Co-chairs
  • Ann C. Miller, PhD, MPH
  • Kim Wilson, MD, MPH

Globally, approximately 250 million children under 5 years of age are at risk of not reaching their full developmental potential. Children living in low- and middle-income countries (LMICs) are at increased risk of not reaching their developmental potential, due to poverty and its manifestations such as undernutrition, infectious diseases, exposure to heavy metals and toxins, exposure to psychosocial issues including maternal depression, domestic and societal violence and lack of access to quality healthcare. Besides the direct and immediate impact on children and their families, this has significant long-term implications for LMIC societies, in terms of lost human capital and increased costs to the health and education sectors.

The Global Health Partnership’s Early Child Development Working Group, housed within the Department of Global Health and Social Medicine at Harvard Medical School, is an interdisciplinary initiative that seeks to understand, analyze, innovate on, and help solve some of the most pressing developmental challenges facing children in resource poor settings. The Working Group brings together physicians, researchers, educators, and public health professionals to bring maximum impact to child development research, policy and programming.

ECD Working Group Objectives

The mission of the ECD working group is to promote healthy development for children in the world’s least-resourced settings.

Our Program Objectives include:

  • Increasing awareness of the needs and opportunities in global child development.
  • Proposing and implementing research to understand risk and protective factors in global child development.
  • Developing and evaluating interventions to address these factors
  • Fostering collaboration in global child development research across sites and disciplines, to promote equity in research representation.

Featured Initiatives

CASITA (Peru)

From 2014 to 2015, a community-based early childhood intervention (CASITA) using evidence-based strategies deployed by well-trained, well-supervised community health agents (CHAs) in the community was developed and pilot-tested in Peru by Socios En Salud. CASITA was designed to target the central sphere of the child’s environment—the family—and to ultimately support the healthy neurodevelopment of children at risk for delay through an intervention designed to increase caregiver knowledge, capacity, and self-efficacy at providing developmentally stimulating interactions with their young child. Additionally, CASITA focuses on providing caregiver socio-emotional support. CASITA was derived from an approach developed by Dr. Martha Vibbert at the SPARK Center at Boston Medical Center ("SPARK Center," 2019), and the pilot phase incorporated input from local families, providers, leaders, and CHAs to develop a model that could be readily scaled if proven effective In 2016-2020, CASITA was scaled to all of Carabayllo district and enrolled 3000 children through a grant from Grand Challenges Canada (Leonid Lecca, PI). At scale, CASITA also targets wider social spheres—other local parents as part of the group activities, and the macrosystem of community as a whole, through the implementation of community CASITA rooms and interactions with the District and National governments. CASITA was expanded and adapted in a south-to-south collaboration to Partners in Health, Lesotho. Current initiatives in 2021 include integrating with Socios En Salud’s maternal health initiative to provide a life course intervention for both maternal and child health and childhood development. Pilot results have been published (2016, 2019) and manuscripts regarding scale-up results in Peru and the Lesotho experience are under review.

Pediatric Development Clinic (Rwanda)

Global investments in safe birth and neonatal care have meant that more high-risk newborns survive the neonatal period than in the past. However, these infants remain at significant medical, nutritional, and developmental risk. In most LMICs, no follow-up system for early intervention for these vulnerable children exists. In 2014, Inshuti Mu Buzima, in collaboration with the Rwanda Ministry of Health with support from UNICEF and specialists from Boston Children’s Hospital implemented a novel Pediatric Development Clinic (PDC) to provide comprehensive follow-up with early intervention to at-risk under-five children, led by nurses and social workers in a district hospital and surrounding health centers in rural Rwanda. Nurses, social workers and doctors are provided with training in supporting high-risk babies. At each PDC visit, children undergo clinical/nutritional and developmental assessment and caregivers participate in counseling sessions. Through developmental monitoring using the Guide for Monitoring Child Development tool, children identified with developmental difficulties and disability are referred to early intervention program (EIP) parent support groups co-facilitated by trained expert parent and PDC care providers. Social assessments identify families needing additional social support. PDCs have been decentralized from 2 district hospitals to 8 health centers and health posts, to improve access to care for these infants and their families. Manuscripts describing the development, implementation and population of the PDC model have been published and evaluation of various aspects of the program is underway. The PDC model is being developed and adapted at APZU in Malawi as well.

Evaluating the Guide for Monitoring Child Development (Guatemala, India)

The Guide for Monitoring Child Development (GMCD), developed by Dr. Ilgi Ertem at Ankara University,  is a new individualized intervention for early childhood development designed for use in LMICs. The GMCD is a multi-component package including monitoring--based on a set of internationally-validated functional developmental milestones specific to the GMCD--and a parenting intervention to support development which includes individualized messages and guidance about nurturing care. The intervention is based on a family-cantered and strengths-based approach to child wellness. As such, it trains frontline health workers to communicate with participants using non-stigmatizing language about developmental differences, while at the same time assessing children’s ability to conduct age-appropriate activities in multiple domains. Two external expert panels have rated the GMCD as the highest-performing individual instrument available for monitoring, screening and early identification of developmental difficulties in LMIC, however, as yet, its efficacy for improving children’s development has not been tested. This initiative, funded by an NIH R01 grant awarded in 2021 (Peter Rohloff, Principal Investigator)  represents the first formal, controlled evaluation of the GMCD. Implementing organizations Wuqu’ Kawoq|Maya Health Alliance in Guatemala (an ECD Working Group partner) and Mahatma Ghandi Institute of Medical Sciences in India, will be supported by trainers from Umeed in India and Ankara University, and analysts from the Department of Global Health and Social Medicine at Harvard Medical School on this new initiative.

Partnerships

The Global Health Partnership includes
  • The Department of Global Health and Social Medicine at Harvard Medical School
  • The Division of Global Health Equity at Brigham and Women’s Hospital
  • Partners In Health, a Boston-based nonprofit that provides free medical care to poor patients in several countries.
Additional partners and collaborators in the Partnership’s Early Child Development Working Group include participants from
  • Boston University
  • Boston Medical Center
  • Boston Children’s Hospital
  • Socios En Salud (Peru)
  • Wuqu’Kawoq|Maya Health Alliance (Guatemala)
  • Partners In Health, Lesotho
  • Sangath (India)
  • Inshuti Mu Buzima (Rwanda)
  • PIVOT (Madagscar)
  • D-tree (Zanzibar)
  • Abwenzi Pa Za Umoyo (Malawi)
  • University of Rwanda
  • Boston College