School Transition and Readiness (STAR) Project

Early Childhood Cognitive Stimulation and Successful Transition to Preschool in a Disadvantaged Population in Rural Pakistan

*Boston Children’s Hospital/Harvard University & Aga Khan University

Eighty-eight million young children worldwide are estimated to drop out of school before completing primary (elementary) school. In Pakistan and many other developing countries, this presents a significant problem for economic growth. The high drop out rate is associated with a range of factors such as poor cognitive stimulation, inadequate nurturing and malnutrition in early life. In this study, we will follow a group of children who received cognitive stimulation and responsive parenting intervention in their first 2 years of life as part of the Pakistan Early Child Development Scale Up (PEDS) Trial. The goal is to evaluate whether these children make a more successful transition from home to preschool at 4 years of age.

The PEDS Trial was implemented to determine whether early cognitive stimulation and a responsive parenting intervention, either alone or in combination with a nutrition intervention, could improve development and growth outcomes in the first 2 years of life. The parenting intervention was a local adaptation of the UNICEF and WHO ‘Care for Child Development’ module. Female health workers delivered the interventions through monthly community group meetings, which provided primary caregivers with advice on improved early nutrition and/or child development, and allowed them to practice different play activities that promote cognitive stimulation in young children. This was followed up by a home visit to check how caregivers were implementing intervention advice.

We will follow the PEDS Trial cohort during the transition period from home to preschool at 4 years of age in order to identify effects of this intervention on school readiness in disadvantaged children living in rural Sindh, Pakistan. This study will provide evidence on how early cognitive stimulation influences children’s executive functioning skills, brain development, and school readiness as well as family commitment to helping children achieve future potential. A multidisciplinary approach will be used and we will capitalize on the original cluster RCT design by collecting data in order to understand processes at the child, caregiver, and community levels. At the level of the child, we will measure executive functions, school readiness skills, brain development, stress reactivity, health and nutrition status, and child/caregiver interactions. At the level of the primary caregiver, we will measure emotional wellbeing, cognitive abilities, care-giving practices and home environment in order to capture factors that may affect child outcomes. At the community level, we will assess whether participation in the ECD interventions influenced expectations for education of children in the community. We will also assess current preschool and school enrollment rates in the intervention and control communities.

By learning more about these factors, we aim to shed light on ways to better support children who need to successfully regulate their behavior and attention in order to adapt to the preschool environment. We also hope to provide valuable evidence to policy makers who have the power to allocate public funding to early childhood interventions.