Implementation of early child development and maternal mental health care package for forcibly displaced Myanmar population in Bangladesh refugee camps: a process evaluation and cost-effectiveness study
- 1Association for Social Development
Abstract
BackgroundThe risk of developmental delays among infants in the refugee camps is high due to prolonged exposure to adverse situations such as poverty, violence, lack of access to basic necessities, safety, poor maternal mental health and inadequate access to healthcare. To reduce the risk of developmental delays, a contextualized early child development and maternal mental health care package, was implemented through enabling and engaging the refugee women as community-based care providers.
MethodsThe process evaluation study was conducted using a mix-method design to explore the acceptability, feasibility, appropriateness, adoption, and cost of the Early Child Development (ECD) and maternal mental health care package in refugee camps, by applying Proctor et als framework. Data on quantitative indicators was reviewed for 348 mother-child dyads in the intervention arm. Qualitative interviews were conducted with 12 mothers, 5 community health workers, and 2 members of the implementing research team. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the healthcare provider perspective to estimate the incremental cost-effectiveness of the ECD care package in reducing proportion of children with two or more developmental delays.
ResultsHome-based delivery of counselling sessions was a key facilitator in ensuring the successful implementation of intervention. The delivery of intervention by modestly educated refugee women reduced cultural and language barriers and facilitated the home-based delivery of sessions. Mothers found the recommended activities feasible to do in routine as they were culturally appropriate, and did not require maternal literacy or additional resources. The intervention was cost-effective with an ICER of 63 USD in reducing the proportion of children with two or more developmental delays by one percentage point.
ConclusionContextualized ECD and maternal health care package is a potentially replicable and scalable intervention for refugee healthcare systems.
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BibTeX
@misc{khan2026implementation,
title = {{Implementation of early child development and maternal mental health care package for forcibly displaced Myanmar population in Bangladesh refugee camps: a process evaluation and cost-effectiveness study}},
author = {N. Khan and M. A. Khan and A. Warraitch and K. Islam and M. A. Khan and S. E. Khan and Z. A. Azdi and I. Jahan and R. Huque},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.01.26364288},
url = {https://www.medrxiv.org/content/10.64898/2026.10.01.26364288v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Implementation of early child development and maternal mental health care package for forcibly displaced Myanmar population in Bangladesh refugee camps: a process evaluation and cost-effectiveness study
AU - N. Khan
AU - M. A. Khan
AU - A. Warraitch
AU - K. Islam
AU - M. A. Khan
AU - S. E. Khan
AU - Z. A. Azdi
AU - I. Jahan
AU - R. Huque
PY - 2026
DA - 2026/10/01
PB - medRxiv
DO - 10.64898/2026.10.01.26364288
UR - https://www.medrxiv.org/content/10.64898/2026.10.01.26364288v1
AB - BackgroundThe risk of developmental delays among infants in the refugee camps is high due to prolonged exposure to adverse situations such as poverty, violence, lack of access to basic necessities, safety, poor maternal mental health and inadequate access to healthcare. To reduce the risk of developmental delays, a contextualized early child development and maternal mental health care package, was implemented through enabling and engaging the refugee women as community-based care providers. MethodsThe process evaluation study was conducted using a mix-method design to explore the acceptability, feasibility, appropriateness, adoption, and cost of the Early Child Development (ECD) and maternal mental health care package in refugee camps, by applying Proctor et als framework. Data on quantitative indicators was reviewed for 348 mother-child dyads in the intervention arm. Qualitative interviews were conducted with 12 mothers, 5 community health workers, and 2 members of the implementing research team. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the healthcare provider perspective to estimate the incremental cost-effectiveness of the ECD care package in reducing proportion of children with two or more developmental delays. ResultsHome-based delivery of counselling sessions was a key facilitator in ensuring the successful implementation of intervention. The delivery of intervention by modestly educated refugee women reduced cultural and language barriers and facilitated the home-based delivery of sessions. Mothers found the recommended activities feasible to do in routine as they were culturally appropriate, and did not require maternal literacy or additional resources. The intervention was cost-effective with an ICER of 63 USD in reducing the proportion of children with two or more developmental delays by one percentage point. ConclusionContextualized ECD and maternal health care package is a potentially replicable and scalable intervention for refugee healthcare systems.
ER -