Reach Up in Bangladesh

In 1999, Dr. Jena Hamadani was pursuing a Doctor of Philosophy degree at the University College London. Under the supervision of Professor Sally McGregor, Dr Hamadani’s thesis studied the effects of psychosocial stimulation on malnourished children’s development and behaviour, and their mothers’ knowledge of parenting, when added to the Bangladesh integrated nutritional programme. The tactics were based on the original Jamaica Home Visit curriculum designed by Professor McGrego

Since then several randomised-controlled trials were designed to target moderately or severely malnourished/iron-deficient anemic/non anemic/maltreated/disadvantaged children in rural and urban Bangladesh. In 2014, after the positive outcomes of the trials and thanks to the support of icddr,b and donors, Dr. Hamadani and her team scaled the intervention. Today, the Reach Up intervention in Bangladesh has been implemented in several communities of Mymensingh, Narsingdhi, Shirajganj, Rangpur, Hobiganj, Brahman Baria, Laxmipur, Kishoreganj, Bhola, Satkhira, and Dhaka.

Country team

Dr. Jena Derakhshani Hamadani

Emeritus Scientist, Maternal and Child Health Division (MCHD

Dr Fahmida Tofail

Scientist, Nutrition Research Division, icddr,b

Dr. Syeda Fardina Mehrin

Assistant Scientist Maternal, Newborn and Child Health, MCHD icddr,b

Sheikh Jamal Hossain

Associate Scientist Maternal, Newborn and Child Health, MCHD icddr,b

Implementation partners

International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) is a world-renowned health research institute committed to solving a wide range of public health problems through innovative scientific research. By
developing, testing and assessing the implementation of interventions specifically designed for resource poor settings, icddr,b aims to improve the health and wellbeing of people living in the world’s poorest nations. Reach Up Bangladesh operates from icddr,b’s Maternal and Child Health Division and benefits greatly from the organisation's extensive clinical research infrastructure.

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The International Rescue Committee (IRC) is an international humanitarian organization operating in over 50 countries, who mission is to help families in crisis and conflict settings. In 2020, the icddr,b worked with the IRC to design a remote intervention for displaced Rohingya refugees from Myanmar, living in camps in Cox’s Bazar, Bangladesh

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Communities we serve

The Reach Up intervention in Bangladesh has been implemented in several communities of Mymensingh, Narsingdhi, Shirajganj, Rangpur, Hobiganj, Brahman Baria, Laxmipur, Kishoreganj, Bhola, Satkhira, and Dhaka.

The Bangladesh team has helped with training and implementation of ECD programmes in Brazil, Nepal and India. They also helped the International Rescue Committee on their programmes for refugees, including displaced Rohingya refugees from Myanmar, living in camps in Cox’s Bazar, Bangladesh.

Mymensingh

Narsingdhi

Rangpur

Sathkhira

Cox Bazaar, Bangladesh

Our Approach

Reach Up Bangladesh complements a range of existing government-run primary health services in rural communities, including nutritional counseling and unconditional cash transfer program for poor pregnant and lactating women.

We deliver the intervention through group sessions, home visits, or a combination of both. Group sessions usually accommodate two to four mother/child dyads and are held at community health centers.

A community clinic in Bangladesh. Photo credit: Mehrin et al, 2022

Key Stats

Since 2006, the programs run in various districts in Bangladesh has reached 1,403 children (enrolled in randomized control trials) aged 5 – 24 months.

The programs were delivered as weekly and fortnightly home visits, group sessions, as well as a combination of home visits and group sessions.

Home visits lasted approximately 60 minutes and group sessions, lasted approximately 40 minutes and were held at community clinics with two to four mother/child dyads.

Program durations were 6, 9 and 12 months.

Organisational Structure

We train and empower government health workers to deliver the Reach Up curriculum.

These frontline implementers include community health care providers, health assistants, and family welfare assistants in community clinics. We also recruit local residents to serve as play leaders and village health workers in some projects.

Our research team members and government inspectors are responsible for supporting and supervising the workforce.

Cultural Adaptations

Although the methods and underlying concepts of the Reach Up intervention remained unchanged, we adapted the content of the curricula and training materials from their original form to be more relevant to the communities we serve.

We translated the training manual, toy manual, supervisor manual, and train-the-trainer video voiceovers into Bengali. In our materials, the depictions of mothers wear sarees, the traditional Bangladeshi clothing for women, and houses are made of mud, as seen in our villages. We replaced original songs and games with local, traditional versions.

Outcomes

Impact on children:
Thanks to the work of Reach Up Bangladesh, researchers have observed tangible improvements on participating children’s health and well-being.
Cognition
Behaviour
Outcomes - Nutritional status
Expressive and receptive language
Outcomes - Fine and gross motor skills
Impact on caregivers:
Secondary outcomes include an increase in the mother’s parenting knowledge, more stimulation in the home, reduced
maternal depressive symptoms and household violence against women.

