Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan

Ann N Y Acad Sci. 2014 Jan:1308:149-161. doi: 10.1111/nyas.12367.


Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs.

Keywords: Pakistan; cost effectiveness; early childhood development; nutrition; responsive stimulation.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Development*
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Cost-Benefit Analysis
  • Early Intervention, Educational / economics*
  • Early Medical Intervention / economics*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Male
  • National Health Programs / economics
  • Pakistan
  • Rural Health Services / economics
  • Workforce