Burden: Provision of health care to urban poor population is a great challenge because of supply and demand barriers in the urban health system, which is considered patchy and fragmented. The poor urban people, especially mothers have little access to government health facilities. The health care platform is not well designed in primary health care delivery for urban health system but presently almost 30 percent people are living in urban area of the country. Knowledge gap: Little is known about what happen if psycho social stimulation is provided using urban lactating allowance program on children's cognition and behavior. There is little information about nature and bottleneck of Early Childhood Development (ECD) activities available in the urban Bangladesh. Relevance: This is an opportunity to develop a combined package integrating psycho social stimulation with the existing urban lactating allowance program on disadvantaged children's development. As the urban health system is complex, patchy and fragmented, prior to this intervention An analysis will be done on ECD services and its bottleneck in urban area through Tanahashi framework. Hypothesis (if any): Adding psycho social stimulation to urban lactating allowance program will have additional effect on children's cognitive, motor and language development and behavior compared to the comparison group Secondary Hypothesis: Additionally the intervention will- improve mothers' quality of life and reduce their depressive symptoms be cost effective, Objectives: * To evaluate the effect of integrated urban lactating allowance and psycho social stimulation on children's cognitive, motor and language development and behavior * To measure nature and bottleneck of ECD services in urban Bangladesh Secondary objectives: To measure effect of the programs on: * mothers' quality of life and mental health (depression symptoms) * cost effectiveness of the intervention Methods: A two-arm, Cluster Randomized Controlled Trial: i) Lactating allowance + Psycho social stimulation; (ii) Only lactating allowance Outcome measures/variables: Children's cognitive, motor and language development measured on Bayley-III, behavior on Wolke's rating scales, Mother's quality of life and depressive symptoms , household food security status, socioeconomic status, quality of home stimulation using family care indicators, Mother's knowledge on child care and development, children's growth measured by length/height, weight and head circumference,mothers' height, weight and mid upper arm circumference, direct and indirect cost of the project.
Age range
6 Months – 16 Months
Sex
ALL
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Children's cognitive composite score ranging from 55 to 145 using Bayley Scales of Infant and Toddler Development (Bayley-III)
Timeframe: Children's cognitive composite score ranging from 55 to 145 using Bayley Scales of Infant and Toddler Development (Bayley-III) after one year intervention
Children's language composite score ranging from 45 to 155 using Bayley Scales of Infant and Toddler Development (Bayley-III)
Timeframe: Children's language composite score ranging from 45 to 155 using Bayley Scales of Infant and Toddler Development (Bayley-III) after one year intervention
Children's motor composite score ranging from 45 to 155 using Bayley Scales of Infant and Toddler Development (Bayley-III)
Timeframe: Children's motor composite score ranging from 45 to 155 using Bayley Scales of Infant and Toddler Development (Bayley-III) after one year intervention
Children's approach behaviour using Wolk's behavior rating scale ranging from 1 to 9
Timeframe: Children's approach behaviour using Wolk's behavior rating scale ranging from 1 to 9 after one year intervention
Children's general emotion tone behaviour using Wolk's behavior rating scale ranging from 1 to 9
Timeframe: Children's general emotion tone behaviour using Wolk's behavior rating scale ranging from 1 to 9 after one year intervention
Children's activity behaviour using Wolk's behavior rating scale ranging from 1 to 9
Timeframe: Children's activity behaviour using Wolk's behavior rating scale ranging from 1 to 9 after one year intervention
Children's cooperation behaviour using Wolk's behavior rating scale ranging from 1 to 9
Timeframe: Children's cooperation behaviour using Wolk's behavior rating scale ranging from 1 to 9 after one year intervention
Children's vocalization behaviour using Wolk's behavior rating scale ranging from 1 to 9
Timeframe: Children's vocalization behaviour using Wolk's behavior rating scale ranging from 1 to 9 after one year intervention