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Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

Globally, studies have shown associations between maternal stimulation and early child development. Yet, little is known about the prevalence of paternal and other caregivers' stimulation practices, particularly in low- and- middle-income countries (LMICs). Data from the Multiple Indicators Cluster Survey (MICS) and the Demographic and Health Survey (DHS) were combined across 62 LMICs (2010-2018). The sample included 205,150 mothers of children aged 3 and 4 years. High levels of stimulation were defined as caregiver engagement in at least 4 out of 6 possible activities with the child. The proportion of mothers, fathers, and other caregivers providing high levels of stimulation was calculated by country, region, and for the whole sample. Socioeconomic disparities within and between countries were estimated. On average, 39.8% (95% CI 37.4 to 42.2) of mothers, 11.9% (95% CI 10.1 to 13.8) of fathers, and 20.7% (95% CI 18.4 to 23.0) of other adult caregivers provided high levels of stimulation. Stimulation varied by region, country income group, and Human Development Index (HDI), with higher levels of maternal and paternal-but not other caregivers'-stimulation in high-income and high-HDI countries. Within countries, stimulation levels were, on average, lower in the poorest relative to the richest households, and some but not all countries exhibited differences by child sex (i.e., boys vs. girls) or area (i.e., urban vs. rural). Results suggest a need for intervention efforts that focus on increasing caregiver stimulation in LMICs, particularly for fathers and in low-income contexts.

IntroductionParenting interventions during early childhood are known to improve various child development outcomes immediately following programme implementation. However, less is known about whether these initial benefits are sustained over time.MethodsWe conducted a systematic literature review of parenting interventions in low- and middle-income countries (LMICs) that were delivered during the first 3 years of life and had completed a follow-up evaluation of the intervention cohort at least 1 year after the primary postintervention endpoint. We summarized intervention effects over time by child-level and parent-level outcomes as well as by timing of follow-up rounds in the short-term (1–3 years after programme completion), medium-term (4–9 years), and long-term (10+ years). We also conducted exploratory meta-analyses to compare effects on children’s cognitive and behavioral development by these subgroups of follow-up rounds.ResultsWe identified 24 articles reporting on seven randomised controlled trials of parenting interventions delivered during early childhood that had at least one follow-up study in seven LMICs. The majority of follow-up studies were in the short-term. Three trials conducted a medium-term follow-up evaluation, and only two trials conducted a long-term follow-up evaluation. Although trials consistently supported wide-ranging benefits on early child development outcomes immediately after programme completion, results revealed a general fading of effects on children’s outcomes over time. Short-term effects were mixed, and medium-term and long-term effects were largely inconclusive. The exploratory meta-analysis on cognitive development found that pooled effects were significant at postintervention and in the short-term (albeit smaller in magnitude), but the effects were not significant in the medium-term and long-term. For behavioural development, the effects were consistently null over time.ConclusionsThere have been few longer-term follow-up studies of early parenting interventions in LMICs. Greater investments in longitudinal intervention cohorts are needed in order to gain a more comprehensive understanding of the effectiveness of parenting interventions over the life course and to improve the design of future interventions so they can have greater potential for achieving and sustaining programme benefits over time.

Background Globally, there is mounting evidence about the importance of father involvement for improving child and family wellbeing. However, there are limited measurement tools available for assessing father involvement in low-resource settings globally. The objective of this study was to develop and validate a scale for measuring fathers’ engagement in caregiving activities for young children and families in rural Kenya. Methods We used baseline data collected in February–March 2023 from a cluster-randomized controlled trial of a parenting intervention aimed at improving early child development in Nyamira and Vihiga counties in Western Kenya. The analytic sample comprised 460 primary caregivers of children under 18 months of age (91.3% mothers) who were in a relationship with a male caregiver of the young child (i.e., father). The primary caregiver reported on the 25-item father involvement scale. We conducted exploratory and confirmatory factor analyses to determine the dimensionality of the measure and estimated latent variable regression models to assess construct and predictive validity in terms of associations with sociodemographic factors, other paternal and maternal psychosocial measures, and early child development outcomes. Results The scale had a four-factor structure representing father involvement in (1) childcare activities, (2) play and affection, (3) household chores, and (4) early learning activities . Each factor showed good internal consistency reliability and evidence of multiple forms of validity. The four factors were associated with child and household sociodemographic characteristics and more positive paternal and maternal psychosocial outcomes. Father involvement across all four domains was associated with higher early child cognitive, language, motor, and socioemotional development scores. Conclusions Our findings highlight the multidimensional nature of fathers’ caregiving roles in the lives of young children and their families. We establish a valid tool for assessing father involvement in rural Western Kenya that has potential for use in other similar contexts.

