Bundled parenting and nutrition outreach program may positively influence the developmental and nutritional outcomes of siblings of targeted children

1. Siblings of children receiving bundled parenting and nutrition intervention had better expressive language development, fewer internalizing behaviors, and improved dietary intake compared to siblings of children who did not receive the intervention. 

2. When compared to caregivers in the control group, both mothers and fathers receiving the intervention showed more responsive caregiving behaviors towards the sibling of the targeted child. 

Evidence Rating Level: 2 (Good)     

Study Rundown: Lack of socio-emotional and cognitive stimulation, along with nutritional deficiencies, put children at risk of falling short of their developmental potential. Interventions that bundle counseling on parenting and nutrition have become increasingly popular in low- and middle-income countries to address both risk factors at once. However, much of the evidence supporting these interventions has focused on the impact on one targeted child. The developmental outcomes of siblings have yet to be determined. This study evaluated the effect of a bundled parenting and nutrition intervention on developmental, nutritional and caregiving-related outcomes in siblings of targeted children. The intervention was performed in 118 multiple-children households in Mara, Tanzania with 104 non-intervention households serving as controls. Compared with controls, siblings of intervention subjects had greater dietary diversity and expressive language development. Both mothers and fathers in intervention households engaged more with the sibling child and showed more responsive behaviors than did the caregivers in control households. This study demonstrates that siblings of targeted children may benefit from a bundled parenting and nutrition intervention. It contributes to the literature on spillover effects from early childhood interventions, and has important implications for our understanding of the magnitude of the impact of these programs on families. Future research should explore whether the spillover effect is diluted in larger households. 

Click to read the study in Pediatrics

Relevant Reading: Early childhood development caregiver training and neurocognition of HIV-exposed Ugandan siblings

In-Depth [cluster-RCT]: This was a sub-study within a larger trial, the ‘Engaging Fathers for Effective Care for Nutrition and Development in Tanzania Study’ (EFFECTS). EFFECTS aimed to investigate the impact of engaging fathers compared to mothers on the outcomes of a bundled parenting and nutrition intervention versus a nutrition intervention only. This sub-study evaluated a total of 222 two-children households, with 118 receiving the intervention and 104 serving as controls. Each household had a child younger than 18 months of age who was targeted by the intervention, and a sibling younger than six years of age. The sample included families with more than two children but only evaluated outcomes of the youngest sibling. The intervention families received 24 sessions delivered by government community health workers who educated caregivers on child nutrition, socio-emotional and cognitive stimulation, and positive couple’s relationship dynamics. Outcomes measured were child development using the Mullen Scale for Early Learning tool, child nutrition according to the number of food groups consumed in the previous day, and family caregiving based on the self-reported and observed frequency of socio-emotional and cognitive stimulating behaviors. Regression analysis was applied between outcomes of the youngest sibling in each intervention household and those in control households. Intervention sibling children had greater expressive language development scores (ꞵ = 0.33 [95% CI: 0.03 to 0.62]) and fewer internalizing problems (ꞵ = -0.56 [-1.07 to -0.06]) than control siblings. Intervention sibling children also had greater dietary diversity (ꞵ = 0.52 [0.10 to 0.93]) and were more likely to achieve minimum dietary diversity (odds ratio = 3.65 [1.21 to 11.05]) than control siblings. Stimulating behaviors from both mothers (ꞵ = 0.31 [0.01 to 0.61]) and fathers (ꞵ = 0.33 [0.02 to 0.65]) towards the intervention sibling children were greater than those towards control siblings. 

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