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Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial

BMJ 2014; 349 doi: (Published 29 September 2014) Cite this as: BMJ 2014;349:g5785
  1. Orazio P Attanasio, Jeremy Bentham chair of economics1,
  2. Camila Fernández, senior survey researcher2,
  3. Emla O A Fitzsimons, professor of economics3,
  4. Sally M Grantham-McGregor, emerita professor of international child health4,
  5. Costas Meghir, Douglas A Warner III professor of economics5,
  6. Marta Rubio-Codina, senior research economist6
  1. 1Department of Economics, University College London, London, UK
  2. 2Mathematica Policy Research, Princeton, NJ, USA
  3. 3Institute of Education, London WC1H 0AL, UK
  4. 4UCL Institute of Child Health, London, UK
  5. 5Department of Economics, Yale University, New Haven, CT, USA
  6. 6Centre for the evaluation of development policy, Institute for Fiscal Studies, London
  1. Correspondence to: E O A Fitzsimons e.fitzsimons{at}
  • Accepted 11 September 2014


Objective To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children’s development, growth, and hemoglobin levels.

Design Cluster randomized controlled trial, using a 2×2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control.

Setting 96 municipalities in Colombia, located across eight of its 32 departments.

Participants 1420 children aged 12-24 months and their primary carers.

Intervention Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months.

Main outcome measures Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention.

Results Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels.

Conclusions Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children’s cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.

Trial registration Current Controlled trials ISRCTN18991160.


  • Contributors: All authors were responsible for the study design, data gathering, data analysis, and interpretation of the results. As such, authors are arranged in alphabetical order. All errors are the responsibility of the authors. The sponsors of the study approved the study design but had no role in data collection, analysis, or interpretation, or in the writing of the paper. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. EOAF is the guarantor.

  • Funding: This study was funded by the Economic and Social Research Council (grant RES-062-23-1548), Inter-American Development Bank, World Bank, and International Growth Center.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: all authors had financial support from the Economic and Social Research Council, the Inter-American Development Bank, World Bank, the International Growth Center for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the University College London research ethics committee (No 1827/001).

  • Data sharing: The protocol and statistical code are available from the corresponding author at e.fitzsimons{at}

  • Transparency: EOAF (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted; and any discrepancies from the study as planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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