1. Cognitive development among young children in Cambodia: Implications for ECED programs

2. Outline 1. Previous research on cognitive delays 2. Impact Evaluation purpose and design 3. Descriptive Statistics 4. The TVIP 5. The Results: Raw TVIP scores by age 6. Implications of results 7. Socioeconomic status and Raw TVIP scores 8. Nutrition and Raw TVIP scores 9. Implications for ECED programs

3. 1. Previous Research Previous research has indicated that cognitive delays are more likely to affect children from low-income countries because they are exposed to multiple risk factors, including  lack of access to basic water and sanitation infrastructures,  lack of access to quality health services;  inadequate nutritional inputs;  parents with low education levels; and  lack of access to quality daycare centers and preschools. Documenting cognitive delays in low-income countries is critical to design well-targeted effective and timely interventions

4. 2. Impact Evaluation Purpose and Design Purpose of the impact evaluation:  To assess the effectiveness and relative cost effectiveness of the three ECD interventions, namely the formal preschools, the community based preschool and the home based program. Data collection Baseline data collected from May, 2008 to Jan 2009. The baseline data has been used to as an indicator of cognitive development in young children

5. 2. Impact Evaluation Purpose and Design The survey was conducted in some of the most disadvantaged areas in the country. All communities had a poverty rate exceeding 30%. Given the national poverty rate was estimated at 30.1% in 2007, this sample of children is poorer than the national average. The sample contains 4,072 children aged 36 to 59 months in 141 communities across seven provinces.

6. 3. Descriptive Statistics Basic CharacteristicsNMean SD Age (months)4,07247.06.8 Male4,07051.5% Urban4,07217.9% Caregiver Education4,0392.92.7 Caregiver without education4,03928.5% Stunted4,01147.6%

7. 4. The TVIP The TVIP was used as an indicator of cognitive development Involves presenting each child with four pictures and asks them to correctly identify the picture corresponding to the vocabulary word presented. For example, the child could be presented with pictures of a dog, a glass, a piece of cake, and a fork and be asked to point to the “glass”. The test continues until the child makes six mistakes in eight consecutive responses and is scored according to the number of vocabulary words the child correctly identified. The TVIP is a version of the Peabody Picture Vocabulary test that was adapted for spanish children in low income-settings It was translated into Khmer and extensively piloted before it was used in Cambodia.

8. 5. The Results: Raw TVIP scores by age

9. 6. Implications of results The data show that the are very large variations in cognitive development between children of the same age in each sample (even though children from the high end of the distribution are showing substantial signs of delay).  Some children perform much better than their peers within each sample. I will now discuss the factors which cause this variation, thereby suggesting factors which contribute to improved cognitive development.

10. 7.Socioeconomic status and TVIP scores

11. 8. Nutrition and TVIP scores

12. 9. Implications for ECED programs The earlier the intervention the better. Socioeconomic status matters  Strategies on how to prioritize children from very low income households in ECED programs should considered

13. 9. Implications for ECED programs ECED programs could be complemented with nutrition supplements  Information on nutrition may not be sufficient to prevent or reverse stunting among young children.  Research indicates that stunting typically occurs in the first two years of life.  However, after the age of two, good nutrition continues to play an important role in a child’s growth and development.