The integrated early childhood development (ECD) care package for public health facilities was found to be effective, leading to a reduction in global development delays and improvement in growth outcomes within the low-resource setting in Pakistan.

The pragmatic study design shows that lady health visitors can successfully integrate ECD into their routine work.

The integration of ECD care at public health care facilities can successfully reduce global development delays among children aged 12–24 months.

The study indicates promising evidence for the scale-up and further integration of ECD interventions in the existing primary and secondary care in similar low- and middle-income country contexts.

Significant brain development in children occurs from birth to 2 years, with environment playing an important role. Stimulation interventions are widely known to be effective in enhancing early childhood development (ECD). This study aims to assess the feasibility and effectiveness of integrating ECD care delivered by lady health visitors (LHVs) at public health facilities in rural Pakistan.

A cluster randomized controlled trial was conducted through public health facilities in 2 districts of Punjab, Pakistan. A total of 22 clusters (rural health centers and subdistrict hospitals) were randomly allocated to receive routine care (control: n=11 clusters, 406 mother-child pairs) or counseling (intervention: n=11 clusters, 398 mother-child pairs). All children aged 11–12 months without any congenital abnormality were eligible for enrollment. The intervention was delivered by the LHVs to mothers with children aged 12–24 months in 3 quarterly sessions.

The primary outcome was the prevention of ECD delays in children aged 24 months (assessed with the Ages and Stages Questionnaire-3). Analysis was done on an intention-to-treat basis. A total of 804 mother-child pairs were registered in the study, of which 26 (3.3%) pairs were lost to follow-up at the endpoint. The proportion of children with 2 or more developmental delays was significantly less in the intervention arm (13%) as compared to the control arm (41%) at an endpoint (odds ratio=0.21; 95% confidence interval=0.11, 0.42). Children in the intervention arm also had significantly better anthropometric measurements when aged 24 months than the children in the control arm.

The integrated ECD care intervention for children aged 12–24 months at public health facilities was found to be effective in enhancing ECD and reducing the proportion of children with global development delays.

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