The impact of an integrated nurturing care intervention to improve early childhood development outcomes in Nampula Province, Mozambique

Abstract Objective: To estimate the effect of integrating responsive care, early learning and development monitoring into a community-based package of activities on nutrition, sanitation and hygiene, on improvements in early childhood development (ECD) outcomes. Design: This was a quasi-experimental study with nonequivalent comparison groups. The study’s primary outcome, ECD, was measured using the Ages and Stages Questionnaire (ASQ-3) and the Global Scales for Early Development (GSED). We also collected data on the early learning home environment, nutritional practices and caregiver depressive symptoms as secondary outcomes. Setting: This study was conducted across twelve districts in Nampula Province, Mozambique. Half of the districts received holistic nurturing care with responsive care, early learning, nutrition, sanitation and hygiene packages (intervention) and the other half received only nutrition, sanitation and hygiene packages (comparison). Participants: We recruited an age-stratified random sample of 961 caregivers and their children, aged 0–23 months. Results: We found a significantly higher mean caregiver engagement total score (mean difference: 0·36; P ≤ 0·001) and a higher number of activities to support learning (mean difference: 0·30, P = 0·004) in the intervention group than in the control. There were no measurable impacts on the remaining early stimulation activities or the primary outcomes of the ASQ and GSED developmental scores. Conclusions: We discuss the challenges in the integration of nurturing care interventions into existing programmes in high-vulnerability contexts, highlighting the aspects needed to achieve effective caregiver behavioural changes that can translate into improved ECD outcomes.