# Bridging early development gaps in rural Egypt: a community-based approach to equitable childhood care

## TL;DR

A community-based program in rural Egypt improved early childhood development by enhancing caregiver practices and child outcomes.

## Contribution

The study demonstrates the effectiveness of a WHO/UNICEF-based intervention in improving rural childhood development in Egypt.

## Key findings

- Families in the intervention village had higher odds of having children's books and engaging in interactive activities.
- Children in the intervention group showed significantly better development in motor, language, and social skills.
- The program was associated with increased preschool attendance and improved nurturing care practices.

## Abstract

Early childhood development (ECD) is a critical foundation for health, learning, and social well-being. In Egypt, many children suffer from developmental delays, particularly in rural areas where early nurturing care is neglected.

This study evaluated the effectiveness of a community-based intervention, based on the framework of WHO/UNICEF Care for Early Child Development, in improving caregiving practices and developmental outcomes among children under six years in a rural Egyptian district.

A quasi-experimental longitudinal study with a post-test-only control group was implemented in one intervention and one control village. The intervention involved structured caregiver education, skill-building sessions, and continuous home-based support delivered by trained community health workers. Family Care Indicators (FCIs) from the Multiple Indicator Cluster Surveys and child development assessments using the Denver II Screening Tool were applied to evaluate progress. Statistical analyses were conducted using SPSS v24. Descriptive comparisons used Chi-square and paired t-tests. Multivariable logistic regression analyses were performed to control for potential confounders and to identify independent predictors of positive family care and developmental outcomes. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, with significance set at p ≤ 0.05.

Adjusted regression analyses showed significant associations between intervention participation and improved outcomes across all domains. Families in the intervention village had higher odds of Availability of ≥ 3 children’s books (AOR = 3.41, 95% CI 1.87–6.24), and engaging in ≥ 4 caregiver–child interactive activities (AOR = 3.22, 95% CI 1.97–5.25). Children carried more odds to attend preschool (AOR = 3.76, 95% CI 2.01–7.02) and demonstrate normal fine-motor (AOR = 3.18, 95% CI 1.92–5.26), language (AOR = 2.64, 95% CI 1.63–4.27), gross-motor (AOR = 2.93, 95% CI 1.75–4.91), and personal–social development (AOR = 3.83, 95% CI 2.07–7.09), (all p < 0.001).

Participation in the community-based program was positively associated with improved nurturing-care practices and developmental performance after controlling for key sociodemographic factors. The findings suggest that integrating similar caregiver training and early stimulation programs into national child health strategies may help promote equitable early childhood development.

The online version contains supplementary material available at 10.1186/s12939-025-02728-4.