Introduction
adversity
A strong body of evidence demonstrates that the negative impacts of early adversity on child development in low- and middle-income countries (LMICs) can be mitigated through appropriate early life interventions [Community health workers (CHWs) in LMICs are increasingly being tasked with implementing home visit programs focused on child development. Evidence of the impact of early childhood services delivered by CHWs on child health and development is mixed, and in many settings, CHWs are overburdened and lack supportive supervision [Trials testing home visits and related early childhood interventions in LMICs have predominantly used linear growth and assessments of children’s skills as primary outcomes. Recent reviews of the science of child development have identified the need to include “direct assessments of the brain” in trials, in part to improve understanding of the neural mechanisms through which early interventions affect skill formation [We tested a primary hypothesis that a CHW-delivered home visit intervention would improve child development in South Africa.