This mixed-method study sought to share evidence that would aid the Malawi government and other stakeholders to better understand the complex dynamics that ‘enable’ or ‘inhibit’ quality early childhood development (ECD) for children with disabilities using one rural district in Southern Malawi as an example. Tikule Limodzi (‘Let’s Grow Together’) was a three-year (2015 to 2018) multi-agency study that seeks to promote the inclusion of children with disabilities in community based child centres (CBCCs) in a rural district of Southern Malawi. The main purpose of the project was to explore ways of developing the skills of volunteer caregivers to support children with disabilities in CBCCs through the use of inclusive strategies and resources. This mixed-method study also sought to share evidence that would aid the Malawi government and other stakeholders to better understand the complex dynamics that ‘enable’ or ‘inhibit’ quality early childhood development (ECD) for children with disabilities using one rural district in Southern Malawi as an example.The University of Birmingham (UoB) and Sightsavers International have invited researchers and academics from leading institutions working in the areas of early childhood development and education (ECDE) and special educational needs and disability (SEND), educational psychology, applied anthropology, and epidemiology in Malawi, the UK and the USA to co-design and conduct an innovative three-year study. This study will provide the ESRC, DfID, the Malawi Government and its partners in education with a better understanding of the complex dynamics that can enable or inhibit quality ECDE for CWDs. The Malawi Government has prioritised ECDE as part of its Growth and Development Strategy II (2012-16) to increase equity of access and improve the quality of early childhood services which are currently reaching just over one third of children aged three to five years. This research programme, which aims to address the widespread need for equitable and quality ECDE services in Malawi, will establish advanced level collaboration between UoB - a research institution specialising in the education of children with disabilities (CWDs) - and Sightsavers, a UK-based charity that supports the educational inclusion of CWDs in sub-Saharan Africa and South Asia. They will collaborate with the University of Malawi (Chancellor College), Arizona State University, and a UK-based research organisation specialising in applied anthropology in global health research (Anthrologica). Non-academic stakeholders will include the Malawi Ministry of Gender, Children and Social Welfare (MoGCSW) and the Ministry of Education, Science and Technology (MoEST), Save the Children, and the Association of Early Childhood Development in Malawi (AECDM), the main agency responsible for the delivery of ECDE training to all caregivers in Malawi. The research questions and mixed method study design were developed in consultation with the partners, and will be further refined at the study outset during an inception workshop. A study group will be formed of representatives from a wide range of governmental, academic and non-governmental stakeholders, including people with disabilities, who will guide and oversee the implementation of the activities. The study will be subject to ethical approval at the Universities of Birmingham and Malawi, and will adhere to best practice in acquiring informed consent from all participants.

The study was a cluster-randomised controlled trial (CRCT) of a caregiver training intervention delivered in CBCCs in a rural district in Malawi. Forty-eight CBCCs were selected and randomly allocated to an intervention or a control group (24 CBCCs each). This report presents the baseline data collected at the pre-intervention stage. The primary outcomes for the CRCT were: 1) percentage of children with developmental age equal to actual age (primary outcome), 2) caregiver satisfaction/motivation score, 3) CBCC environmental rating scale. All outcomes were measured pre and post intervention. The sample size was calculated to detect a 10% change in the proportion of children whose developmental age being equal to their biological age (expected increase from 70% to 80%). Based on the 95% confidence interval, 80% power, 10% non-response and 50% variation between the clusters (7), we recruited a total of 935 children (around 467 per arm) or 20 children per CBCC. We also collected qualitative data in the form of focus group discuss and interviews at 9 (non- trial CBCCs) in the same district as the trial: 1) understanding the current provision of early childhood development and education for children with disabilities in rural Malawi. 2) 10 case studies of children with disabilities attending CBCCs in the intervention arm of trial.