{"doc_desc":{"title":"Exploring the use of mobile phone technology for optimizing, tracking and responding to children's developmental progress in Korogocho, Nairobi, Kenya","idno":"DDI-KEN-APHRC-SAVINGBRAINS-2024-v1.0","producers":[{"name":"African Population Health Research Center","abbreviation":"APHRC","affiliation":"","role":"Documentation of the DDI"}],"prod_date":"2024-06-04","version_statement":{"version":"Version 1.0 (June 2024)"}},"study_desc":{"title_statement":{"idno":"DDI-KEN-APHRC-SAVINGBRAINS-2024-v1.0","title":"Exploring the use of mobile phone technology for optimizing, tracking and responding to children's developmental progress in Korogocho, Nairobi, Kenya","sub_title":"Saving Brains","alt_title":"SB"},"authoring_entity":[{"name":"Patricia Kitsao-Wekulo","affiliation":"African Population and Health Research Centre"}],"production_statement":{"producers":[{"name":"Elizabeth Kimani-Murage","affiliation":"African Population and Health Research Centre","role":"Overseeing the implementation of research activities"},{"name":"Margaret Nampijja","affiliation":"African Population and Health Research Centre","role":"Overseeing the implementation of research activities"},{"name":"Kenneth Odhiambo Okelo","affiliation":"African Population and Health Research Centre","role":"Lead research officer in charge of the day to day operation of the study"},{"name":"Silas Onyango","affiliation":"African Population and Health Research Centre","role":"Assist in coordination of the project activities"},{"name":"Milka Njeri","affiliation":"African Population and Health Research Centre","role":"Assist in coordination of the project activities"},{"name":"Abhishek Khamrai","affiliation":"Val Partners Limited","role":"Provision of  technical support in designing the mobile technology application "},{"name":"Dominic Muindi","affiliation":"Val Partners Limited","role":"Provision of technical support in designing the mobile technology application "},{"name":"Brian Odhiambo","affiliation":"African Population and Health Research Centre","role":"Data Documentation Specialist"},{"name":"Bonface Ingumba","affiliation":"African Population and Health Research Centre","role":"Data Governance Expert"}],"copyright":"Copyright \u00a9 APHRC, 2025","funding_agencies":[{"name":"Grand Challenges Canada","abbreviation":"","role":"Funder"}]},"series_statement":{"series_name":"Demographic and Health Survey, Round 1 [hh\/dhs-1]","series_info":"The Saving Brains Baseline is the first of the the three data collection rounds, conduted from 17th April 2019 to 16th May 2019"},"version_statement":{"version":"v1.0","version_date":"2024-06-05"},"study_info":{"abstract":"Background: \n\nThe massive use of technology can be leveraged to facilitate access to growth and development programs for children with access constraints. Existing programs supporting children's growth and development especially for children younger than three years are inadequate and not accessible to most families. In most cases, primary caregivers are unable to identify delayed milestones in their children's growth and development due to inadequate information on how to assess the key developmental milestones, and they often report the cases when they have become very severe. To promote early identification of possible developmental delays, the African Population and Health Research Center (APHRC) together with Val Partners developed, implemented and evaluated the use of mobile phone technology to help young mothers track their children's development. \n\nObjective:\n\nThe objective of the study was to develop and test the feasibility of using mobile phone technology for optimizing, tracking, and responding to children's developmental progress.  \n\nStudy design: \n\nThe study employed a quasi-experimental design and  used a mixed-methods approach combining quantitative and qualitative methodologies. It was  a two-arm study, where the first arm was trained on the use of a mobile phone application to assess their children's growth and development, while the second group received the standard of care provided by community health volunteers (CHVs). A total of 220 mothers\/primary caregivers-child dyads were recruited into this study. The causal effect of the intervention was estmated using mixed linear models and the Difference-in-Differences estimator.  \n\nStudy duration: 24 months\n\nBudget: CAD 250,000","coll_dates":[{"start":"2019-04-17","end":"2019-05-16","cycle":""}],"nation":[{"name":"KENYA","abbreviation":"KEN"}],"geog_coverage":"The survey covered sampled young children between 6 to 24 months and their caregivers from urban settlements in  Korogocho, Nairobi, Kenya","analysis_unit":"The survey covered sample of young mothers (including adolescents) of children under the age of three years","universe":"The survey covered sample of young mothers (including adolescents) of children under the age of three years","notes":"Questionnaires were used to establish the use of the mobile application. Data was collected through interviews woth both mothers and fathers about their experiences with the mobile phone technology, and with caregiving.