Early support for children living in marginalised communities can improve developmental outcomes

The Omama study, undertaken by Dr Michelle Fernandes and the F1000 research group, focused on Roma children living in poor communities in Eastern Slovakia who are subjected to the “triple threat” of poverty, stunting and early developmental delays, with many prevented from achieving their full developmental potential by age five years. The study compared neurodevelopmental outcomes at age two years between Roma children receiving a community-based early child development (ECD) intervention, and age and sex-matched Roma and non-Roma children who did not receive the intervention. Results of the comparison show that the interventions significantly improved the neurodevelopmental outcomes of children at age two years, including their cognitive, language, and motor skills without directly intervening on nutritional and poverty status.

The Roma are Europe’s largest ethnic minority with high rates of neurodisability, malnutrition and poverty reported in preschoolers. The interventions delivered in the study were multi-modal and delivered by trained Roma women (termed Omamas which is Slovak for grandmothers) to Roma children aged three weeks to 24 months. They were delivered in weekly, 1-hour sessions in the child’s home in the presence of the primary caregiver who was trained in the activities and encouraged to continue these during the week. The Omamas received a pre-defined schedule of age-appropriate activities via the INTER-NDA, a mobile-device-based application which included aspects of kangaroo mother care, infant massage, play, reading, music and responsive caregiving.

The assessments showed that where the Omamas intervened, children were 88% less likely to be delayed in their neurodevelopment and demonstrated significantly better cognitive, language, and motor skills, compared to their peers living in the same communities who had not received the same stimulation.

Dr Michelle Fernandes, MRC Clinical Research Training Fellow and Principal Investigator of the F1000 research group at the Department of Paediatrics, said: 'These results confirm that early interventions during the first 1000 days of life - the period from conception to age two years when brain growth and development is at its most rapid and consequently, most sensitive to environmental influences than at any other time during the lifecourse - can significantly improve the prospects of children living in disadvantaged settings. In the context of the Omama project, these results have resulted in the scale-up of the program in Eastern Slovakia, with plans for extension to Hungary, Northern Macedonia and Greece.

'Although the Omama programme has been able to mitigate the risk of developmental delays, disparities in neurodevelopmental skills between Roma children and their non-Roma peers persisted in our study. This underlines the need for integrated strategies that also focus on nutrition, healthcare and education and work to improve holsitic child health outcomes for children from disadvantaged communities the world over. In addition to rescuring neurodevelopment, simultaneously pomoting adequate nutrition and combating poverty could bring about even more significant results.'

The Omama programme was implemented by the non-profit organization Cesta von [Way out], and based on the principle of community engagement. Olga Shaw, co-author of the study from Cesta von, said: 'Omamas are not only intervention providers, but also ambassadors of change in their communities. Their work is proof that the involvement of local people is essential for the sustainability and success of similar projects.'

The paper, 'A community-based intervention (the Omama Project) improves neurodevelopment in impoverished 2-year-old Roma children: a quasi-experimental observational study', is published in the European Journal of Paediatrics.