Effects of a parenting and unconditional cash transfer intervention on child development and maternal well-being in urban Bangladesh: medium-term follow-up of a cluster randomised controlled trial

Background: Despite extensive evidence that early childhood parenting interventions improve children's development, whether these effects are sustained in the longer term remains uncertain. We measured the medium-term effects of a parenting and cash transfer programme compared to a cash transfer alone on child, parenting, and maternal outcomes. Methods: In the original trial, we recruited twenty clusters in Rangpur City Corporation of Bangladesh and randomised them equally to intervention (parenting and unconditional cash, 299 participants) or control groups (unconditional cash transfer only, 300 participants). Participants were mothers of children aged 6-16 months on enrolment. Here, we followed up mother/child dyads five years after the intervention when children were aged 6.2 to 8.4 years. The parenting intervention involved fortnightly home visits by trained facilitators for one year. Funds for the cash transfer were provided by the Government of Bangladesh. The primary child outcome was IQ, while secondary ones included reading and mathematics skills. Parenting outcomes included quality of home stimulation and mothers' childcare knowledge. Maternal outcomes included depressive symptoms, empowerment, violence exposure and quality of life. Results: Out of the 599 participants enrolled in the initial trial, 555 (92.7%) mother/child dyads participated in this five-year follow-up. We observed no benefits of the combined intervention compared with cash alone for the primary outcome of child IQ (effect size = 0.11; 95% confidence interval = -0.04, 0.27); for the secondary outcomes, we observed benefits for reading, but not for mathematics skills. We also found benefits for home stimulation, mothers' childcare knowledge, depressive symptoms, and empowerment, but none for mothers' violence exposure and quality of life. Conclusions: Although we found no benefit for the primary outcome of child IQ, a combined parenting and cash transfer intervention showed medium-term benefits compared to cash transfer alone for children's reading skills, home stimulation, mothers' childcare knowledge, depressive symptoms, and empowerment. However, as these findings are related to secondary outcomes of interest for our study, they should be considered as hypothesis-generating only. Registration: clinicaltrials.gov: NCT03753646 (original cluster randomised controlled trial), NCT07432971 (follow-up).