Improving the development of young children in Vietnam through community based Learning Clubs
Sub-optimal brain development is common among young children in low- and lower-middle income countries. Nearly a quarter of a million children fail to reach their developmental potential worldwide, each year. Previous research has shown that this is influenced by multiple factors including the mother’s mental health, maternal iron or iodine deficiencies, her access to health services, not being breastfed, low household wealth, poor parenting skills and family violence.
Finkel Professor of Global Health and Director of Global and Women’s Health, Professor Jane Fisher has been conducting maternal and child health research in collaboration with colleagues in Vietnam since the 1990s.
On her first visit, a study tour of women’s health services, she asked whether mental health problems related to childbearing were ever seen. She was told that as mothers are honoured and well cared for in traditional ways, these problems are not seen. However, the Vice Director of the Hung Vuong Obstetric Hospital, noted that the question could not truly be answered because there were no data.
Together they secured funding from the WHO to investigate this question. 506 women attending a clinic for a routine postpartum check were assessed using a translated depression symptom checklist. Although it was thought that women might not want to talk about their emotions, most answered all the questions.
They found that a third of participants met criteria for low mood associated with childbearing. Risks included lack of support from an intimate partner or their own mother, having to return to income-generating work with a week of giving birth and having a baby who cried a lot and could not be soothed.
Since the early 2000s Professor Fisher has worked collaboratively with a community-based research organisation in Hanoi, and colleagues from the Doherty Institute to identify and address the risks to healthy development experienced by young children in rural areas.
Dr Thach Tran, from Jane’s research group, conducted research for his PhD that found that by the age of six months, children from rural Vietnam already have lower average cognitive, language and motor development than children from the United States of America.
“Deficiencies in micronutrients including iron and iodine are a common problem, and while they explained some of the deficiencies in development, they don’t account for all the problems that children are experiencing, especially in emotional and social development,” Professor Fisher said.
This realisation inspired her, with the team, to develop a community-based program that addresses the eight major risk factors associated with poor early childhood development. ‘Learning Clubs’ follow a tailored curriculum from pregnancy to one year after birth.
Participants are women living in 84 communes in the rural Hà Nam province. The communes are randomly assigned to offering usual care plus the Learning Clubs, and a control group providing usual care.
The Club includes 19 small group sessions, facilitated by members of the Women’s Union, a commune health worker and a kindergarten teacher. Each meeting focused on a clear topic including promoting maternal health, fostering optimal cognitive development for infants, sensitive care and infant safety and hygiene.
“We provided participants with our local evidence about the importance of providing breastmilk, regular sleeping patterns, nutritious weaning foods and cognitive stimulation for their babies to grow well. Parents learnt how to engage with their child, and how to use low-cost materials to stimulate their baby’s mind.”
Professor Fisher has recently received an award from the World Bank to extend Learning Clubs to involve fathers, permitting researchers to gather unique data from men.
The Learning Clubs meetings showed the men how challenging it can be for pregnant women to do all the household tasks chores and care for the baby.
“As a country that's had quite traditional gender norms, where men have had little involvement in infant care or household work, and where intimate partner violence has been common, this program aims to make men feel welcome, included and valued, as a way of promoting respectful relationships and a more equal share of these tasks. These changes are known to improve women’s mental health and we hope they also assist infant development” said Professor Fisher.
1,200 women and children were assessed at six time points across this period.
Participants in the Learning Clubs said that their husbands were kinder and more involved in household tasks than they used to be.
The full results, scheduled for release in late 2020, will show if Learning Clubs benefitted the child’s cognitive development at two years of age, by comparing their development to those children whose parents did not attend Learning Clubs.
“We would like to expand to low- and lower-middle income countries in South East Asia and the Pacific. We believe it’s a model that’s low-cost, non-stigmatising and can be implemented at a local level by community health workers,” said Professor Fisher.