Stimulation of Children And effects on Learning and Education at 8 years

The SCALE-8 study seeks to assess the impact of exposure to early responsive stimulation and nutrition interventions and their effect on learning, behaviour and growth later in life.

More than 250 million children living in low- and middle-income countries (LMICs) are not achieving their full development potential due to biological, psychosocial and environmental risks. These risks include inadequate stimulation, malnutrition, infectious illnesses, maternal depression and societal violence. The current study is a follow up to a previous project that assessed the effectiveness, feasibility and cost of integrated early stimulation and nutrition interventions in a government community-based health service. The initial study reported a significant impact on children’s development at age 2 years (36). There is evidence that these gains were sustained at age 4 years although with smaller impact. On the other hand there is very limited evidence of the enduring effects on later life outcomes in LMICs. The current study will re-enroll children in 80 population clusters at age 8 years to determine which beneficial effects on learning, behaviour and growth have endured to school age. These data will provide insights on whether there are any sustained benefits and whether any particular sub-group of children have benefitted more or less from the exposure to early interventions. The data will also identify risks and protective factors that influence outcomes to inform the development of interventions.

Project Management Team

Principal Investigator
MUNEERA A RASHEED is a clinical psychologist working with children with developmental and behavioural difficulties in Pakistan. Her research portfolio includes seven years of communitybased research experience in the development, implementation and evaluation of interventions to promote children’s early development in disadvantaged communities. Rasheed has also gained extensive experience in building capacity, and has trained more than 100 community-based child development assessors in six different countries: Armenia, Bosnia and Herzegovina, Pakistan, Rwanda and the United Republic of Tanzania. She is currently Senior Instructor at the Department of Paediatrics and Child Health, Aga Khan University, Karachi while simultaneously undertaking PhD studies at the University of Bergen, Norway.
Co-Principal Investigator
AISHA K YOUSAFZAI has extensive experience in evaluating early childhood interventions in low- and middle-income countries. She is currently the PI of a randomized controlled trial in Pakistan investigating the impacts of community youth leaders delivering early childhood care and learning interventions on a host of early childhood and community outcomes. Yousafzai serves on a number of international early childhood development committees including the Technical Advisory Group for the UNICEF Central and Eastern Europe/Commonwealth of Independent States Regional ­Office and the Advisory Group for the Early Learning Program of the World Bank. Yousafzai is an associate Professor of Global Health at the Department of Global Health and Population, Harvard T.H. Chan School of Public Health in Boston, USA.


Arooba Farid


Shahnaz Hakro


Saima Siyal


Zarina Siyal


Tor A Strand


Country: Pakistan