Review of early childhood development interventions — Beukes et al.

This review investigates the types and extent of early childhood development (ECD) interventions in Sub-Saharan Africa using the Nurturing Care framework (NCF). The review includes 21 randomized-controlled trial (RCT) studies conducted in 13 countries, mainly in Eastern and Southern Africa, and published between 2019 and 2024. Target of the interventions were 0-8 years old children, and sample sizes varied from 134 to over 9000 participants. Of the single-focused interventions, nutrition-focused interventions were the most common (n = 9) showing positive impact on child weight and growth. Responsive caring interventions (n = 2) resulted in fewer reports of maltreatment, reduced endorsement of corporal punishment and fewer behavioural problems in children. The remaining three NCF dimensions (i.e., early learning opportunities, safety and security, and good health) each had only one intervention and the results on child development were mixed. Seven studies combined multiple ECD support elements, and these multidimensional interventions showed positive outcomes across multiple NCF domains more probably than single-focus interventions, although the results were mixed. Increased focus on underrepresented regions, i.e. Western and Central Africa, is needed, and interventions that incorporate all elements of NCF in African contexts should be developed and evaluated.

Author: J. Beukes, S. Alcock, M. Leal, U. Thompson, C. Draper & S. Norris

Source: Beukes, J., Alcock, S., Leal, M., Thompson, U., Draper, C., & Norris, S. (2025). Exploring Early Childhood Development Interventions for Building Human Capital in Sub‐Saharan Africa: A Scoping Review. Child : care, health & development, 51(4), e70138-n/a. https://doi.org/10.1111/cch.70138

• Early childhood development (ECD) interventions have a critical role in human capital development, but there are inequalities in the provision of them in low-and middle-income countries (LMICs).
• Human capital relates to knowledge, health, interpersonal and socioemotional skills, abilities and education possessed by individuals essential for workplace productivity and wellbeing, and is important for economic growth and societal advancement.
• Early life experiences are important in adult human capital development and ECD interventions have moderating role on this development.
• The first 1000 days (i.e., from conception to 2 years) and the next 1000 days (i.e., from 2–5 years) are vital and sensitive windows of opportunity where interventions help to ensure optimal health, growth and development.
• By 5 years of age, children who received adequate early learning opportunities and responsive care were almost one standard deviation ahead (difference of 2 years of development) on multiple child outcomes (e.g. literacy, numeracy, motor skills and social-emotional development) of their peers who had not received this support.
• Many children in LMICs are still exposed to environmental risks affecting both health and development, e.g. poverty, malnutrition, inadequate healthcare, physical punishment, poor caregiver mental health and limited access to early learning opportunities.

Nurturing Care Framework (NCF)

• NCF is supported by the World Health Organization (WHO) and UNICEF.
• Nurturing care relates to the provision of stable environments that promote the needs of individuals in five interrelated components, i.e., health, nutrition, safety and security, learning and relationships.
• Collectively, these components ensure healthy and enabling environments that support optimal human capital development.

The context of Sub-Saharan Africa

• Sub-Saharan Africa experiences the slowest progress in implementing integrated ECD policies and programmes.
• Most Sub-Saharan African countries fall significantly short of key indicators related to the NCF.
• There is an urgent need for coordinated, multidimensional ECD interventions in African contexts.
• There is a lack of knowledge on which ECD interventions are efficacious, such that they may be scaled up in Sub-Saharan Africa, and to what extent the full NCF has been incorporated.
• Thus, the aim of this scoping review was to investigate the types and extent of ECD interventions in Sub-Saharan Africa, using the five interrelated components of the Nurturing Care as classification (i.e., health, nutrition, safety and security, learning and relationships).

Methods

• Scoping reviews aim to broadly map key concepts and identify gaps in research.
• Scoping review differs from systematic review in that it does not necessarily evaluate the methodological quality of included studies or draw conclusions about effectiveness.
• Peer-reviewed journal articles and theses of randomized controlled trials of ECD interventions conducted in Sub-Saharan Africa, as well as follow-up or longitudinal studies assessing the long-term effects of these interventions, published between January 2019 and December 2024, were eligible for this review.
• The inclusion criteria focused on randomised controlled trials that explicitly aimed to improve ECD outcomes or components of human capital, as defined by indicators or outcomes related to cognitive, social–emotional, physical and educational development.
• Eligible studies included those that compared ECD interventions to a control condition, for example, standard care, groups that did not receive an intervention or alternative interventions that target similar outcomes.
• The population included children aged 0–8 years; the concept was ECD intervention programmes aiming to improve human capital outcomes; and the context was Sub-Saharan Africa.
• The final sample of 21 sources was synthesised thematically; interventions were grouped by NCF domain, i.e., good health, nutrition, responsive caregiving, early learning, and safety and security.

Implications

• This review demonstrated variations in research activity across the region and highlighted that nutrition-focused interventions are the most prevalent and yield the most positive child development outcomes in this context.
• Although responsive caregiving interventions were less common, they also demonstrated positive effects on developmental outcomes.
• There is a need for interventions that also include good health, safety and security, and early learning opportunities.

Conclusions

• Findings illustrate a predominance of nutrition-focused interventions, and the multidimensional interventions mostly did not include all elements of the NCF.
• The predominance of nutrition-focused interventions was expected, given the rise of food insecurity across Sub-Saharan Africa, where it is estimated that 123 million people (approximately 12% of the population) experience malnutrition, and to the globally recognized impact of nutrition on early development.
• These interventions were consistently reported to have positive associations with child growth outcomes, particularly those incorporating nutritional supplementation and breastfeeding support.
• The multidimensional interventions identified were reported to show mixed effects: three of the seven showing positive effects, while four not.
• Reasons for these mixed results may be the complexity of the intervention design, contextual barriers, implementation fidelity and the duration of the intervention.
• Most multidomain interventions did not incorporate all the NCF domains. They focused mainly on nutrition and health while often neglecting early learning, responsive caregiving, and safety and security.
• This finding underscores the necessity of designing integrated interventions that not only address immediate health risks but also support cognitive and socioemotional development.
• The five NCF components are embedded within a broader ecological context of structural and policy environments that affect interventions’ delivery and effectiveness.
• The ECD interventions must be situated within a broader developmental framework that includes multisectoral coordination, policy support and community-level engagement.
• Findings highlight a need for studies that include more diverse geographic contexts and underrepresented regions in Sub-Saharan Africa to ensure that local ECD needs are effectively addressed.
• Various studies show that ECD interventions are predominantly delivered in high-income countries and that there seems to be a large mismatch between where these interventions are most needed and where they are being implemented and evaluated.
• Thus there is a need to expand the research focus to underrepresented regions in Sub-Saharan Africa (and other LMICs) and consider local contextual factors that could influence the administration and success of ECD interventions.
• There is a critical need for longitudinal studies to assess the long-term impacts of ECD interventions, particularly in LMICs. These are interventions that should be implemented at home, such as parenting education, social protection, violence prevention and mental health support.
• As LMIC research populations often face compounded challenges that necessitate tailoring interventions to fit the specific context, interventions in LMICs should leverage community resources and emphasize local adaptability of interventions.
• Findings emphasize the importance of culturally sensitive intervention delivery and study methods; engagement with community stakeholders to gain participants access and trust; and the integration of interventions into existing health and education systems to simplify intervention delivery and research.