\n\nCAREGIVING KNOWLEDGE, ATTITUDES AND PRACTICES (KAP): Was measured using a set of questions that coverd topics such as appropriate care, feeding practices, play and communication activities and learning activities likely to promote holistic development in children. Caregiving knowlege was assessed through maternal report of the different aspects of the child development. Ten questions on caregiver Early Childhood Development (ECD) knowledge was scored on a Likert scale ranging from '1' = agree completely to '4' = disagree completely \nCaregiving practices was assessed by maternal self report of their responsiveness and the opportunities for afe-appropriate play and learning available to the child at home. The mother\/caregiver was also asked about their involvement with the child, acceptance and provision of learning materials. One question from the child development module of the UNICEF Multiple Indicator Cluster Survey (MICS) was used to assess caregiving practices. Each activity was scored separately and a point was given for every positive response. A summated score was derived from adding up all the scores obtained. Higher scores denoted better caregiver KAP. Follow up questions per practice to validate self reports from the mothers\/caregivers were asked.\n\nAdditional information such as the child's date of birth and the birth weight was obtained from the MoH Mother-Child Booklet and other health records during the initial data collection period. Where these documents were not available, the research team relied on maternal recall. Trained data collectors collected length, weight and head circumference data according to the standard protocol. Weight was measured to the nearest 0.1 kg (20). Mothers were interviewed at their hoseholds to obtain information on sociodemographic characteristics such as maternal age, eduaction and occupation, crowding (Person per room) and household possessions at recruitment. All assessements with children and interviews with mother\/caregivers was conducted in the language with which the participants were most comfortable with, that is Kiswahili or English.\n\nMENTAL HEALTH AND STRESS LEVEL: Data on caregivers' well being (mental health and stress levels) was obtained by conducting interviews with primary caregivers to establish the frequency of the use of health services. Parenting Stress Index which determines overall levels of primary caregiving stress was also administered. The tool has items rated from '1' (strongly disagree) to '5' (strongly agree) assessing stress related to parental distress and is concerned with primary caregiver perceptions of self esteem, sense of competence and role restrictions.\n\nPROTOCOL FOR CHILD MONITORING - INFANT-TODDLER VERSION (PCM-IT): Trained field workers administered the PCM-IT to assess children's developmental outcomes. The items on the PCM-IT are derived from tools that include the Kilifi Developmental Inventory (KDI), the Developmental Milestones Checklist (DMC) and the Profile for Socioemotional Development (PSED). Information on children's functioning was obtained through a combination of caregiver self-reported questions and direct observations, similarly to the procedures used in a study conducted in Kilifi, Kenya (19).   These tools have been validated among young children living in rural communities and these earlier studies have reported community acceptability. \nThe PCM-IT consists of measures of psychomotor skills, early cognition, functional language and socio-emotional development, and taps into five developmental domains: psychomotor skills (gross and fine motor), cognitive, language, self-help\/adaptive behavior and social and emotional regulation.  The psychomotor assessment combines both parental report and direct observation of the child's performance in the assessment of two main domains, locomotor development and fine motor skills. The PCM-IT items are scored '0' if the child is unable to carry out action\/activity, '1' if a child able to complete action\/activity momentarily or with much support\/effort, '2' if the child is beginning to carry out the action\/activity, with limitations to control or strength or regularity and '3' 'if able to carry out specific action\/activity with little effort or force. The responses to each of the questions\/items in each domain will be summed to provide a score for each area.  Higher scores indicate outcomes that are more positive for children. \nAll the assessments of children's performance were completed individually on a one-to-one basis in a private place away from distractions but within the sight of other children to reduce anxiety. Data was collected at the participants' homes during the implementation period. These assessments took approximately one hour. On the language measure, the parent was presented with a number of words on a checklist and asked which of the words the child is able to understand and to say. Children's social-emotional behavior was assessed through an interview with the parent\/home caregiver. The interview asked about the child's behavior on a number of aspects including eating, sleeping, and independent activities and playing with others. A language adaptation protocol was followed to ensure that the conceptual integrity of the original items is retained in the translation. Child developmental outcomes were assessed at two time points - at the baseline before the intervention begins, and at endline after the intervention period has ended.