Globally, mothers are disproportionately responsible for childcare, while fathers are predominantly viewed as breadwinners. Although recent studies reveal that fathers are becoming more engaged in parenting, little is known about the broader contexts surrounding how fathers allocate their time between parenting, income-generating work, and other daily activities. The objective of this study was to characterize the typical daily schedules from morning to evening among fathers with young children under aged 2 years. Additionally, we aimed to identify the perceived barriers and facilitators influencing fathers’ time spent on parenting. We conducted 60 in-depth interviews (29 fathers and 23 mothers and 8 community stakeholders) and 9 focus group discussions (3 with fathers only, 2 with mothers only, and 4 mixed parent groups) across 4 purposively sampled, peri-urban communities in Mwanza, Tanzania. Among a subsample of 14 fathers, we revisited and conducted follow up in-depth interviews to further obtain retrospective hourly accounts of fathers’ daily time use. Data were analyzed using both deductive and inductive approaches. Overall, fathers spent most daytime hours out of the home engaging in work-related activities, and evenings were often a time when some fathers socialized with peers. Approximately half of fathers reported some involvement in parenting, childcare, or household chores. However, these activities were generally brief and concentrated at specific times of day, such as early mornings before fathers left for work, during lunchtime when men returned home, or on weekends when men spent more time at home. Key barriers to fathers’ time allocation to parenting included patriarchal gender norms that frame childcare as primarily women’s responsibility, poverty, and work-related stress. Facilitators of fathers’ time towards parenting included greater autonomy over work schedules and positive attitudes valuing fathers’ nurturing care roles. These findings provide important insights into fathers’ daily routines in this context and the social, cultural, and structural factors that enable or constrain their engagement in parenting. By illuminating men’s time use patterns, this study offers evidence to inform the design of parenting programs that are more responsive to fathers’ schedules and constraints and ultimately promote greater father engagement in childcare.

Background Lack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children’s physical growth and developmental outcomes in LMICs. Methods We combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36–59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects. Results In the total sample, 34.7% of children aged 0–59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (β = − 0.18; 95% CI: -0.23, − 0.14), WAZ (β = − 0.10, 95% CI: -0.13, − 0.07), and ECDI z-scores (β = − 0.10; 95% CI: -0.13, − 0.07) among children aged 36–59 months. Conclusion Our findings document links between birth registration and children’s early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.

Background Early childhood development (ECD) is a key determinant of long-term health, education, and wellbeing. However, one major global challenge is the lack of ECD assessment tools validated for use in low- and middle-income countries. To address this gap, the World Health Organization (WHO) launched in 2023 the Global Scales for Early Development, an open-access tool designed to generate reliable, valid, and internationally-comparable data on ECD for children aged 0–3 years globally. In this study, we examined the concurrent and convergent validity of the Global Scales for Early Development-long form (GSED-LF) for use with children aged 0–24 months in Kenya. Methods We analyzed baseline data collected in October-November 2023 as part of a cluster-randomized controlled trial evaluating a parenting program for improving ECD in rural Western Kenya. Primary caregivers (91% mothers) with a child under 24 months were enrolled across 64 villages in Busia and Homabay counties. The GSED-LF was administered to all children ( N  = 647). In a randomly selected sub-sample of children ( N  = 116), the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Caregiver Reported Early Development Instruments (CREDI) were also administered to compare their scores with those from the GSED-LF. Concurrent validity of GSED-LF was assessed in terms of its correlations with Bayley-III and CREDI. Convergent validity of GSED-LF was examined with respect to parenting outcomes, including parental stimulation, home caregiving environment, and maternal mental health. Results GSED-LF scores had moderate associations with those on the Bayley and CREDI across the domains of cognitive, language, and motor development. GSED-LF had small associations with socioemotional development and relatively weaker concurrent validity for younger children under 12 months. GSED-LF also demonstrated good convergent validity in terms of showing moderate associations with maternal and paternal stimulation and the home caregiving environment. Conclusions Overall, this study demonstrated the feasibility and initial validity of the GSED-LF as a direct assessment tool for use in rural Western Kenya. Additional psychometric analyses across diverse settings are needed to strengthen the reliability and validity evidence of the GSED-LF and establish it as a robust, globallyapplicable tool for assessing ECD in resource-limited settings.

