Table 2 Primary and Secondary Outcomes of Interest and Survey Measures (BL = baseline, EL = endline, FU = follow-up)

Primary: Child cognition, language, motor skills, socio-emotional

The Bayley Scales of Infant Development 3rd edition (Bayley’s III), which is validated in African settings and provides measures for all these dimensions of child development up to 42 months of age.

X

X

X

The Malawi Developmental Assessment Tool (MDAT), that can be applied to children up to 6 years old, is culturally relevant in SSA settings, with good reliability (Gladstone et al. 2010) [39].

X

Primary: early childhood stimulation behaviors

The Family Care Indicators is a self-report questionnaire including questions such as how often parents take children out to the park, or other recreational activities, whether there is always an adult looking after children, the frequency of learning and play activities with children, and the amount and variety of play and learning materials (Hamadani et al. 2010) [40].

X

The Home Observation for Measurement of the Environment (HOME) inventory, a 45 item structured survey combining mother self-report and observational measures widely used and validated in both developed and developing countries (Bradley and Caldwell 1984) [41]. Versions of the HOME inventory have already been adapted to African settings for children up to 4 years old. For the second follow-up, we will adapt a version of the HOME-SF for parents of children of 3 to 6 years old.

X

X

Secondary: child anthropometrics

Child weight and height, and arm circumference will be measured using techniques for the WHO Multicenter Growth Reference Study (MGRS) (de Onis et al. 2004) [49].

X

X

X

Secondary: nutrition practices

Dietary diversity will be measured by maternal self-report of the foods eaten by the child in the last 24 h, following WHO recommendations about young and infant child feeding (Organization and Others 2010; Organization and UNICEF. 2003) Food security will be measured using the Household Food Insecurity Access Scale (HFIAS) (Swindale and Bilinsky 2006) [50]. A child questionnaire will be administered to all mothers including delivery information, breastfeeding history and status, and the timing of the introduction of complementary feeding.

X

X

Secondary: preventive health

A composite score of nine items including access to safe water, use of latrines, immunizations against illnesses like diphtheria, polio, tetanus, and others, deworming, etc. (Singla et al. 2015a) [13].

X

X

Mediator: Social support

We will measure perceived social support using the Lubben Social Network Scale (LSNS) which is a self-reported measure of social engagement including family and friends (Lubben et al. 2006) [51]. It consists of an equally weighted sum of 10 items used to measure size, closeness and frequency of contacts of a respondent’s social network. We will also use the Duke-UNC Functional Social Support Questionnaire (Broadhead et al. 1988) [52], which is a self-reported measure examining an individual’s perception of the amount and type of personal social support he or she receives. This scale is a multidimensional, self-administered instrument that assesses the social support that a person perceives that he or she has. The social support is measured as 2 scales for confidant or affective support. This scale has also been validated in different LMIC settings in Sub-Saharan Africa.

X

X

X

To capture specifically the support from the spouse we will use the Relationship Support Scale that ask questions about positive and negative behaviors of husbands with wives and children. Singla et al. 2015a) [13]

X

X

X

Mediator: perceived self-efficacy

We will use the Self-Efficacy for Parenting Tasks Index-Toddler Scale or SEPTI-TS (Van Rijen et al. 2014) [53]. The SEPTI-TS enables the identification of problematic parental self-efficacy during childhood. SEPTI-TS is a 26-item questionnaire to assess parental self-efficacy in parents of toddlers. The Short Form of the SEPTI-TS showed a strong factor structure with four subscales of domain-specific parental self-efficacy (Nurturance, Discipline, Play, and Routine) that showed high reliability. Scores are rates from strongly disagree to strongly agree, and higher scores indicate stronger parental self-efficacy

X

X

Mediators: problem solving

We will adopt measures from our work in Uganda to measure ways of coping with interpersonal conflicts and daily stressors (Singla et al. 2015a) [13].

X

X

X

Mediators: mental health

Parental stress will be assessed using the Daily Stress Index (DSI) (Abidin 1990) [54]. The DSI measures on a 0–2 scale (never, sometimes, often) the difficult things that sometimes happen to people. This index has previously been used in Uganda, and the raw score will be aggregated over the 15 parts with a range of 0–30. We will measure maternal psychological well-being using the widely used Center for Epidemiologic Studies Depression Scale (CESD) scale with proven psychometric properties (Knight et al. 1997) [55].

X

X

Mediator: knowledge

Mother’s knowledge of child development will involve six questions asking mothers at what age children generally acquire social and cognitive skills (ie, recognize their mother, understand spoken words, communicate hunger, enjoy colorful moving objects, self feed, and learn things from playing with objects) (Singla et al. 2015a) [13]

X

X

X

Moderators: household socio-demographics

Socio-economic data for all households will include family composition, employment, wealth, incomes, education and housing conditions.

X

X

X

Moderators: maternal cognition

As an important predictor of child cognition, measuring maternal cognition is important to assess heterogeneous impacts by this dimension of maternal traits. While we will not measure IQ directly, we will proxy it by measuring maternal receptive language using the Peabody Picture Vocabulary Test, scale that has already been adapted to the Kenyan context (Serpell 2014) [56].

X

X

Moderators: village and CHV characteristics

Village information will include: i) access to health clinics and to primary schools, measured with distance; ii) village average socio-economic index including average employment rates; iii) prices of staple goods; iv) prices of child investment goods such as food, books, clothing, shoes, uniforms, etc.; v) data on floods and other types of weather shocks.

X

X

X