Community-based interventions to enhance early childhood development in fragile contexts: evidence from the West Bank

Introduction The first 1,000 days, from pregnancy through the 1 st 2 years, constitute a critical window for brain development. During this period, adequate nutrition, responsive caregiving, early learning, and safety are essential for optimal child development. In fragile and socioeconomically vulnerable settings, poverty, movement restrictions, food insecurity, caregiver stress, and limited access to early childhood services may constrain child development. This study evaluated a community health worker (CHW)-delivered parenting intervention aligned with the Nurturing Care Framework and implemented through World Vision's Go Baby Go model. Methods We conducted a quasi-experimental pre–post study in 30 vulnerable West Bank communities. A total of 449 mother–infant pairs, with infants aged 0–4 months at baseline, participated in the 11-month intervention delivered by trained CHWs. The intervention combined monthly group sessions, home visits and coaching, and developmental screening. Maternal knowledge of early development and responsive caregiving was assessed using a standardized 23-item WV questionnaire. Caregiver practices and engagement in reading, storytelling, singing, playing, and stimulation, as well as play-material availability and supervision practices, were measured using UNICEF Multiple Indicator Cluster Survey-adapted items. Both tools were administered at baseline and endline. Child developmental progress was monitored using the EDUS Developmental Behavioral Scales–Palestine (DBS-P), administered at age-appropriate points, with targeted follow-up for children not on track. Results Maternal knowledge of brain development, early learning, and stimulation improved significantly ( t (448) = −43.29, p < 0.001, d = 2.05). Engagement in early stimulation activities increased significantly across reading, storytelling, singing, going out, and playing with the child (all p < 0.001), and access to two or more play materials rose from 37.9% to 80.6%. Unsafe supervision practices declined significantly. In total, 777 DBS-P screenings were completed; 86%−93% of children were on track across age-specific intervals. Among 57 children initially identified as delayed who received follow-up, 49 children (86%) moved into the typical developmental range. Discussion A CHW-delivered community-based parenting program combining group learning and home-based coaching was associated with substantial improvements in caregiver knowledge and nurturing practices and may support developmental recovery among children initially identified as delayed in fragile settings.