Intervention Design
developmental disorder
The intervention was developed in consultation with a technical working group composed of public health experts, pediatricians, nutritionists, child psychiatrists, developmental disorder experts, LHVs, and mothers.In the intervention arm, at least 1 LHV at each facility was given a 2-day training on delivering the intervention package. The competence of the LHV to deliver the ECD care was assessed using an adapted checklist. LHVs scoring 80% or above on the competence checklist were allowed to deliver ECD care. LHVs scoring less than 80% were retrained until they met the threshold for competence. The fidelity of LHV was assessed through observation by project staff.The LHVs delivered the ECD care package to each mother-child dyad individually in 3 quarterly sessions. The average duration of each session was 30 minutes. Sessions were conducted in developmental order, starting from the chronological age level and progressing to the next session on a quarterly basis. Each session comprised age-appropriate key strategies to enhance children's mental health and physical growth (Key Messages of the Integrated Early Childhood Development Care Intervention in Punjab, PakistanEngage your child in a playful activity (hide-and-seek) and guide him/her to find you through your voice.Appreciate your child for participating and helping with routine activities.Help your child identify new objects and words with the help of images.Encourage your child to get involved in everyday chores by giving him/her easy instructions.Show your child a colored shoe or sock and ask him/her to find the other.Encourage your child to balance on 1 leg while you hold his/her hands.Take your child out for a walk while holding his/her finger (as per the child's needs). Encourage him/her to follow simple instructions and assist them in identifying new items as they walk.Urge the child to squeeze a damp sponge or piece of cloth.Encourage the child to collect their toys in a basket and turn it over.Encourage your child to imitate your bodily movements and show him/her your appreciation for it (by clapping hands, rolling out your tongue).Make your child eat his/her meals 3 times a day with the family. As per the child's need, soften the food bits. Breastfeed the child if he/she is hungry in between the 2 meals.A healthy diet keeps the child disease-free. To keep the food clean, wash your hands with soap, use clean utensils, and cover food before having/preparing it.Encourage your child to eat his/her meals on their own while having food with all the family members.Encourage your child to push his/her arms through sleeves and legs through pants while changing clothes.Help your child to learn and pronounce new words by showing him/her items and describing them.Show your child animals and imitate their noises to help him/her recognize new sounds. Also, encourage your child to imitate these sounds, such as "cat meows."Show your child an object, and ask him to identify similar objects in the house such as a fan, chair, etc.Show the child how to kick a ball and encourage him/her to kick and then chase it themself.Instruct the child to pick an object, bring it, and then put it back.Play with blocks with your child and while counting teach him/her how to put 1 block over the other.Encourage your child to doodle on a piece of paper.Show your child how to arrange 2 or more items in an order, then have them repeat it.Show your child how to wash her/her hands with soap by opening the tap and encouraging them to repeat it.Encourage your child to engage in daily household chores while playing with toys.Encourage your child to narrate to his/her family about a significant incident from the day.Encourage your child to use a 2- or more word sentence to describe what they need, such as "give water/ I need water."Help them to recognize new words and concepts such as empty, full, straight, and tilted while playing with cups and sand.Encourage your child to catch you while running in the park/garden.Encourage your child to jump from a small step/stair.Encourage your child to mix 2 or more food items in the bowl.Encourage your child to build a tower out of blocks by stacking them on top of 1 another.Draw 2 horizontal lines on a piece of paper and encourage your child to draw vertical lines in between them.The intervention content was based on the Ages and Stages Questionnaire-3 (ASQ-3) learning activities manual.In the control arm, LHVs provided routine care. To ensure LHVs took standardized measurements as well as recording and reporting, they received a 1-day training on taking and recording children's anthropometric measurements using growth monitoring cards. However, the training was limited to measurements, recording, and reporting and did not include any standardized intervention care on child development. The LHVs took and recorded the anthropometric measurements at every follow-up visit in the control arm.