EN-REACH: Every Newborn - Reach up Early Education intervention for All Children in Bangladesh, Nepal & Tanzania

The Sustainable Development Goals (SDGs) target the unfinished agenda for child survival with 5.3 million deaths of children before their fifth birthday. Importantly, the SDGs also reflect families' and national governments' aspirations that all children thrive as well as survive, meeting their full developmental potential. Unfortunately, children most at risk include those with neurodevelopmental delays and developmental disabilities like cerebral palsy, who are less likely than their peers to access pre-primary and primary school education. Whilst 48% of low- and middle-income countries (LMIC) countries have policies to address pre-primary education, there remain major gaps in provision, and major gaps for evidence-based, feasible approaches that are inclusive of children with NDD/D.

OPPORTUNITY: 'Reach Up' (a Jamaican home visiting programme) is one of the most evidence-based parenting programmes to support early child development and educational outcomes. Effects have been seen into adulthood, including increased earning power. Up until now 'Reach Up' has focused on children under 3 years of age and has not included those with severer developmental delays and disabilities. Effects on pre-school readiness children at the age of 5 years, an important factor in longer term educational achievement, have not to date been examined and is the focus of the 'Every Newborn-Reach Up Early Education Intervention For All Children' (EN-REACH) research

PARTNERSHIP: Our proposal builds on a well-established, equitable partnership since 2015 between three leading research institutions in Bangladesh, Nepal and Tanzania and the UK. We have a cohort of 2,000 children, now aged 2-3 years, in these three countries to compare accuracy and feasibility of range of early child development (ECD) assessment tools, known as the EN-SMILING study. EN-SMILING is partnering with the World Health Organization and UNICEF, to contribute to accurately measuring ECD and detecting disability early in children in LMICs and provides. It provides a timely opportunity to rigorously test more feasible ways to improve educational outcomes for all children, including those with disabilities.

OBJECTIVES:
The EN-REACH study has 3 objectives:

Objective 1: INNOVATION
To adapt the existing "Reach Up" parenting package to include those with disability and additional materials to support pre-school readiness for all children.

Objective 2: IMPACT EVALUATION
To conduct a 'quasi-experimental' research study to compare early child development markers for school readiness and other important development, health and well-being outcomes for children and their families between those receiving the adapted "Reach-Up" package, and those who did not.

Objective 3: IMPLEMENTATION:
To improve our understanding of important factors in implementing the new adapted 'Reach up' package to support integration of the package into routine child health systems if it is found to be effective.

IMPACT EXPECTED:
EN-REACH could have significant impact for children in these three high priority countries, both for education and care of children at risk of poor developmental outcomes, with strong links to national and global policy including MoHs WHO, UNICEF and many stakeholders. Direct research benefits will include identification and roll-out of testing tools to screen children for developmental delay and disability to ensure early detection of difficulties. This research would enable understanding of acceptability of the parenting package to be inclusive of children with disability more widely across Africa and Asia. Since the team have a 5-year track record of collaborative work, with strong site teams and have proven ability to deliver outputs and joint publications throughout 2020, ongoing effective work can be anticipated despite the COVID19 pandemic.

Sustainable Development Goals (SDGs) include targets for the unfinished child survival agenda, given 5.3 million deaths of children before their 5th birthday, half in the neonatal period. SDG target 4.2 aims that, by 2030, all children access quality early child development (ECD), pre-primary education and are ready for primary education. However, children most at risk of poor educational outcomes, including those with neuro-developmental delay and disability (NDD/D), are less likely to access school, including pre-school services.

This proposal, co-led by Dr Jena Hamadani of iccdr,b and Prof Joy Lawn of LSHTM is called EN-REACH (Every Newborn - Reach up Early Education intervention for All CHildren) and will evaluate the impact and implementation of an adapted 'Reach Up' parenting program in in Bangladesh, Nepal & Tanzania with three objectives:

Objective 1: INNOVATION: To adapt 'Reach Up' parenting package for ECD for all children, inclusive of those with NDD and disability, in three diverse low-and middle- income countries (LMIC).

Objective 2: IMPACT EVALUATION: To use a quasi-experimental design to measure early child development markers for school readiness (cognition, psycho-social, etc), and child and caregiver quality of life after receiving the adapted "Reach-Up" package (delivered to 50% of the cohort, est:1000 children), compared to the other 50%.

Objective 3: IMPLEMENTATION: To undertake process evaluation of implementation, including examining barriers & enablers for uptake of adapted "Reach Up" package integrated into routine health systems.

EN-REACH aims to have significant impact for children and their families, at country level and on global policy for care of children with disabilities through links with global organisations such as UNICEF and WHO. This study will provide evidence on effectiveness and acceptability of a disability-inclusive and scalable parenting package in diverse Asian and African settings.