BACKGROUND In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan. METHODS We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436). FINDINGS LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p<0·0001) as compared with the control condition. INTERPRETATION LEAPS offers a scalable solution to expand access to high-quality ECCE and promote children's school readiness while providing employment for female youth in rural Pakistan and settings with similarly low ECCE participation. FUNDING Dubai Cares; and Saving Brains, Grand Challenges Canada. TRANSLATION For the Urdu translation of the abstract see Supplementary Materials section.

中文翻译：

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青年主导的幼儿保育和教育计划对巴基斯坦信德省农村儿童发展和学习的影响 （LEAPS）：一项阶梯楔形整群随机实施试验。


背景 在低收入和中等收入国家，估计有 1.819 亿 （74·6%） 学龄前儿童在健康、营养、保护、学习和响应性护理方面没有得到足够的养育照顾，从而危及他们整个生命历程的健康发展。与卫生部门合作，包括社会保护和教育在内的多部门行动对于实现儿童健康和发展成果是必要的。需要创新来扩大幼儿获得高质量幼儿保育和教育 （ECCE） 的机会以及青年发展的机会。“确保儿童为上学做好准备的青年领袖”（Youth Leaders for Early Childhood Assuring Children are Going for School，简称LEAPS）是一项由两代人组成的计划，旨在培训18-24岁的女性青年提供幼儿保育和教育。我们评估了 LEAPS 在巴基斯坦农村大规模实施时对提高儿童入学准备率的有效性。方法 我们从 2018 年 12 月 3 日至 2021 年 6 月 30 日实施了一项分三个步骤的阶梯楔形整群随机试验。巴基斯坦信德省农村四个地区的 99 个村庄（集群）被随机分配 （1：1：1） 分三个步骤引入 LEAPS。符合条件的集群包括那些拥有由联邦教育和专业培训部下属部门国家人类发展委员会 （National Commission for Human Development） 管理的支线小学的集群;是安全的;有空间容纳 LEAPS 学前班;能够确定一名女性青年来提供幼儿保育和教育服务;并且之前没有参加过试点研究。政府合作伙伴培训了 18-24 岁的女性青年，以提供社区为基础的幼儿保育和教育，每个班级最多招收 20 名 3·5-5·0 岁的儿童。 在基线和每个步骤后对居住在集群中的符合条件的儿童进行基于人群的横断面调查，调查时年龄在 4·5-5·5 岁之间，并且没有任何严重的临床健康状况或残疾。使用国际发展和早期学习评估 （IDELA） 综合评分，包括新兴算术、新兴识字、社会情感发展和运动技能，主要结局是儿童的入学准备情况。使用考虑聚类和阶梯楔形设计的线性混合模型进行了意向性治疗分析。试用版已在 ClinicalTrials.gov （NCT03764436） 注册。调查结果 LEAPS 在 99 个村庄中的 91 个村庄实施。在 8 个集群中，无法建立 LEAPS 学前班。对于干预计划，LEAPS 学前班儿童的平均入学人数为 19 人 （SD 3，范围 12-20）。在 2019 年 1 月 1 日至 2021 年 3 月 31 日期间进行的四轮调查中，共有 3858 名儿童（n=3852 名具有完整的 IDELA 数据）接受了评估。与对照条件相比，LEAPS 提高了入学准备率（标准化均数差：0·30 [95% CI 0·20-0·40];p<0·0001）。解释 LEAPS 提供了一个可扩展的解决方案，以扩大获得高质量幼儿保育和教育的机会，促进儿童的入学准备，同时为巴基斯坦农村和同样幼儿保育和教育参与率低的地区的女性青年提供就业机会。资助 Dubai Cares;和 Saving Brains，加拿大大挑战。翻译 关于摘要的乌尔都语翻译，见补充材料部分。