenge is clear.
The size and nature of the
problem is defined, along with
the seriousness of its longterm
consequences. What
remains open is only the world’s
response, and our own.
Richard Jolly, The Lancet 2007
environment on the outcomes of
children adopted into middle-class
homes (see figure 3).
All of the eight evaluations of
centre-based programmes find
a significant effect on children’s
cognitive development, either through
preschools or treatment centres
for malnourished children. These
programmes also demonstrate noncognitive
gains such as social skills,
self-confidence, willingness to talk to
adults, and motivation. Evaluations
that follow children into school report
improvements in the number of
children entering school, age of entry,
retention, and performance.
Of the six parenting interventions using
home visiting that were evaluated,
four found positive effects on child
development. The remaining two
parenting programmes used group
sessions with mothers. In one, mothers
practice skills to play with their children,
with demonstrated short- and longterm
effects on child development.
In the other programme, sessions
include information, but no activities.
The mothers’ knowledge increased,
but no impact on child development
was demonstrated. Effective parenting
programmes need to be designed to
help parents improve their skills with
children. One approach is to emphasise
skill-based activities involving children.
Five of the six community-based
programmes illustrate the beneficial
effects of integrating ECD programmes
into existing community-based systems.
The remaining programme shows
how reduced gains occur when child
development interventions are not
delivered with a sufficient level of
intensity.
The size of the effect ranged from
one third to almost two standard
deviations (effect sizes). Given these
effect sizes, if there were coverage
of 90% of disadvantaged children
COORDINATORS’ NOTEBOOK: ISSUE 29