Improving early childhood development in rural Ghana through scalable low-cost community-run play schemes

• Register: ISRCTN
• Last refreshed on: 11 June 2018
• Main ID: ISRCTN21215509
• Date of registration: 16/05/2018
• Prospective Registration: No
• Primary sponsor: Institute for Fiscal Studies
• Public title: Improving early childhood development in rural Ghana through scalable low-cost community-run play schemes
• Scientific title: Improving early childhood development in rural Ghana through scalable low-cost community run play schemes : a cluster randomised controlled trial
• Date of first enrolment: 11/07/2017
• Target sample size: 2400
• Recruitment status: Completed
• URL: http://isrctn.com/ISRCTN21215509
• Study type: Interventional
• Study design: Evaluator-blinded randomised controlled cluster study; (Quality of life)

Countries of recruitment

Ghana

Contacts

• Name: Sonya Krutikova

Key inclusion & exclusion criteria

Inclusion criteria: There are three kinds of participants in the study; target children, volunteer mothers, and kindergarten teachers. The inclusion criteria are as follows:
1. Children
To be part of the intervention, children have to be attending the kindergarten of one of the 40 treatment schools. They can be either male or female. Officially only those aged 4 and 5 are supposed to be attending kindergarten, however in reality there are many children who attend that are not in this age range. Of these total participants, a subset will be chosen to be part of our sample and therefore surveyed. These children are chosen as a random sample of all children meeting the following inclusion criteria:
1.1. Aged 3-5 years as of the start of the school term 11th September 2017
1.2. Reported in July 2017 that they are either currently attending one of the 80 study schools or intend to do so come the start of school term in September 2017
2. Mothers
Volunteers in the place scheme can be anyone willing to take part as long as they are female – this is because a major focus of the program is on female empowerment. Our sample of volunteer mothers to be surveyed will be made up from the sample of primary caregivers. Hence to be eligible to be surveyed, individuals must be the primary caregiver of one of the sampled target children.
3. Teachers
The only requirement of kindergarten teachers is that they are a teacher in one of the study schools as of the start of the intervention in October 2017. All kindergarten teachers in the study schools will be surveyed.

Exclusion criteria: Inclusion criteria not met.

Age minimum:
Age maximum:
Gender: Both

Health Condition(s) or Problem(s) studied

Childhood cognitive, socio-emotional, and motor development and hygiene practices.
Mental and Behavioural Disorders
Child development

Intervention(s)

The intervention focuses on unlocking the potential of caregivers, both mothers and teachers, training and empowering them with the knowledge, skills and confidence to run educational Play Schemes in kindergarten classes and provide better care and stimulation at home, using local materials. The intervention will be carried out by Lively Minds, an award-winning organisation that has been running the programme in rural Ghana (as well as Uganda) for 8 years. The structure of the program is as follows:
1. Kindergarten teachers trained at centralised workshops. There are ten practical and participatory sessions, which cover the importance of education and play, classroom management, how to use and make games, and how to train Mothers.
2. Teachers train 30 Mothers in their community. Training includes two community meetings and nine participatory workshops. It is designed for women who are illiterate and have never been to school. Content includes how to make and play games, child-friendly teaching, and health practices. The syllabus uses behaviour-change and play-based approaches to transform mindsets, gain buy-in and volunteerism. Teachers are supervised and supported by high performing Kindergarten Teachers from schools with existing Schemes.
3. Play Schemes run. A different group of 7 Mothers come into kindergarten each day of the week for an hour. 6 Mothers teach 30 kindergarten children indoors (1:5 parent child ratio). The remaining children and Mothers participate in outdoor play. The teachers supervise. Children learn by playing with a variety of games that strengthen six different skillsets (counting/numeracy; matching/sorting; imagination and creativity; reading/books; sensory awareness; and physical education). These crosscutting skills develop executive functions, providing the foundation for learning. Teaching uses discovery and play-based methods, rather than rote method which is the norm in school.
4. Health and hygiene activities are incorporated.Child

Primary Outcome(s)

The primary outcome is children’s cognitive and socio-emotional developmental outcomes. We will measure developmental outcomes of the child, through the use of the International Development and Early Learning Assessment (IDELA) tool, developed by Save the Children. This provides measures of development along 5 core domains; emergent numeracy, emergent literacy, socio-emotional skills, motor skills, and executive function. The full set of primary outcomes will be measured at two timepoints; baseline - before the start of the intervention (September 2017), and endline - soon after the end of the intervention 10 months later (August 2018). In addition a reduced form of the IDELA will be delivered at midline - the midway point of the intervention (March 2018).

Secondary Outcome(s)

All of the following will be measured at baseline and midline:
1. Target children’s health outcomes - we will collect data on the incidence of diarrhoea, fever and respiratory infections using the definitions of the WHO as measures of morbidity. We will also measure arm circumference.
2. Developmental outcomes of siblings - we will measure the development of younger siblings through the Caregiver-Reported Early Development Index (CREDI) short form, and of older siblings through Ravens progressive matrices and tests of basic literacy and numeracy. Child pre-school attendance and participation in the Play Schemes - the household survey will collect details on target child’s pre-school attendance.
3. Maternal knowledge of child stimulation and care practices - we will collect information on the mother’s knowledge of stimulation and care practice, and her beliefs regarding the importance of these for children’s development. To test knowledge, we will rely on a selection of items from the Knowledge of Infant Development (KIDI).
4. Psychological well-being of primary caregivers - We will measure psychological wellbeing outcomes of primary caregivers through the use of two scales: the SRQ-20 measure of depression and the Rosenberg measure of Self-esteem.
5. Enhanced quantity of resources allocated to child within the households - the presence of toys and learning materials in the house will be assessed together with parental involvement with the child, the child’s routines and organisation of the child’s time inside and outside the family house. This will be assessed using the Family Care Indicators, developed by UNICEF.
6. Target children’s hygiene knowledge - we will construct a hygiene knowledge score based on child’s responses to questions such as what are good times to wash your hands, what material is needed to wash hands and what are reasons for why washing hands is important.
7. Pre-school engagement of primary caregivers - we collect data on the frequency of primary caregivers’ school visits and the extent to which they know the teacher’s name
8. Teacher wellbeing, teaching practices and knowledge - we will measure outcomes of teachers using an instrument developed in a previous study in Ghana. This includes a variety of measures including teacher presence, practices, burnout and job satisfaction. The SRQ-20 will also be administered to teachers to assess their mental wellbeing. Given the small sample size of teachers in our study, however, we may not have sufficient power to detect significant impacts on this outcome.

Secondary ID(s)

AEARCTR-0002777

Source(s) of Monetary Support

Jacobs Foundation , Global Innovation Fund

Ethics review

Status:
Approval date:
Contact:

1. University College London (UCL), UCL Ethics Committee, 11/07/2017, 10167/001 2. Innovations for Poverty Action (IPA) - USA, Ethics Review, 21/06/2017, #14340 3. Ghana Health Services Ethics Review Committee (GHSER), 03/09/2017, GHSERC012/07/17

Results

• Results available: Yes
• Date Completed: 14/06/2019