Strengthening Early Childhood Development Programs and Interventions in Low- and Middle-Income Countries: Systematic Review of Interventions.

Early childhood development (ECD) is essential across life courses, yet many children lack adequate nurturing care needed for optimal ECD. The Nurturing Care Framework (NCF) is designed to optimize ECD outcomes through evidence-based programs and interventions. Therefore, the NCF is key to identify and characterize programs and interventions and to determine key challenges and enabling factors for their effective large-scale implementation. A systematic review following the PRISMA reporting guidance was conducted. PubMed Central, Web of Science, Science Direct, Scopus and MEDLINE databases were used. Studies in English and Spanish, from 2014-2024, 2014 to 2024, addressing interventions or programs based on NFC in low- and middle-income countries (LMICs)(LMICs) were included. Exclusion criteria were studies focused only on caregivers. Quality was assessed with the NICE checklist. A narrative synthesis was conducted by NCF domains. A total of 34 studies were included (from 784 identified), representing five ECD programs and 29 interventions across 19 LMICs. Overall, most elements delivered were aligned with the early learning and nutrition NCF domains. Key implementation challenges and enablers identified were related to logistical constraints, heterogeneity in program fidelity, resistance among implementers to adopt new practices, and low attendance to sessions. Based on 10 interventions, the average annual cost per child was $197.4; 6 reported that the interventions were cost-effective. Despite the need for comprehensive ECD interventions and programs, these remain fragmented and insufficiently address the NCF domains. Addressing these evidence implementation gaps and assessing their cost-effectiveness is essential to inform policy and guide decision-making for scalable and sustainable ECD programs in LMICs.