Peer-reviewed article
Programmatic guidance for interventions to improve early childhood development in high HIV burden countries: a narrative review
Mark Tomlinson, Xanthe Hunt, Kathryn Watt, Sara Naomi Naicker, Linda Richter ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This narrative review of 197 studies examines how early childhood development programmes work in high HIV burden countries, particularly sub-Saharan Africa. The review finds that home visiting by trained non-professionals benefits children most, while professional delivery works better for parent outcomes. Programmes are most effective when they include regular sessions lasting at least an hour, run for 6-12 months, and achieve high attendance, with the greatest benefits reaching the most vulnerable children.
Key points
- Home visiting by trained non-professionals produced positive outcomes for children
- Professional delivery was more effective for improving parent outcomes
- Benefits were greatest for the most at-risk children, though parent benefits were less clear
- Programmes need high attendance, sessions of at least one hour, and duration of 6-12 months to be effective
- Early childhood care and education programmes delivered by both professionals and trained non-professionals showed positive outcomes
Limitations
As a narrative review, this synthesis does not employ systematic methods to identify or appraise studies, which may introduce bias in study selection and interpretation. The review does not provide detail on the quality of evidence from individual studies or quantify effect sizes, limiting ability to draw strong causal conclusions.
Abstract
Exposure to a multitude of risks, including food insecurity, poverty, and – perhaps most prominently – HIV can be damaging for early childhood survival, healthy growth and development. Yet, guidance regarding the implementation factors that contribute to early child development-focussed programme success is lacking in low- and middle-income countries broadly, and sub-Saharan Africa in particular. Having access to guidelines for practice and implementation could assist in improving the implementation of programmes to improve early childhood development. We conducted a narrative review of the literature with the goal of identifying how implementation features of these early interventions may influence the effectiveness of such work in the complex contexts which characterise this region. Our final review included 197 for final analysis. There were two primary cross-cutting findings. Firstly, the benefit for parents was less clear than they were for children, and secondly, while the benefits for children were clear, those most at risk benefited the most. Home visiting was found to be the predominant service delivery platform, and positive outcomes for children were reported when home visiting programmes were implemented by trained non-professionals, whereas positive parent outcomes were reported more frequently when delivered by professionals. In early childhood care and education programmes, positive outcomes for children and parents were reported when they were implemented by both trained non-professionals and professionals. Trained non-professionals facilitating parent groups produced similar benefits to groups run by professionals. Take-home lessons for successful programmes were that high levels of attendance, regular sessions of at least an hour duration, with the programme continuing for more than 6 months and closer to a year are key for effectiveness.