Effects of integrated psychosocial stimulation (PS) and Unconditional Cash Transfer (UCT) on Children's development in rural Bangladesh: A cluster randomized controlled trial

There is evidence on benefits of psychosocial stimulation (PS) and cash transfer programmes in low- and middle-income countries on children’s development. We integrated PS into an unconditional cash transfer (UCT) programme for poor Bangladeshi mothers to examine the effects on children’s development. Methods: This cluster randomized controlled trial was conducted in rural Bangladesh from July 2017 to December 2018 in 33 clusters, with 11 clusters randomly assigned to each of the three arms, namely i) PS + UCT ii) UCT-only and iii) Comparison. We enrolled poor mothers and child (6–16 months) dyads eligible to receive maternity allowance by the Government of Bangladesh. Trained local women imparted training to mothers to provide psychosocial stimulation to their children for one year. Children’s cognitive, language and motor development were measured with Bayley-III, behaviour with Wolke’s ratings and maternal self-esteem with Rosenberg self-esteem scale. The analysis was intention-to-treat. Results: Of the 594 mother-child dyads, 40 (6⋅8%) were lost to follow-up. Compared to UCT-only, children in the PS + UCT had significant improvement in cognitive (B = 2.96, 95% CI: 0.46–5.47, Effect Size [ES] 0.24SD) and language (2.73, 0.39–5.00, ES 0.21SD) scores and were more responsive to examiner (0.30, 0.06–0.52, ES 0.27SD), while compared to comparison group, they had significantly higher cognitive (3.37, 1.27–6.19, ES 0.32SD), language (2.82, 0.53–5.10, ES 0.24SD) and motor (2.65, 0.24–5.06, ES 0.22SD) scores and were more responsive to examiner (0.30, 0.08–0.52, ES 0.26 SD). The mothers’ self-esteem was significantly higher in PS + UCT (2.46, 0.94–3.98, ES 0.48 SD) and UCT-only (1.67, 0.02–3.20, ES 0.32 SD) compared to the comparison group. Conclusion: PS integrated into an UCT programme benefited children’s neurodevelopment and UCT improved mother’s self-esteem. UCT programme may be an important platform for child stimulation programmes for rural poor populations.