Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. We show that a minimum package of 1 year of ECCE for all children would cost on average less than 0·15% of low-income and middle-income countries' current gross domestic product. The societal cost of not implementing this package at a national and global level (ie, the cost of inaction) is large, with an estimated forgone benefit of 8–19 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children's progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life-course perspective.

🔗 Read more here: https://doi.org/10.1016/S0140-6736(24)01390-4

Recent international development efforts have emphasized the importance of supporting early childhood development, yet little is known about the availability of early learning opportunities in low- and middle-income countries (LMICs). The present study uses nationally representative data from >163,000 three- and four-year-olds living in 63 countries to estimate the availability of in- and out-of-home early learning opportunities in LMICs. Results suggest that 71.9% of preschool-aged children experience high levels of at-home stimulation (e.g., reading, counting, drawing), 33.6% attend center-based early childhood care and education (ECCE) programming, 29.1% experience both, and 22.9% experience neither. Large geographical and socioeconomic disparities in learning opportunities were found both across and within countries, particularly for ECCE.

Despite increased investment in early childhood care and education (ECCE) globally, little is known about its effectiveness in low-income countries. Using kernel exact matching within a national sample of 1,623 Zambian 6-year-olds, we test the associations between ECCE participation and seven domains of children's school readiness. We find ECCE participation to be significantly and positively predictive of children's receptive vocabulary, letter naming, reasoning, fine motor, executive function, and task performance skills (d = 0.20 − 0.65). Although ECCE predicted better outcomes across program types and dosage levels, associations between ECCE participation and school readiness were descriptively if not significantly larger for children attending nonprofit (versus governmental or private) programs and for those attending ECCE between three and five hours per day (versus those attending less than three or six or more hours per day). Implications of these findings, particularly for the 68% of Zambian children who remain out of ECCE, are discussed.