Un Buen Comienzo: Cluster Randomized Controlled Trial of Early Education and Health Intervention in Preschools in Santiago, Chile

Chile has second highest rate of economic inequality in Latin America. Integrated preschool programs that include education and health have been shown to reduce economic inequality, but rarely measure health outcomes. Un Buen Comienzo (UBC) is two-year, cluster randomized controlled trial of intensive professional development for preschool teachers to improve literacy and health among low-income Chilean children. UBC coordinates efforts between public clinics and municipal preschools with four goals: improve language and literacy practices; improve respiratory health, well child visit attendance and nutrition; improve socio-emotional development; foster family engagement in children's learning. UBC consists of monthly modules of workshops, in-classroom coaching, and feedback. Pilot occurred in 2007. Randomization and implementation for first cohort of 6 preschools with 800 children occurred in 2008. By 2010, 54 schools, 240 teachers/aides and 8800 children will enroll. Health component contents were determined with local stakeholders and pilot data: 18% of preschoolers had respiratory problems causing high rates of absenteeism, 58% were up-to-date on well-child visits, 21% were overweight, 19% were obese. We will present health component goals, methods and preliminary outcomes. Respiratory intervention introduces alcohol-based hand gel to reduce respiratory infections among all children and written asthma action plans to improve symptom control among asthmatics. Outcome measures include absenteeism, clinic visits, emergency room visits, and hospitalizations for respiratory symptoms. Well-child visit intervention uses teacher-initiated reminders and parent-child activities to increase children up-to-date on well-child screening. Nutrition component includes anthropometrics on all children to document nutritional status of this population.