Identifying the Common Elements of Early Childhood Interventions Supporting Cognitive Development in Low- and Middle-Income Countries

Abstract

Psychosocial interventions for infants and young children in low- and middle-income countries (LMICs) have great potential, but there is a large and diverse range of techniques and procedures used within them, which poses challenges to evaluating and adapting them for scale-up. Our objective was to review psychosocial interventions conducted in LMICs to improve young children’s cognitive outcomes, and identify common techniques used across effective interventions. We systematically searched for relevant reviews using academic databases (PsycINFO, Web of Science, PubMed) and subject-specific databases (EPPI Centre, WHO Global Health Library, UNICEF Publications Database) for publications dated up to March 2021. Reviews of psychosocial interventions aimed at parents and children in LMICs, measuring child cognitive outcomes, were eligible. Study selection was performed in duplicate. Review characteristics and effectiveness data were extracted, with a proportion checked by a second reviewer. AMSTAR2 was applied to assess review strength. The PracticeWise coding system was used to distil practice elements from effective interventions. We included ten systematic reviews demonstrating evidence of effectiveness. Comprehensive interventions of higher intensity and longer duration yielded better results. From these reviews, 28 effective interventions were identified; their protocols and/or linked publications were coded for common practice elements. Six elements occurred in ≥ 75% of protocols: attachment building, play/pretend, psychoeducation, responsive care, talking to baby, and toys use. Interventions and reviews were highly heterogenous, limiting generalizability. LMIC-based psychosocial interventions can be effective in improving children’s cognitive development. Identifying common practice elements of effective interventions can inform future development and implementation of ECD programs in LMICs.