Table 2. Implementation context of each identified Care for Child Development (CCD) programs.

Country	Program Name	Years of Implementation (total duration)	Program Aims (implementation and/or outcome goals of program)	Implementation Scale (Rural/Urban)	Reach (n)	Child Age (in months)	Implementation Site
African Region
Kenya (low income)	Msingi Bora	2018 to 2019 (6 months)	Implementation Goal: Implement the ECD program with the most effective, cost-effective, and scalable delivery model in rural Kenya. Outcome Goal: Improve short- and medium-term child developmental outcomes by changing parental caregiving behavior.	Regional (rural)	1070 children	6–30 months	Study takes place in former Western and Nyanza Provinces in Kenya where there are high rates of poverty, child mortality, stunting ranging from 31–34%, and spousal violence, and adolescent motherhood. The area is very rural and most occupants work in subsistence farming or as unskilled informal workers. There is large linguistic diversity
	Smart Start Siaya County (PATH)	2012 to present (ongoing)	Implementation Goal: Integrate CCD into the health system supported by a local government policy framework supporting ECD Outcome Goal: Improve ECD to support sustainable social and economic development	Regional (rural)	Not specified; county wide	0–36 months	Siaya county is one of the most rural counties in the country. It has a high prevalence of HIV and under-5 mortality. Under five child mortality has been decreasing with the 2017 prevalence of 45.6 per 1,000 live births down by half since 2003. Stunting has fallen from 35% in 2008 to 26% in 2014. Challenges include teenage pregnancy, maternal mental health, father involvement, low access to pediatric medical and specialty care, unregistered children. Existing data suggests children are not meeting universal development standards with 50% of children in a neighboring county not on track to meet development benchmarks in three of four categories.
Malawi (low income)	CCD	Formative qualitative assessment: 2012 to 2013 (7 months) Feasibility trial: 2013 to 2018 (duration not reported)	Implementation Goal: Adapt CCD to be culturally appropriate and acceptable to the existing community health worker workforce and caregivers. Outcome Goal: Improve ECD of children facing multiple insults of poverty, malnutrition, infection, and lack of stimulation.	Multi-Community (rural and urban)	60 participants	0–24 months	Implementation took place in the rural Mangochi district and the urban Blantyre district. Mangochi district is an area dependent on fishing and agriculture and has a mixture of Christian and Muslim community members. Blanture district is a major commercial city with a more diverse, mobile population.
Mozambique (low income)	Nurturing Care Collaboration (PATH)	2018 to present (ongoing)	Implementation Goal: Strengthen the capacity of subnational health system actors to deliver ECD services for early learning and nutrition. Outcome Goal: Improved ECD and nutrition outcomes of children under 3 and increased families’ awareness of nurturing care services	Regional (rural)	Not specified; universal in multiple counties	0–36 months	This program was implemented in Monapo district. Monapo is a rural district with most locals working in agriculture in subsistence farming. Common ECD priorities and challenges included: low access to medical care, demanding workload of farming, malnutrition, stigma of developmental delays
Rwanda (low income)	Sugira Muryango	Pilot: 2014 to 2015 (duration not reported) Feasibility trial: 2018 (3–4 months)	Implementation Goal: Feasibly deliver the integrated ECD program with the use of community-based lay workers Outcome Goal: Support families living in poverty to improve caregiver child interactions, reduce family conflict, promote childhood development and ultimately break the intergenerational cycle of poverty.	Community/regional (rural)	Pilot 20 households; full trial 541 households	6–36 months	Implemented in Rubona and Munyaga sectors of the Rwamagana district.
Tanzania (low income)	Integrated health, nutrition, responsive stimulation package	Effectiveness trial: 2017–2019 (18 months)	Implementation Goal: Integrate home visit-based intervention, including responsive stimulation, health, and nutrition with and without conditional cash transfer program delivered by community health workers. Outcome Goal: Reduce pregnant and maternal depressive symptoms by addressing multiple risk factors and providing a range of coping strategies and peer support.	Regional (rural)	593 households; 395 children under 12 months, and 198 pregnant women	0–12 months and pregnant women	This program was implemented in 12 villages of Ifakara Health Institute HDSS in the Kilombero and Ulanga districts in the Morogoro region of Tanzania. The intervention area is predominately rural, and the majority of residents are subsistence farmers. Common ECD priorities included: 16.9% of low birthweight (< 2500 g) and 36.2% stunting (HAZ < -2) among children 18–36 months of age
Americas Region
Brazil (middle income)	Criança Feliz	2016 (ongoing)	Implementation Goal: Integrate the ECD home visiting program with an intersectoral nurturing care actions Outcome Goal: Teach parents in the most vulnerable communities how to provide opportunities for early learning by helping them develop their responsive parenting skills as a means of improving nurturing care to their children and ultimately seeks to help reduce poverty, inequities, and violence in the country	National (66.4% of eligible municipalities in Brazil—both rural and urban)	13,000 children and 145,000 pregnant women	0–36 months for all socially vulnerable children, and pregnant women, 0–72 months for children with disabilities	The program is implemented country-wide and it is one of the largest home visiting programs in the world. Young children under the age of 6 comprise 11% of the country’s population of 200 million. Approximately 6.5% of all Brazilian families live below the poverty line, and nearly 25% of Brazilians are living in poverty. Roughly 42% of children under the age of 6 come from families whose income is below the poverty line. Brazil is a highly inequitable society which is captured through the great socio-economic variation across regions and the 5,570 municipalities.
