Worldwide, 43% of children are at risk for poor development. In low-resource countries like Liberia, this prevalence jumps to 54%.
October 22, 2025 | Erin Bluvas, bluvase@sc.edu
Leila Larson has been awarded nearly three million dollars from the National Institutes of Health to lead a five-year study aimed at improving childhood health and development. The health promotion, education, and behavior assistant professor and global health researcher will use the funds to deploy a health intervention (i.e., the BUNDLE study) that employs three strategies, individually and in combination, that address critical adversities faced by many children in resource limited settings.
These interventions include responsive caregiving (e.g., two-way conversations tailored to the child’s ability and interest, challenging and age-appropriate early learning opportunities, etc.), nutrient-dense foods, and disease prevention and treatment (with a focus on malaria and hygiene). These interventions are all part of the Nurturing Care Framework.
“Previous research has shown that these types of intervention components benefit child
development, yet no studies have examined the benefits of bundling all three together,”
Larson says. “The use of a bundled intervention to improve early childhood development
is important because in areas with high burdens of infectious disease, poor responsive
stimulation, and malnutrition, leaving one or more of these conditions unaddressed
may be a significant impediment and a missed opportunity to achieving an intervention’s
full impact. ”
Worldwide, 43% of children are at risk for poor development (i.e., not able to remember, relate, learn, and articulate ideas appropriate for their age and maturity). In low-resource countries like Liberia, where Larson’s study will take place, this prevalence jumps to 54%. In rural Liberia, poor responsive parenting, undernutrition, and lack of psychosocial stimulation are prevalent.
More than 250 million children under the age of five do not achieve their developmental potential, leaving them unprepared for school, at higher risk of poor academic performance, and less able to cope with stress, all of which have long-term consequences on work productivity and overall wellbeing.
Larson’s BUNDLE study, which is a close collaboration with Plan International Liberia, will address these important conditions. In a pilot study, funded by the USC Office for the Vice President of Research's ASPIRE program, Larson and colleagues demonstrated the feasibility and acceptability of leveraging the existing community-based health system to deliver the interventions.
Using a Phase II four-arm cluster-randomized trial, the study will randomize 2240 children and their caregivers from 160 rural communities into one of four study arms (standard-of-care disease prevention and treatment, nutrient-dense food provision, responsive stimulation, or all combined). The study will involve not just female caregivers, but also male caregivers, in group sessions aimed at supporting responsive caregiving. The primary outcome is child cognitive, language, socio-emotional, and motor development, but the study also includes other measures of child health and female and male caregiver outcomes, such as mental health, social support, responsive caregiving, and co-parenting. Importantly, the study also includes a cost-effectiveness component.
“More than 250 million children under the age of five do not achieve their developmental potential, leaving them unprepared for school, at higher risk of poor academic performance, and less able to cope with stress, all of which have long-term consequences on work productivity and overall wellbeing,” Larson says. “The findings from this study have the potential to be applied not only across Liberia but will be generalizable to other countries in the region, most of which experience a similar prevalence of suboptimal child development.”
Find out more
The Nutrition and Early Learning (NELI) research group aims to improve the health and development of children and women across the world, particularly by addressing malnutrition, low responsive stimulation, and infectious disease.