Type IIA topoisomerases are essential DNA processing enzymes that must robustly and reliably relax DNA torsional stress. While cellular processes constantly create varying torsional stress, how this variation impacts type IIA topoisomerase function remains obscure. Using multiple single-molecule approaches, we examined the torsional dependence of eukaryotic topoisomerase II (topo II) activity on naked DNA and chromatin. We observed that topo II is ~50-fold more processive on buckled DNA than previously estimated. We further discovered that topo II relaxes supercoiled DNA prior to plectoneme formation, but with processivity reduced by ~100-fold. This relaxation decreases with diminishing torsion, consistent with topo II capturing transient DNA loops. Topo II retains high processivity on buckled chromatin (~10,000 turns) and becomes highly processive even on chromatin under low torsional stress (~1000 turns), consistent with chromatin’s predisposition to readily form DNA crossings. This work establishes that chromatin is a major stimulant of topo II function. Here the authors discover that chromatin stimulates topoisomerase II function by enabling the enzyme to achieve exceptionally high processivity and efficient supercoiling relaxation, even under low torsional stress.

Background Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan. Methods Data were collected between January and March 2017 through in-depth interviews with fathers ( N  = 33) and their partners ( N  = 32); as well as separate focus group discussions with fathers ( N  = 7) and mothers ( N  = 7). Data were analyzed using thematic content analysis. Results Parents described a distinct division of roles between fathers and mothers; and also several shared caregiving roles of fathers and mothers. Specifically, parents highlighted aspects of fathers’ coparenting and several common ways by which fathers supported their partners. We found that these gendered divisions in parenting roles were strongly embedded within a complex network of interacting factors across the individual, family, and sociocultural contexts of the study community. Conclusions Our findings suggest a more family-centered conceptualization of fatherhood during early childhood that encompasses both fathers’ direct engagement with their young children and their indirect contributions through coparenting, while recognizing a variety of contextual systems that shape paternal parenting. Future parenting interventions that reflect the lived experiences of both fathers and mothers as parents and partners may further enhance the nurturing care environments that are critical for promoting healthy early child development.

Caregiver engagement is crucial for early child development; however, research on paternal involvement remains limited, particularly in urban settings of the Global South. This exploratory study aimed to understand how fathers' lived experiences and aspirations, along with systemic inequities, shape their parenting practices in urban poor settings in Bangalore, South India. Ten fathers of children aged 4-6 years from low socio-economic backgrounds in the MAASTHI birth cohort were purposively selected for in-depth interviews, conducted using a pre-tested topic guide in Hindi and Kannada. All interviews were transcribed, translated, and analysed using a thematic analysis approach. Fathers prioritized their children's education and safety, often viewing financial provision as their primary role due to ingrained gender norms and economic hardship. Most worked long hours in informal employment, thereby limiting their participation in daily caregiving, which was typically handled by their mothers. Fathers' own childhood experiences influenced their parenting, with those who experienced adversity often aiming to break intergenerational cycles by being more emotionally present and supportive. While structural barriers limited involvement, many fathers expressed a strong desire to be more engaged, thereby challenging traditional roles. Safety concerns in their neighbourhoods further shaped protective parenting practices. Despite these constraints, some fathers reported that they preferred spending time with their families and participated in co-parenting through shared decision-making and engaging in play. This study highlights the intersectionality between gender, socio-economic status, and intergenerational adversity in shaping fathering practices. To promote inclusive caregiving, early childhood programmes must actively include fathers and address both individual and structural barriers that constrain their involvement.