To estimate the effect of integrating responsive care, early learning, and development monitoring into a community-based package of activities on nutrition, sanitation, and hygiene, on improvements in early childhood development outcomes.

This was a quasi-experimental study with nonequivalent comparison groups. The study primary outcome, early childhood development, was measured using the Ages and Stages Questionnaire (ASQ-3) and the Global Scales for Early Development (GSED). We also collected data on the early learning home environment, nutritional practices, and caregiver depressive symptoms as secondary outcomes.

This study was conducted across 12 districts in Nampula Province, Mozambique. Half of the districts received holistic nurturing care with responsive care, early learning, nutrition, sanitation, and hygiene packages (intervention), and the other half received only nutrition, sanitation, and hygiene packages (comparison).

We recruited an age-stratified random sample of 961 caregivers and their children, aged 0–23 months.

We found a significantly higher mean caregiver engagement total score (mean difference: 0.36; P ≤ .001) and higher number of activities to support learning (mean difference: 0.30, P = 0.004) in the intervention group than in the control. There were no measurable impacts on the remaining early stimulation activities or on the primary outcomes of the ASQ and GSED developmental scores.

We discuss the challenges in the integration of nurturing care interventions into existing programs in high-vulnerability contexts, highlighting the aspects needed to achieve effective caregiver behavioral changes that can translate into improved early childhood development outcomes.