SPRING KILKAARI(Sustainable PRogram Incorporating

Nutrition and Games)

Dr Gauri Divan , Sangath

gauri.divan@sangath.in

IFPRI POSHAN, New Delhi 2016

Theoretical underpinning of the impact of promoting ECD on neural processes

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SPRING• Evaluating an innovative feasible, affordable and sustainable

intervention package delivered through home visits to mothers from pregnancy through the first two years of the life in order to maximize child growth and development in India and Pakistan.

• In India, the SPRING-Kilkaari intervention is being delivered by a new cadre of community based agents- the Kilkaari worker.

• District Rewari, State of Haryana in North India

SPRING KILKAARI

• To evaluate the effectiveness of the Kilkaari intervention through a cluster randomised control trial and assess its impact on stunting and cognition

• SPRING Kilkaari is informed by the • WHO-UNICEF Care for Child Development,

• WHO Infant & Young Child feeding guidelines

• Cognitive behaviour therapy.

SPRING CONCEPTUAL FRAMEWORK

Outcomes

Key Evaluations around at 12 and 18 months of age

Child growth and feeding patterns

Child cortisol levels to evaluate impact on early life stress

Child development ( cognition)

Maternal mental health, efficacy and decision making

Baseline findings of interest ( 2014)

• Eligible women (n=13, 431)• 35% finished high school

• 82% institutional deliveries

• 51% initiated breastfeeding within one hour ( n=2,771)

• 46% stunting (n=1,654: 17-35 months)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Age in months

Excl. BF Solids Or Semi-Solids

Feeding by age ( n=5405)

SPRING KILKAARI Intervention

• Delivered by program worker who shares similar characteristics to the current workers in government programs (ASHAs and Aangawadi Workers).

• 27 monthly visits are conducted at home from pregnancy until 2 years of age.

• A maximum of four key messages per visit.

• Messages are repeated and scaffolded across visits.

Kilkaari Intervention Booklet

I. FETAL GROWTH AND DEVELOPMENT

II. INFANCY

III. TODDLERS

Day 0

Day 1000

© Bill & Melinda Gates Foundation |

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SPRING KILKAARI Supporting growth to 2 years of age

SUPPORTIVE SUPERVISION

Individual Supervision Group Supervision

Once a month , field based Once a month, centre based

Used to track the quality and

performance of the individual KW

Addresses common issues and

challenges

Allows individual feedback to support

skill building

Supports peer group learning

Supervision adopts the Kilkaari principles of being empathetic to the workers’ issues,

helping them problem solve and supporting them with new strategies

Use of a checklist to monitor KW skills

LESSONS LEARNT DOMAIN LESSONS LEARNT

Worker Child Development worker is an acceptable and feasible delivery agent for ECD

messages

Characteristics may need to take into account cultural aspects for an

intervention which is delivered at home

Child development worker can be made responsible for developmental

surveillance to identify and support children with delays

Adaptation Need to understand cultural family dynamics - mother in law as key decision

maker

Content of messages e.g., acceptable foods

Integrate cultural roadblocks e.g., lack of access in early post-natal period

Training

Materials

Training manuals to be integrated into intervention manuals to increase

usability of resources

Training Workers need to understand not just the ‘why ‘of child stimulation but also the

‘how’

Next steps

• Long term follow up of this cohort

• Partnerships for implementation sites

• Design a package for 25-72 months to address the needs of SDG 4 Target 4.2

• By 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education

Acknowledgements

Kamalkant Sharma, Reetabrata Roy, Neha Hooda, Neha Singhal, Ruchi Sareen

Partners in

Institute for Global Health, Faculty of Population Health Sciences, UK; Faculty of Epidemiology and

Population Health, London School of Hygiene and Tropical Medicine, UK; Institute of Psychology

Health and Society, University of Liverpool, UK