Integrated early childhood development services in market and cross-border communities in Rwanda: a mixed-methods pre–post evaluation

Abstract Introduction Access to quality early childhood development (ECD) services remains limited for families working in economic settings in many low-and middle-income countries. This study examined the associations between participation in integrated ECD centres of integrated ECD centres located in market and cross-border communities in Rwanda and childcare access, child nutrition, caregiving practices, and developmental outcomes. Methods A repeated cross-sectional pre–post evaluation without a comparison group was conducted between 2023 and 2025 across eight markets and cross-border ECD centres in Rwanda. Quantitative data were analyzed with logistic regression models adjusted for socio-demographic characteristics, while qualitative data were analysed thematically. University of Rwanda College of Medicine and Health Sciences Institution review board approved the study (No.366/CMHS IRB/2023). Results The proportion of children aged 6–23 months who achieved minimum meal frequency increased from 26.6% to 57% (AOR=2.35; 95% CI: 1.01–5.49), and those meeting minimum acceptable diet increased from 15.4% to 51.4% (AOR=4.51; 95% CI: 1.77–11.45). Stunting declined from 32.6% to 15.7% (AOR=0.45; 95% CI: 0.32–0.63) and underweight from 9.3% to 4.3% (AOR=0.55; 95% CI: 0.32–0.97). The proportion of children aged 24–59 months who were developmentally on track increased from 77.9% to 93.8% (AOR=3.85; 95% CI: 2.23–6.65). Households reported higher income at endline, and the centres generated strong demand for childcare services. However, reports of scolding and physical punishment increased between surveys. Conclusions Integrated ECD centres in market and cross-border settings were associated with improved child feeding practices, nutritional status, and developmental outcomes among children from vulnerable working families in Rwanda. Place-based childcare models may represent a promising strategy for expanding access to integrated ECD services while supporting women’s economic participation in economic settings.