\n\nAGES AND STAGES QUESTIONNAIRE - THIRD EDITION (ASQ-3) (20) was administered to establish children's 'developmental' age before the start of the intervention. This information  enabled us to determine the level at which the messages which were sent to the mothers\/caregivers began, as the messages on the mobile phone app were crafted according to the age of the child. For instance, with regards to motor development, if the child is able to 'sit on his\/her own,' the messages that was sent to the mother\/caregiver at the first contact were those where the mother was encouraged to stimulate the development of the next milestone, that is, crawling.  The ASQ-3 was used to measure children's developmental outcomes in terms of their gross and fine motor skills, language, socio-emotional and physical development through a combination of primary caregiver self-reported questions and direct observations(21).   The ASQ-3 is a globally used parent\/primary caregiver-reported, easy-to-use, reliable, and validated screening instrument to identify potential developmental delays among children aged between 2 and 60 months.  Apart from self-reports, primary caregivers were requested to try each activity with their child to facilitate accurate item assessment. Items were scored 'yes' (= 10 points) if the child was  able to perform the activity, 'sometimes' (= 5 points) if the child tried and fails but the primary caregiver reported that the child could perform the activity sometimes, and 'no' (= 0 points) if the child was unable to perform the item. The responses to each of the six questions in each domain were summed to provide a score for each area. Scores for each domain fell  between 0 and 60. Higher scores indicated more positive outcomes for children.","study_scope":"Questionnaires were used to establish the use of the mobile application. Data was collected through interviews woth both mothers and fathers about their experiences with the mobile phone technology, and with caregiving.\n\nCAREGIVING KNOWLEDGE, ATTITUDES AND PRACTICES (KAP): Was measured using a set of questions that coverd topics such as appropriate care, feeding practices, play and communication activities and learning activities likely to promote holistic development in children. Caregiving knowlege was assessed through maternal report of the different aspects of the child development. Ten questions on caregiver Early Childhood Development (ECD) knowledge was scored on a Likert scale ranging from '1' = agree completely to '4' = disagree completely \nCaregiving practices was assessed by maternal self report of their responsiveness and the opportunities for afe-appropriate play and learning available to the child at home. The mother\/caregiver was also asked about their involvement with the child, acceptance and provision of learning materials. One question from the child development module of the UNICEF Multiple Indicator Cluster Survey (MICS) was used to assess caregiving practices. Each activity was scored separately and a point was given for every positive response. A summated score was derived from adding up all the scores obtained. Higher scores denoted better caregiver KAP. Follow up questions per practice to validate self reports from the mothers\/caregivers were asked.\n\nAdditional information such as the child's date of birth and the birth weight was obtained from the MoH Mother-Child Booklet and other health records during the initial data collection period. Where these documents were not available, the research team relied on maternal recall. Trained data collectors collected length, weight and head circumference data according to the standard protocol. Weight was measured to the nearest 0.1 kg (20). Mothers were interviewed at their hoseholds to obtain information on sociodemographic characteristics such as maternal age, eduaction and occupation, crowding (Person per room) and household possessions at recruitment. All assessements with children and interviews with mother\/caregivers was conducted in the language with which the participants were most comfortable with, that is Kiswahili or English.\n\nMENTAL HEALTH AND STRESS LEVEL: Data on caregivers' well being (mental health and stress levels) was obtained by conducting interviews with primary caregivers to establish the frequency of the use of health services. Parenting Stress Index which determines overall levels of primary caregiving stress was also administered. The tool has items rated from '1' (strongly disagree) to '5' (strongly agree) assessing stress related to parental distress and is concerned with primary caregiver perceptions of self esteem, sense of competence and role restrictions.\n\nPROTOCOL FOR CHILD MONITORING - INFANT-TODDLER VERSION (PCM-IT): Trained field workers administered the PCM-IT to assess children's developmental outcomes. The items on the PCM-IT are derived from tools that include the Kilifi Developmental Inventory (KDI), the Developmental Milestones Checklist (DMC) and the Profile for Socioemotional Development (PSED). Information on children's functioning was obtained through a combination of caregiver self-reported questions and direct observations, similarly to the procedures used in a study conducted in Kilifi, Kenya (19).   These tools have been validated among young children living in rural communities and these earlier studies have reported community acceptability. \nThe PCM-IT consists of measures of psychomotor skills, early cognition, functional language and socio-emotional development, and taps into five developmental domains: psychomotor skills (gross and fine motor), cognitive, language, self-help\/adaptive behavior and social and emotional regulation.  