Eastern Mediterranean Region
Pakistan (low-middle income)	Pakistan Early Child Development Scale-up Study (PEDs)	2009 to 2012 (33 months)	Implementation Goal: Use Lady Health Worker program to scale up integrated nutrition and stimulation intervention delivery in a feasible, cost-effective, and effective way. Outcome Goal: Improve child development, growth and morbidity outcomes in rural Pakistan.	Regional (rural)	1302 children	0–24 months	In 2010, there were severe floods damaging homes and health facilities, challenging health outcomes and delivery. This intervention was implemented in the Nausehro Feroze district, a predominantly rural and impoverished district.
	Sustainable Program Incorporating Nutrition and Games (SPRING)	2011 to 2016 (duration not reported)	Implementation Goal: Develop a feasible, affordable, and sustainable home visiting intervention using community-based workers. Outcome Goal: Improve maternal psychosocial wellbeing and child development.	Community (rural)	37 families	0–24 months	Program takes place in a low-income rural setting in Rawalpindi, Pakistan- Bagga Sheikhan Union Council with population 20,000.
Europe Region
Turkey (upper-middle income)	Care for Development	2004 (3 months)	Implementation Goal: Provide a cost-effective method of improving child development in a public healthcare setting with low resources Outcome Goal: Improve child development and address ECD disparities between high and low- and middle-income contexts	Community- one pediatric outpatient clinic (urban)	120 children	0–24 months	Program implemented in an outpatient pediatric clinic of a medical school in Ankara, a city of 4.5 million people. The clinic provides care to patients from low- or middle-income backgrounds.
Kazakhstan (low-middle income) Tajikistan (low income) Kyrgyz Republic (low income)	Better Parenting Initiative (Kazakhstan) Integrated Management of Childhood Illness with CCD (Tajikistan, Kyrgyz Republic)	Kazakhstan, Tajikistan: 2005 (duration not reported) Kyrgyz Republic: 2004 (duration not reported)	Implementation Goal: Integrate the integrated management of childhood illness and CCD into the national health system Outcome Goals: Strengthen parent’s ability to support their children to improve child development and health.	Regional implementation across each of three countries (rural and urban)	Not reported	0–36 months	Kazakhstan: Initiated in South Kazakhstan and expanded to East Kazakhstan in 2008 Tajikistan: Initiated in four districts, then expanded to health centers throughout the country Kyrgyz Republic: Trained CCD providers work in health centers across the country
South-East Asia Region
India (middle income)	Project Grow Smart	2012 to 2013 (8 months)	Implementation Goal: Integrate a micronutrient program and early learning intervention to improve the development, grown, and nutrition of young children in rural India Outcome Goal: Improve the developmental, education, and economic potential of children	Regional (rural)	513 infants	6–12 months (children aged 12–48 months did not receive CCD but were part of the intervention)	The intervention took place in rural villages of Nalgonda District of Andrha Pradesh. Rates of infant anemia exceed 80% in this district.
	Sustainable Program Incorporating Nutrition and Games (SPRING)	2011 to 2016 (60 months)	Implementation Goal: Develop a feasible, affordable, and sustainable intervention using community-based workers to deliver a home visiting program to improve early childhood growth and development Outcome Goal: Promote child development, grow and survival and maternal psychosocial wellbeing in rural India	Regional (rural)	1726 participants	0–24 months; women during pregnancy and post-partum periods	The intervention took place in Rewari district, Harwana State with a total population of 200,000 and is predominantly rural. The literacy rate in the state is 76% with female literacy being lower at 67%. There is a very low female to male infant sex ratio. Infant mortality is 41/1000 births which is around the national average. 46% of children under the age of five are stunted despite the province being considered to be "food secure." A sub-study of the population found that there are high rates of childhood adversity that are associated with poor growth and development.
Western Pacific Region
Vietnam (low-middle income)	Learning Clubs	Pilot: 2014–2015 (duration not reported) RCT: 2016–2018 (18 months)	Implementation Goal: Create a psycho-educational ECD program in rural Vietnam that can be implemented universally. Outcome Goal: Improve physical and mental health of women and their children by addressing multiple risks to their well-being in a low-resource setting.	Community (rural)	300 mothers and 100 fathers and grandparents	0–24 months and pregnant women	Pregnant women in the study area of rural Vietnam are affected by household food insecurity, undernutrition, iodine deficiency, anemia, and intimate partner violence disproportionately compared to women in high-income countries.
China (low-middle, upper-middle income)	IMCI with CCD	2003 (6 months)	Implementation Goal: Adapt Care for Development to be efficacious and appropriate in rural China. Outcome Goal: Improve psychological and physical child development through improved child caregiving practices.	Community (rural)	50 families	0–24 months	Program implemented in seven villages in a rural county with high poverty in Anhui Province.
	Integrated Early Childhood Development Program (IECD)	2014–2016 (26 months*)	Implementation Goals: To effectively deliver a comprehensive nurturing care intervention to children in poor, rural areas. Outcome Goal: Reduce neurodevelopmental child delays to promote subsequent educational achievement and adult productivity.	Regional (rural)	5698 participants (N = 2953 children under 36 months and their caregivers were enrolled at baseline; N = 2745 child-caregiver pairs completed the postintervention assessment)	0–36 months	Program implemented in four rural counties with high poverty: Songtau and Liping counties in Guizhous province and Fenxi and in counties in Shanxi Provinces.