Integrated Early Childhood Development Centres in Market and Cross-Border Settings: a Mixed-Methods Evaluation in Rwanda

A mixed-methods evaluation in Rwanda demonstrates that integrated Early Childhood Development centres located in market and cross-border settings significantly improved child nutrition, developmental outcomes, and household income, despite a noted increase in reports of physical punishment.

The Gist

Imagine a bustling marketplace in Rwanda. It's loud, busy, and full of people trying to sell goods to make a living. For many parents working there, especially mothers, there's a big problem: who watches the kids?

Without a safe place to leave their children, parents face a tough choice: leave their kids wandering in the dangerous, crowded market, or take them out of work entirely. This study looks at a creative solution: building "childcare hubs" right inside the markets and border crossings.

Here is what the researchers found, explained simply:

The Experiment: A "Daycare in the Marketplace"

Think of these centers as safe islands in the middle of a stormy sea of commerce. The researchers set up eight of these centers in busy markets and border towns. They didn't just watch the kids; they fed them, taught them songs, checked their health, and made sure they were safe.

They checked how things were before the centers opened (in 2023) and after two years of operation (in 2025). They compared the data to see if the "islands" made a difference.

The Good News: Kids Thrived

The results were like watching a garden bloom after a long drought.

• Better Food: Before the centers, only about 1 in 4 young children were eating enough meals a day. After the centers started, that number jumped to more than half. The "minimum acceptable diet" (eating a good variety of foods) went from a rare treat (15%) to a common occurrence (51%).
• Growing Stronger: The number of children who were "stunted" (too short for their age due to poor nutrition) dropped significantly. It's as if the centers helped the children catch up on their growth.
• Smarter and Happier: Children who were 2 to 5 years old became much more "developmentally on track." They learned to count, sing, and speak better. One parent said, "My child came here without speaking, but now he sings songs and counts."
• Parents Got a Boost: Because parents knew their kids were safe, they could work longer hours. Household incomes went up. It's like giving a parent a "superpower" to focus on their work without worrying about their child's safety.

The Mixed News: Discipline and Hygiene

Not everything was a straight line up, though.

• The "Reporting" Puzzle: The study found that parents reported more scolding and physical punishment at home after the centers opened. The researchers suggest this might be a "reporting glitch." It's possible that because parents were learning about better parenting at the centers, they became more honest about their mistakes, or perhaps the centers made them more aware of what "bad" behavior looks like. It doesn't necessarily mean parents became more violent, but it does mean the centers need to do more work on teaching positive discipline.
• Water Wins: On the hygiene front, families started treating their drinking water much more often. The centers acted like a ripple effect; kids learned to wash their hands at the center and then reminded their parents to do the same at home.

The Challenges: Keeping the Lights On

The study also highlighted some cracks in the foundation:

• Too Many Kids, Too Few Teachers: The centers were so popular that they were often overcrowded. Imagine a teacher trying to sing a song to 30 kids instead of 10; it's hard to give everyone the attention they need.
• Funding Wobbles: While the local government supports the idea, the centers still rely heavily on outside donors (like charities) for money, food, and training. The researchers warn that if the donors leave, the centers might struggle to stay open. They need a more permanent "safety net" from the government budget.
• Disability Gaps: The centers tried to welcome children with disabilities, but they admitted they didn't have enough special training or tools to help the most complex cases.

The Bottom Line

This study is like a proof-of-concept for a new kind of childcare. It shows that if you build a safe, nurturing space right where the parents are working, the whole family benefits. The kids get fed and educated, the parents get to earn money, and the community gets healthier.

However, for this to last, it needs to move from a "project" (funded by outsiders) to a permanent part of the community's daily life, with better support for teachers and a plan to help the poorest families afford it.

Technical Summary

Technical Summary: Integrated Early Childhood Development Centres in Market and Cross-Border Settings in Rwanda

Problem Statement
Access to quality Early Childhood Development (ECD) services remains limited for families engaged in economic activities within low- and middle-income countries. Parents working in markets and cross-border trade often face long working hours, mobility constraints, and a lack of affordable childcare, forcing children into unsafe or unsupervised environments. While multisectoral ECD approaches are recognized as essential for child wellbeing, empirical evidence on "place-based" childcare models embedded directly within economic environments (such as markets and border posts) is scarce, particularly in sub-Saharan Africa. This study addresses the gap in understanding how integrated ECD centres located in these specific settings affect childcare access, child nutrition, caregiving practices, and developmental outcomes among vulnerable working families.

