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Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal control design
  1. Stella Maria Hartinger1,2,3,4,
  2. Claudio Franco Lanata3,
  3. Jan Hattendorf1,2,
  4. Jennyfer Wolf1,2,
  5. Ana Isabel Gil3,
  6. Mariela Ortiz Obando5,
  7. Magaly Noblega6,
  8. Hector Verastegui3,4,
  9. Daniel Mäusezahl1,2
  1. 1Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  2. 2University of Basel, Basel, Switzerland
  3. 3Instituto de Investigación Nutricional, Lima, Perú
  4. 4Universidad Peruana Cayetano Heredia, Lima, Perú
  5. 5Programa Nacional CUNA MAS, Lima, Perú
  6. 6Pontificia Universidad Católica del Perú, Lima, Perú
  1. Correspondence to Dr Daniel Mäusezahl, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Socinstr. 57, Basel 4051, Switzerland; Daniel.Maeusezahl{at}


Objective Stimulation in early childhood can alleviate adverse effects of poverty. In a community-randomised trial, we implemented 2 home-based interventions, each serving as an attention control for the other. One group received an integrated household intervention package (IHIP), whereas the other group received an early child development (ECD) intervention. The primary objective of the study was to evaluate the effect of IHIP on diarrhoea and respiratory infections, the details of which are described elsewhere. Here, we present the impact of the ECD intervention on early childhood development indicators.

Methods In this non-blinded community-randomised trial, an ECD intervention, adapted from the Peruvian government's National Wawa Wasi ECD programme, was implemented in 25 rural Peruvian Andean communities. We enrolled 534 children aged 6–35 months, from 50 communities randomised 1:1 into ECD and IHIP communities. In ECD communities, trained fieldworkers instructed mothers every 3 weeks over the 12 months study, to stimulate and interact with their children and to use standard programme toys. IHIP communities received an improved stove and hygiene promotion. Using a nationally validated ECD evaluation instrument, all children were assessed at baseline and 12 months later for overall performance on age-specific developmental milestones which fall into 7 developmental domains.

Findings At baseline, ECD-group and IHIP-group children performed similarly in all domains. After 12 months, data from 258 ECD-group and 251 IHIP-group children could be analysed. The proportion of children scoring above the mean in their specific age group was significantly higher in the ECD group in all domains (range: 12–23%-points higher than IHIP group). We observed the biggest difference in fine motor skills (62% vs 39% scores above the mean, OR: 2.6, 95% CI 1.7 to 3.9).

Conclusions The home-based ECD intervention effectively improved child development overall across domains and separately by investigated domain. Home-based strategies could be a promising component of poverty alleviation programmes seeking to improve developmental outcomes among rural Peruvian children.

Trial registration number ISRCTN28191222; results.

  • Lifecourse / Childhood Circumstances

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  • Contributors DM and CFL obtained the funding. DM, SMH and CFL conceived and designed the study. CFL, SMH, HV and AIG acquired the data. SMH, JW, JH, DM, CFL and MN analysed and interpreted the data. JW, SMH, MOO and JH drafted a first version of the manuscript. All authors critically revised and approved the final version of the manuscript.

  • Funding Financial support for this study was provided by the UBS Optimus, a Swiss private foundation. The funders of the study had no involvement in study design, data collection, analysis or interpretation of the data, nor were they involved in the writing of this paper or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Ethics approval Nutritional Research Institute, Peru and Swiss Cantonal Ethical Review Board (Ethikkommission Beider Basel, EKBB).

  • Provenance and peer review Not commissioned; externally peer reviewed.