The psychomotor assessment combines both parental report and direct observation of the child's performance in the assessment of two main domains, locomotor development and fine motor skills. The PCM-IT items are scored '0' if the child is unable to carry out action\/activity, '1' if a child able to complete action\/activity momentarily or with much support\/effort, '2' if the child is beginning to carry out the action\/activity, with limitations to control or strength or regularity and '3' 'if able to carry out specific action\/activity with little effort or force. The responses to each of the questions\/items in each domain will be summed to provide a score for each area.  Higher scores indicate outcomes that are more positive for children. \nAll the assessments of children's performance were completed individually on a one-to-one basis in a private place away from distractions but within the sight of other children to reduce anxiety. Data was collected at the participants' homes during the implementation period. These assessments took approximately one hour. On the language measure, the parent was presented with a number of words on a checklist and asked which of the words the child is able to understand and to say. Children's social-emotional behavior was assessed through an interview with the parent\/home caregiver. The interview asked about the child's behavior on a number of aspects including eating, sleeping, and independent activities and playing with others. A language adaptation protocol was followed to ensure that the conceptual integrity of the original items is retained in the translation. Child developmental outcomes were assessed at two time points - at the baseline before the intervention begins, and at endline after the intervention period has ended.\n\nAGES AND STAGES QUESTIONNAIRE - THIRD EDITION (ASQ-3) (20) was administered to establish children's 'developmental' age before the start of the intervention. This information  enabled us to determine the level at which the messages which were sent to the mothers\/caregivers began, as the messages on the mobile phone app were crafted according to the age of the child. For instance, with regards to motor development, if the child is able to 'sit on his\/her own,' the messages that was sent to the mother\/caregiver at the first contact were those where the mother was encouraged to stimulate the development of the next milestone, that is, crawling.  The ASQ-3 was used to measure children's developmental outcomes in terms of their gross and fine motor skills, language, socio-emotional and physical development through a combination of primary caregiver self-reported questions and direct observations(21).   The ASQ-3 is a globally used parent\/primary caregiver-reported, easy-to-use, reliable, and validated screening instrument to identify potential developmental delays among children aged between 2 and 60 months.  Apart from self-reports, primary caregivers were requested to try each activity with their child to facilitate accurate item assessment. Items were scored 'yes' (= 10 points) if the child was  able to perform the activity, 'sometimes' (= 5 points) if the child tried and fails but the primary caregiver reported that the child could perform the activity sometimes, and 'no' (= 0 points) if the child was unable to perform the item. The responses to each of the six questions in each domain were summed to provide a score for each area. Scores for each domain fell  between 0 and 60. Higher scores indicated more positive outcomes for children."},"method":{"data_collection":{"sampling_procedure":"The project targeted young mothers (including adolescents) of children under the age of three years and living in informal settlement areas in Nairobi. Community Health Volunteers (CHVs) living within the community were identified and reccruited to assist the study team to recruit mothers\/caregivers who are eligible for inclusion. Effort was made to ensure equal representation of genders in the intervention as both fathers and mothers were included during communications and activities related to the project.","sampling_deviation":"N\/A","coll_mode":"Face-to-face [f2f]","research_instrument":"Two Questionnaires were used during the study\nThe first one was (1) PARENTAL ASSESSEMENT QUESTIONNAIRE which constituted 4 themes including: Knowledge, Attitudes and Perceptions (KAP) questions, Ages and stages questions (ASQ-3), Parental report questions and stress-efficacy questions.\nThe second questionnaire (2) CHILD ASSESSMENT QUESTIONNAIRE","act_min":"Data collection was supervised by carefully trained team leaders and the research team. During fieldwork, data quality was enhanced by APHRC team leads through regular spot checks and sit-ins to approximately 5-10% of each field worker's daily work to verify authenyicity of the data collected. The field supervisor certified the quality of the data through editing of the data before they were transfered to the database.","weight":"The sample size was calculated using G* Power program (18) where the program was set to a two-sided t-test involving the difference between the independent means (18). Using a piori power analysis, we input the values of 0.05 and 0.84 for significance levels  and power, repectively. Additionally, equal sample