Methodology
The study employed a mixed-methods, repeated cross-sectional pre–post evaluation without a comparison group, conducted between October 2023 (baseline) and August 2025 (endline) across eight sites in Rwanda: five market-based centres (Musanze, Gihango, Gakenke, Kimironko, Zinia) and three cross-border centres (Rusizi, Kagitumba, Gatuna).

• Participants: The quantitative component included 552 child–caregiver pairs at baseline and 422 pairs at endline. Eligible participants were children aged 6 months to 6 years and their primary caregivers. The qualitative component utilized purposive sampling, including eight Focus Group Discussions (FGDs), In-Depth Interviews (IDIs) with parents, Community Health Workers (CHWs), and ECD caregivers, as well as Key Informant Interviews (KIIs) with district and national stakeholders.
• Data Collection: Quantitative data were gathered via structured household questionnaires, anthropometric measurements (following WHO standards), and the Early Childhood Development Index 2030 (ECDI2030). Feeding practices for children aged 6–23 months were assessed against 2021 WHO guidelines. Qualitative data were audio-recorded and transcribed.
• Analysis: Quantitative data were analyzed using Stata. Logistic regression models were fitted to assess associations between programme exposure (survey round) and binary outcome variables, adjusted for socio-demographic characteristics (caregiver age, literacy, household headship, and income). Qualitative data were analyzed using an inductive thematic approach.

Key Contributions and Findings

• Service Expansion and Demand: The project established eight operational centres, serving 701 children over two years, exceeding the target of 640. Strong community demand was observed, often surpassing centre capacity, indicating a significant unmet need for accessible childcare in these economic settings.
• Nutritional Outcomes: Significant improvements were observed in child feeding and nutritional status.
  • Feeding Practices: The proportion of children (6–23 months) meeting Minimum Meal Frequency increased from 26.6% to 57% (AOR=2.35), and those meeting Minimum Acceptable Diet increased from 15.4% to 51.4% (AOR=4.51).
  • Nutritional Status: Stunting prevalence declined from 32.6% to 15.7% (AOR=0.45), and underweight prevalence decreased from 9.3% to 4.3% (AOR=0.55).
  • Qualitative Corroboration: Parents and caregivers reported tangible improvements in children's weight, energy levels, and growth, attributing these changes to the balanced diets (including vegetables, fruits, and eggs) provided at the centres.
• Developmental Outcomes: The proportion of children (24–59 months) who were "developmentally on track" increased significantly from 77.9% to 93.8% (AOR=3.85). Qualitative data highlighted gains in communication skills (speaking, counting, singing) and social confidence, linked to play-based learning approaches.
• Health and Hygiene: Household drinking water treatment practices improved significantly, rising from 24% to 54.4% (AOR=3.51). Children demonstrated improved hygiene habits, such as handwashing, which parents reported spilling over into home environments.
• Economic Impact: Households reported higher monthly incomes at endline (50.5% earning ≥60,000 RWF) compared to baseline (20%). Parents linked this to the availability of reliable childcare, which freed time for productive work.
• Child Protection and Discipline: While the centres provided safe environments reducing risks of children roaming markets, there was a notable increase in reported harsh discipline at home. The proportion of children reported to be scolded increased from 34.8% to 78.5% (AOR=9.27), and physical punishment increased from 61.6% to 68% (AOR=1.43). The authors suggest this may reflect increased awareness and willingness to disclose disciplinary practices rather than an actual increase in abuse, though it highlights a need for stronger positive parenting interventions.
• Systems and Sustainability: The centres functioned as integrated platforms linking health, nutrition, and education, supported by collaboration with CHWs and local authorities. However, long-term sustainability remains a challenge due to heavy reliance on external partners for operational costs, training, and food supplies, with only partial integration into district budgets.

Significance and Claims
The paper claims that integrated ECD centres located in market and cross-border settings are associated with improved child feeding practices, nutritional status, and developmental outcomes for vulnerable working families in Rwanda. The study posits that place-based childcare models represent a promising strategy for expanding access to integrated ECD services while simultaneously supporting women's economic participation.

The authors emphasize that while the intervention successfully addressed structural barriers to childcare and improved key child outcomes, challenges regarding service quality (specifically high child-to-caregiver ratios), child protection practices (harsh discipline), and financial sustainability persist. The study concludes that sustaining these benefits requires continued investment in caregiver training, infrastructure, positive parenting interventions, and the integration of these models into national financing frameworks. The authors explicitly note that due to the lack of a control group, findings should be interpreted as associations rather than causal effects.