Project Lead(s): Davidson Hamer
Recent research on brain development suggests that no single risk or developmental stress causes most harm; the main problem is the accumulated impacts of multiple early childhood adversities. Single risk factor interventions are, therefore, unlikely to achieve the highest possible impact on child development.
This project of the Zambia Centre for Applied Health and Development is designed as a comprehensive, integrated, community-based child development program, rolled out in Zambia’s Choma District.
The key innovation, and a critical improvement over previous efforts: establishment of a new cadre of health workers with the sole, explicit mission to monitor and support all aspects of child development under the age of 2.
The newly-trained, community-based “child development agents” (CDA) will form a natural link between mothers and the larger health system, including community health workers.
The CDA will have three principal responsibilities: monitor children’s nutritional status on a monthly basis through home visits, and ensure immediate treatment of moderate to severe malnutrition and acute infections (malaria, diarrhea, and pneumonia) through local CHWs or public health facilities as needed; ensure all children receive the full health benefits as defined in national guidelines, including exclusive breastfeeding to 6 months of age, a complete set of vaccinations, vitamin A supplementation, growth monitoring, and deworming every 6 months starting at 12 months of age; coordinate local selected volunteer mothers in running a home -based stimulation component similar in nature to the ones successfully implemented in Cambodia.
CDAs will be supported with mobile health technology to ensure continuous and efficient communication, monitoring and close implementation of service protocols.
The mobile device will serve three principal functions: provide weekly visit reminders and a list of health services for mothers and children who missed services or appointments; allow CDAs to communicate with local CHWs and health facility staff to ensure immediate treatment of acute health conditions; support CDAs with visual materials (videos) to compliment their weekly training with volunteer mothers
Each CDA will be responsible for 250 households, which corresponds to approximately 50 to 60 children under the age of 2 in their communities. CDAs will enroll eligible mothers and their child in the study, and then will be responsible for the health and development of the respective child up to 24 months of age. Each week, the CDA will be sent a list mothers and children who missed a scheduled services or appointments through an automated electronic system; list of children that should be visited in the respective week for the monthly nutrition and health follow-up well; and reminder of content of early childhood learning sessions to support child nurturing. They will be monitored by CDA supervisors on a regular basis, and will be given verbal feedback on their performance. In each month, the best 10% of CDAs will receive a symbolic “CDA of the month” award.
The project will directly benefit 225 children in the short term, and, the hope, all Zambian children in the long run. Its main targets: reduced stunting and improved child development at age 2.
Says project leader Dr. Davidson Hamer: "The program has the potential to transform how mothers think about child development and early education, and to increase maternal understanding of age-appropriate development and cognitive stimulation.”
Project collaborators include America’s Harvard School of Public Health, and the Center for Global Health and Development at Boston University, and Zambia's Centre for Infectious Diseases Research and Ministry of Health, Child Health Unit.