groups were assumed meaning the allocation ration of N1 (Intervention group) to N(Control group) is 1. The calculation produced a  sample size of 110 for each group, which allowed for 10% attrition rate gave a result of 110. It was therefore hypothesised that with 100 caregiver-infant dyads in the intervention group and 100 in the control group, the sample size achieves 80% power to detect a difference among two groups, with an effect size of 0.4 at the 5% significance level (two-tailed test). A sample comprising a total of 220 households (caregiver-child dyads) were therefore recruited.","cleaning_operations":"Data collection was done electronically using tablets\/phones, with spot checks for quality control. Once all the data collection were completed, all the inconsistencies were resolved prior to data analysis. An automated routine to check on the data completeness, correctness and consistency was also run on 100% of the collected data.","method_notes":"Differences in caregiver KAP and wellbeing at baseline and end-line for the intervention and control groups were determined by summing the scores on the items and running a t-test for comparison.  \n\nFor child developmental outcomes, raw scores were constructed by adding all the items passed for each domain on the PCM-IT. Composite scores were computed by summing the scores across all the domains. As we expected scores on each test to increase with age, the scores were standardized for age to allow for direct comparisons across tests. After the data were cleaned, quantitative data analysis was performed using Stata. A first set of analyses  consisted of descriptive statistics. This will allowed us to detect similarities and\/or differences between subjects' characteristics across the different groups. We compared some baseline measurements between the control group and intervention group using the t-test adjusted for continuous variables, and cluster-adjusted chi-square for binary variables. The second set of analysis consisted of assessing the causal effect of the ECD intervention in Korogocho via the DID estimator, and mixed linear model.  Individual items on the PCM-IT were reviewed for missing data, as well as for floor and ceiling effects.  In the case where more than 10% of the responses on the items were missing, the data was excluded from further analysis. The time taken to complete the assessment was calculated. We also calculated the totals by summing the scores of the items included in the tool to establish children's performance levels at baseline and at end-line. This enabled us to identify child development domains that have acceptable variability."},"analysis_info":{"response_rate":"The response rate was 115.45 percent because the original sample size was 220 in total but the baseline round had 254 participants recruited and interviewed","sampling_error_estimates":"The calculation produced a sample size of 100 for each group, which allowed for a 10% attrition rate gaving a result of 110. We therefore hypothesized that with 100 caregiver-infant dyads in the intervention group and 100 in the control group, the sample size achieved 80% power to detect a difference among the two groups, with an effect size of 0.4, at the 5% significance level (two-tailed test). A sample comprising a total of 220 households (caregiver-child dyads) were therefore recruited."}},"data_access":{"dataset_use":{"contact":[{"name":"African Population and Health Research Center","affiliation":"","email":"datarequest@aphrc.org","uri":"www.aphrcmicrodataprtal.org"}],"cit_req":"Use of the dataset must be acknowledged using a citation which would include:\n- the Identification of the Primary Investigator\n- the title of the survey (including country, acronym and year of implementation)\n- the survey reference number\n- the source and date of download","conditions":"APHRC data access condition\n\nAll non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research.\nThis form is developed to assess applications for data use and facilitate responsible sharing of data with external partners\/collaborators\/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:\n\n1.Data Ownership:\nThe data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.\n\n2.Purpose:\nThe provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.\n\n3.Respondent Identifiers:\nThe Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he\/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.\n\n4.Confidentiality pledge:\nThe user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.\n\n5.Reporting of errors or inconsistencies:\nThe user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.\n\n6.Publications resulting from APHRC data:\nThe Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.\n\n7.Security:\nThe user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.\n\n8.Loss of privilege to use data:\nIn the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him\/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.\n\n9.Acknowledgement:\nAny work\/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:\n\"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City.\"Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.\n\n10.Deposit of Reports\/Papers:\nThe user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.\n\n11.Change of contact details:","disclaimer":"The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses."}}}}