Effect of a home-based health, nutrition, and responsive stimulation intervention and conditional cash transfers on child development and growth: a cluster-randomized controlled trial in Tanzania

Abstract

Introduction: Evidence on the effect of community health worker (CHW) interventions and conditional cash transfers (CCTs) on child growth and development in sub-Saharan Africa remains sparse. Methods: We conducted a single-blind, cluster-randomized controlled trial of an integrated home-visiting health, nutrition, and responsive stimulation intervention alone and in combination with CCTs to promote antenatal and child clinic attendance from 2017 to 2019 in rural Morogoro region, Tanzania. Pregnant women and caregivers with a child <1 year of age were enrolled. Twelve villages were randomized to either a (i) CHW (n=200 participants), (ii) CHW+CCT (n=200), or (iii) control arm (n=193). An intention-to-treat analysis was conducted for the primary trial outcomes of child cognitive, language and motor development assessed with the Bayley Scales of Infant and Toddler Development and child length/height-for-age z-scores (HAZ) at 18-months of follow-up. Results: The CHW and CHW+CCT interventions had beneficial effects on child cognitive development as compared to control (standardized mean difference (SMD): 0.14; 95% confidence interval (CI): 0.05, 0.23 and SMD: 0.17; 95% CI: 0.10, 0.23, respectively). The CHW+CCT intervention also had positive effects on language (SMD: 0.08; 95% CI: 0.02, 0.14) and motor development (SMD: 0.15; 95% CI: 0.03, 0.27). Both CHW and CHW+CCT interventions had no effect on HAZ in the primary analysis; however, there were statistically significant positive effects in multivariable analyses. Conclusion: Integrated CHW home-visiting interventions can improve child cognitive development and may have positive effects on linear growth. Combining CHWs with cash transfers may provide additional benefits on selected outcomes.