Integrated early childhood development services in market and cross-border communities in Rwanda: a mixed-methods pre–post evaluation
- 1School of Public Health, College of Medicine and Health Sciences, University of Rwanda
- 2UNICEF Rwanda
Abstract
Background: Families working in markets and cross-border trade often have limited access to affordable and safe childcare. This study assessed the implementation, reach, and service quality of integrated early childhood development (ECD) centers established in market and cross-border communities in Rwanda. It also examined differences between baseline and endline samples in complementary feeding, nutritional status, child development, health and hygiene practices, caregiving, and child protection, while exploring stakeholder experiences, implementation constraints, and sustainability.
Methods: An embedded mixed-methods pre–post evaluation compared independent cross-sectional samples of child–caregiver pairs assessed at baseline ( n = 551) and endline ( n = 421). Survey-round differences were examined using descriptive statistics and multivariable logistic regression. Endline focus group discussions (FGDs), key-informant interviews (KIIs), and structured observations conducted at all eight centers documented service delivery, staffing, infrastructure, learning materials, safety, accessibility, and other implementation conditions.
Results: The eight centers provided integrated early learning, nutrition, health, hygiene, and child-protection services to 701 children. Endline survey participation was associated with higher adjusted odds of meeting minimum meal frequency (AOR = 2.66; 95% CI: 1.08–6.51), minimum dietary diversity (AOR = 2.78; 95% CI: 1.13–6.88), and minimum acceptable diet (AOR = 4.57; 95% CI: 1.78–11.78) among children aged 6–23 months. It was also associated with lower odds of stunting (AOR = 0.48; 95% CI: 0.34–0.67), higher odds of being developmentally on track among children aged 24–59 months (AOR = 1.69; 95% CI: 1.04–2.76), and higher odds of household drinking-water treatment (AOR = 4.98; 95% CI: 3.53–7.05). Endline survey participation was associated with lower vitamin A supplementation, while associations with household-discipline indicators were mixed. Qualitative participants described safe childcare, regular meals, play-based learning, and increased time for income-generating activities, but identified staffing, financing, and inclusion constraints.
Conclusion: Market- and cross-border-based ECD centers provide a feasible platform for delivering integrated childcare services to families working in trading environments. Although several outcomes were more favorable at endline, the use of independent baseline and endline samples and the absence of a comparison group preclude causal interpretation. Further controlled or longitudinal research is needed to assess the effectiveness of this model.
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BibTeX
@article{matsiko2026integrated,
title = {{Integrated early childhood development services in market and cross-border communities in Rwanda: a mixed-methods pre–post evaluation}},
author = {Eric Matsiko and Annet Birungi and Emmanuel Kubwimana and Pierre Nzeyimana and Samson Desie},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1983280},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1983280/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Integrated early childhood development services in market and cross-border communities in Rwanda: a mixed-methods pre–post evaluation
AU - Eric Matsiko
AU - Annet Birungi
AU - Emmanuel Kubwimana
AU - Pierre Nzeyimana
AU - Samson Desie
PY - 2026
DA - 2026/11/04
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1983280
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1983280/full
AB - Background: Families working in markets and cross-border trade often have limited access to affordable and safe childcare. This study assessed the implementation, reach, and service quality of integrated early childhood development (ECD) centers established in market and cross-border communities in Rwanda. It also examined differences between baseline and endline samples in complementary feeding, nutritional status, child development, health and hygiene practices, caregiving, and child protection, while exploring stakeholder experiences, implementation constraints, and sustainability. Methods: An embedded mixed-methods pre–post evaluation compared independent cross-sectional samples of child–caregiver pairs assessed at baseline ( n = 551) and endline ( n = 421). Survey-round differences were examined using descriptive statistics and multivariable logistic regression. Endline focus group discussions (FGDs), key-informant interviews (KIIs), and structured observations conducted at all eight centers documented service delivery, staffing, infrastructure, learning materials, safety, accessibility, and other implementation conditions. Results: The eight centers provided integrated early learning, nutrition, health, hygiene, and child-protection services to 701 children. Endline survey participation was associated with higher adjusted odds of meeting minimum meal frequency (AOR = 2.66; 95% CI: 1.08–6.51), minimum dietary diversity (AOR = 2.78; 95% CI: 1.13–6.88), and minimum acceptable diet (AOR = 4.57; 95% CI: 1.78–11.78) among children aged 6–23 months. It was also associated with lower odds of stunting (AOR = 0.48; 95% CI: 0.34–0.67), higher odds of being developmentally on track among children aged 24–59 months (AOR = 1.69; 95% CI: 1.04–2.76), and higher odds of household drinking-water treatment (AOR = 4.98; 95% CI: 3.53–7.05). Endline survey participation was associated with lower vitamin A supplementation, while associations with household-discipline indicators were mixed. Qualitative participants described safe childcare, regular meals, play-based learning, and increased time for income-generating activities, but identified staffing, financing, and inclusion constraints. Conclusion: Market- and cross-border-based ECD centers provide a feasible platform for delivering integrated childcare services to families working in trading environments. Although several outcomes were more favorable at endline, the use of independent baseline and endline samples and the absence of a comparison group preclude causal interpretation. Further controlled or longitudinal research is needed to assess the effectiveness of this model.
SN - 2296-2565
ER -