Projects |

Mphatlalatsane (Early Morning Star)

We tested an integrated Early Childhood Care and Development intervention including promotion of cognitive development, HIV testing and treatment support, and nutrition education in rural Lesotho.

WHAT Mphatlalatsane (Early Morning Star)
WHERE Mokhotlong, Lesotho


Infants and young children develop best when caring adults respond with warmth and consistency and when they are provided opportunities for interaction and learning. However, when caregivers are living in circumstances characterized by extreme poverty, poor nutrition and high burden of disease, such as HIV/AIDS, their capacity to fulfil the caregiving role is compromised, placing the child at high risk for poor cognitive and socio-emotional development.

Lesotho is a country with high levels of poverty.  Most of the country is mountainous, and many villages remain accessible only by foot or horseback.  Due to the climate and terrain, and resulting poor food security, an estimated 13% of children in the country are moderately or severely underweight, and 39% have moderate or severe stunting.  It also has one of the highest adult HIV prevalence rates globally, at 23%, and is home to an estimated 36 000 children living with HIV as well as high numbers of children orphaned by HIV/AIDS.  Difficult terrain and long periods of snow cover contribute to low rates of HIV testing and ART coverage amongst children aged 0-14 is only 25%, the lowest in Southern Africa.

To date, however, maternal and child health intervention strategies have tended to address only one health risk at a time and the practice of combining health, nutrition, and ECCD interventions for their additive impact has been limited.  We saw a unique opportunity to promote child development outcomes in Lesotho through the widespread network of informal preschools in rural villages in the country.


The Mphatlalatsane (Early Morning Star) project was an evaluation of an intervention program which integrates Early Childhood Care and Development (ECCD), HIV testing and treatment services, and nutrition support for families with young children (ages 1-5 years). The program was implemented in several villages in the Mokhotlong district of Lesotho, making use of existing village-based ECCD centers to deliver the programme to families. The intervention was designed to increase early childhood stimulation, HIV testing and treatment and child nutrition, and was evaluated using a cluster randomized controlled trial (RCT).

Caregivers of young children (age 1-5 years) received training in sensitive book-sharing skills – a strategy that stimulates the child cognitively and encourages caregiver-child engagement (see book-sharing project). In addition to book-sharing training, intervention sessions include key messages to motivate positive practices and support caregivers to improve growth and health outcomes for their children. In addition to the intervention sessions delivered at the ECCD centres, local organizations were mobilized to co-ordinate community outreach days that aim to increase HIV testing among families through promoting an overall focus on child health.


The research initiative is  based at Stellenbosch University with Principal Investigator Prof Mark Tomlinson and project managers Ms. Sarah Skeen and Ms. Marguerite Marlow. Prof Lorraine Sherr (UCL), and Dr Lucie Cluver (Oxford) are co-principal investigators and Prof. Peter Cooper and Prof. Lynne Murray (University of Reading and Stellenbosch) are active collaborators.


The study is being funded by PEPFAR-USAID, in collaboration with the Government of Lesotho and local community-based organisations.