A pragmatic randomized maternal education trial in rural Uganda - Eight years of sustained improvement in child development

Background Nutrition and stimulation interventions may promote early childhood development, but little is known about the long-term benefits of such interventions, particularly in low- and middle-income countries. We now conducted a follow-up study on a cluster-randomized maternal education trial that was conducted when their children were 6–8 months old, to assess the sustainability of the developmental benefits eight years after the intervention. Methods and findings The intervention consisted of education in nutrition, hygiene, oral sanitation and child stimulation. In the current study, we assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention (TOVA). Using Stata version 17.0, t-tests and multi-level regression were employed to compare scores from KABC-II and TOVA tests in the two study groups adjusting for clustering effect. The data were analyzed by intention-to-treat. The original trial included 511 mother-child pairs (intervention n=263, control n=248), whereas in the current study, 361 (71%; intervention n=185, control n=176) pairs were available for analyses. The intervention group scored higher than the controls (all P-values<0.001) on all five KABC-II sub-scales, as well as on the KABC-II global score (mean difference: 14, 95% CI: 12–16; P<0.001). Furthermore, for all five TOVA variables, the intervention group scored higher than the controls in both the visual and auditory tasks (all P-values <0.05).  The main limitation is that we were unable to determine the exact individual contribution of each component (nutrition, hygiene and stimulation) of the intervention to the developmental benefits since they were all delivered as a combined package. Conclusions The intervention group consistently scored markedly higher on both psychometric tests. Thus, even eight years after the original maternal education intervention, the developmental benefits that we observed at child age of one, two and three years, were sustained. The data was collected through field-work where we approached the study participants in their home communitites. We then cleaned the data, analyzed them statistically and finally interpretated the findings. More details can be found in the Method-section of the paper.