Counting outcomes, coverage and quality for early child development programmes

Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada®-funded Saving Brains® ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a 'theory of change' based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind

The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review

Background: Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. Methods and Findings: We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. Conclusions: Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes

Counting outcomes, coverage and quality for early child development programmes

Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada®-funded Saving Brains® ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a 'theory of change' based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind

Number of studies on care seeking behaviour, by the 5 countries with the highest number of under-five deaths¹.

1<p>The five countries with the highest number of under-five deaths were taken from the annual report by the UN Interagency Group for Child Mortality Estimation <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0093427#pone.0093427-UNICEF1" target="_blank">[1]</a>.</p

The median percentage of caregivers who sought healthcare, by disease (Asia)¹.

1<p>The range is shown in brackets if there are two or more data points. The definition of each category of healthcare is stated in the methods. The values do not add up to 100% because of the varying categorisation of healthcare providers in the included studies and because some studies recorded more than one care seeking event.</p>2<p>Appropriate health facilities included all government and trained private health practitioners, but not traditional healers, pharmacies and unqualified medical practitioners.</p>3<p>Abbreviations: Gov  =  Governmental; CHW  =  Community Health Worker; Trad. Healer = Traditional Healer; ORT  =  Oral Rehydration Therapy; -  =  no data available.</p

The median percentage of caregivers who sought healthcare, by disease (all continents)¹.

1<p>The range is shown in brackets if there are two or more data points. The definition of each category of healthcare is stated in the methods. The values do not add up to 100% because of the varying categorisation of healthcare providers in the included studies and because some studies recorded more than one care seeking event.</p>2<p>Appropriate health facilities included all government and trained private health practitioners, but not traditional healers, pharmacies and unqualified medical practitioners.</p>3<p>Abbreviations: Gov.  =  Governmental; CHW  =  Community Health Worker; Trad. Healer = Traditional Healer; ORT  =  Oral Rehydration Therapy.</p

The median percentage of caregivers who sought healthcare, by disease and continent¹.

1<p>The range is shown in brackets if there are two or more data points. The definition of each category of healthcare is stated in the methods. The values do not add up to 100% because of the varying categorisation of healthcare providers in the included studies and because some studies recorded more than one care seeking event.</p>2<p>Appropriate health facilities included all government and trained private health practitioners, but not traditional healers, pharmacies and unqualified medical practitioners.</p>3<p>Abbreviations: Gov  =  Governmental; CHW  =  Community Health Worker; Trad. Healer = Traditional Healer; ORT  =  Oral Rehydration Therapy; -  =  no data available.</p

Studies retrieved from literature search.

1<p>This number includes studies found through searching the references of already included studies.</p>2<p>Five studies examined two diseases, two studies examined all three diseases and three studies contained data on both recognition of disease and care seeking.</p

Features of studies on care seeking behavior.

1<p>Simulated case studies presented caregivers with a scenario of an illness in their child and asked whether and where he/she would seek care.</p>2<p>Rural/urban refers to studies that were carried out in both urban and rural areas.</p

Characteristics of studies on recognition of illness.

1<p>This is the mid-year of data collection. If the date of data collection was not stated, year of publication was used instead.</p