Sustainable Programme Incorporating Nutrition and Games (SPRING): Maximising Child Development, Growth & Survival

SPRING for MDG's (Sustainable Program Incorporating Nutrition and Games, for Maximising Child Development, Growth and Survival) is a 5-year research programme funded by the Wellcome Trust that brings together researchers from the United Kingdom, India, and Pakistan to work on health interventions for early childhood health and development. This presentation illustrates the SPRING plan to work with existing community-based programmes including those carried out by community-based health workers, such as Anganwadi and Asha workers in India and Lady Health Workers in Pakistan, by modifying the approach, content, and supervision of these programmes to deliver the SPRING intervention package.

The SPRING intervention includes:

• "Home visits (pregnancy, immediately post birth, through infancy) to ALL mothers + Family participation + Range of supporting activities
• Promote key newborn & child survival interventions
• Enhance care giving skills: Incorporate the Care for Development Package
• Support optimal infant & young child feeding practices
• Problem solving/counselling approach: using techniques from cognitive behaviour & inter-personal psychotherapy"

Planning for implementation involves 3 steps:
1. "Intervention design, development & piloting
2. Cluster RCTs [randomised controlled trials] in each setting
3. Dissemination and planning for scale-up"

Specific formative research aims include:
1. "Adapt the existing care for development package to the local context
2. Determine visit timing and target audience
3. Identify activities in communities and health facilities that support the intervention
4. Integrate SPRING within existing activities
5. Identify health system strengthening requirements for implementing the intervention and for scale up if the intervention is found to be effective"

Adaptations to the local context will incorporate findings on local feeding customs and habits, parental expectations of child development, available play materials and foods,  and barriers to adopting 'care for development behaviours'. Counselling cards and checklists will be adapted using appropriate visual aids and language.  Content will be disaggregated according to the best time (pregnancy, post-birth, neonatal period, infancy, etc.) for message delivery, as will visit scheduling. Analysis will be done of who among family members should be included in visits and whether at-risk babies should have higher frequency of visits. Community involvement at its current and at its optimum level will be determined, as well as how to integrate SPRING into existing systems of care. Methodologies include: in-depth interviews; child care narratives; observations; and workshops, including development of messages, session content, manuals, and counselling aids. The document includes a conceptual framework and associated primary outcomes and evaluation planning.