Effect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0-36 months: A systematic review and meta-analysis
Archives of Disease in Childhood
BMJ Publishing Group
School of Arts and Humanities / Kurongkurl Katitjin
Objective: To determine the effect of early childhood development interventions delivered by healthcare providers (HCP-ECD) on child cognition and maternal mental health. Design: Systematic review, meta-analysis. Setting: Healthcare setting or home. Participants: Infants under 1 month of age. Interventions: HCP-ECD interventions that supported responsive caregiving, early learning and motor stimulation. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews were searched until 15 November 2021. Studies reporting prespecified outcomes were pooled using standard meta-analytical methods. Main outcome measures: Cognitive development in children at 0-36 months. Results: Forty-two randomised controlled trials with 15 557 infants were included in the narrative synthesis. Twenty-seven trials were included in the meta-analyses. Pooled data from 13 trials suggest that HCP-ECD interventions may improve cognitive outcomes in children between 0 and 36 months (Bayley Scales of Infant Development version IIII (BSID-III) mean difference (MD) 2.65; 95 % CI 0.61 to 4.70; 2482 participants; low certainty of evidence). Pooled data from nine trials suggest improvements in motor development (BSID-III MD 4.01; 95 % CI 1.54 to 6.48; 1437 participants; low certainty of evidence). There was no evidence of improvement in maternal mental health (standardised MD -0.13; 95 % CI -0.28 to 0.03; 2806 participants; 11 trials; low certainty of evidence). Conclusions: We report promising evidence, particularly for cognitive and motor outcomes, of the effect of HCP-ECD interventions. However, effect sizes were small, and the certainty of evidence ranged from very low to moderate. Additional high-quality research is required. PROSPERO registration number: CRD42019122021.