There were no changes in staff burnout when compared with the control group.

Research & Publications

Akter, F., Rahman, M., Pitchik, H.O., et al (2020). Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. Int J Environ Res Public Health. 17(17):6233. doi: 10.3390/ijerph17176233. PMID: 32867253; PMCID: PMC7503282.

Hamadani, J., Huda, S.N., Khatun, F. and Grantham-McGregor, S. (2006). Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J of Nutr, 136:10, 2645-2652.

Hamadani, J.,Mehrin, SF, Tofial F, et al (2019). Integrating an early childhood development programme into Bangladeshi primary health-care services: an open-label, cluster-randomised controlled trial. Lancet Global Health, 7, e366-375.

Hossain, S.J., Rahman, S.M., Fisher, J., Rahman, A., Tofail, F., Hamadani, J.D. (2024). Effect of a parenting and nutrition education programme on development and growth of children using a social safety-net platform in urban Bangladesh: a cluster randomized controlled trial. The Lancet Regional Health-Southeast Asia, 1;25:100388.

Hossain, S.J., Tofail, F., Mehrin, S.F., Hamadani, J.D. (2023). Six-Year Follow-up of Childhood Stimulation on Development of Children With and Without Anemia. Pediatrics, 1;151(Suppl 2):e2023060221E. doi: 10.1542/peds.2023-060221E. PMID: 37125884.

Hossain, S.J., Roy, B.R., Sujon, H.M., et al (2021). Effects of integrated psychosocial stimulation and unconditional cash transfer (UCT) on Children’s development in rural Bangladesh: A cluster randomized controlled trial. Social Science & Medicine, p.114657.

Hossain, S.J., Roy, B.R., Salveen, N.E., et al (2019). Effects of adding psychosocial stimulation for children of lactating mothers using an unconditional cash transfer platform on neurocognitive behavior of children in rural Bangladesh: protocol for a cluster randomized controlled trial. BMC Psychol, 5;7(1):13. doi: 10.1186/s40359-019-0289-9.

Mehrin, S.F., Salveen, N., Kawsir, M., Grantham-McGregor, S., Hamadani, J.D., Baker-Henningham, H. (2022). Scaling-up an early childhood parenting intervention by integrating into government health care services in rural Bangladesh. Child Care Health Dev. , 1-10.

Mehrin, S.F., Hamadani, J.D., Salveen, N.E., Hasan, MI, Hossain ,S.J., Baker-Henningham, H. (2020). Adapting an Evidence-Based .Early Childhood Parenting Programme for Integration into Government Primary Health Care Services in Rural Bangladesh. Frontiers in Public Health;8:608173.

Mehrin, S. F., Hasan, M. I., Tofail, F., Shiraji, S., Ridout, D., Grantham-McGregor, S., Hamadani, J. D., & Baker-Henningham, H. (2022). Integrating a Group-Based, Early Childhood Parenting Intervention into Primary Health Care Services in Rural Bangladesh: A Cluster-Randomised Controlled Trial. Frontiers in Pediatrics. https://doi.org/10.21203/rs.3.rs-1393282/v1.

Nahar, B., Hossain, I., Hamadani, J.D., Ahmed, T., Grantham-McGregor, S., Persson, L.A. (2014). Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev. doi: 10.1111/cch.12176.

Nahar, B., Hossain, M.I., Hamadani, J.D., Ahmed, T., Grantham-McGregor, S., Persson, L.A. (2012). Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh. BMC Public Health,12:622. doi:10.1186/1471-2458-12-622.

Nahar, B., Hossain, M.I., Hamadani, J.D., Ahmed, T., Huda, S.N., Grantham-McGregor, S.M., Persson, L.A. (2012). Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur J Clin Nutr., 66(6):701-9. doi:1038/ejcn.2012.13. Epub 2012 Feb 22.

Nahar, B., Hamadani, J.D., Ahmed, T., Tofail, F., Rahman, A., Huda, S.N., Grantham-McGregor, S.M. (2009). Effects of psychosocial stimulation on growth and development of severely malnourished children in a nutrition unit in Bangladesh. Eur J Clin Nutr., 63(6):725-31.

Tofail, F., Hamadani, J.D., Mehrin, F., Ridout, D.A., Huda, S.N., Grantham-McGregor, S.M. (2013). Psychosocial stimulation benefits development in nonanemic children but not in anemic, iron-deficient children. Journal of Nutrition 143:885-893.

Tofail, F., Islam, M., Akter, F., et al (2023). An Integrated Mother-Child Intervention on Child Development and Maternal Mental Health. Pediatrics, 151(Suppl 2):e2023060221G. doi: 10.1542/peds.2023-060221G. PMID: 37125887.