Jivapong, Belinda

School of Public Health



Peru-Early child development through safe play and song-based learning approach in peri-urban Peru

Household conditions associated with poverty jeopardize child development and health during the first three years of life. Poor learning environments, characterized by low levels of stimulation and parent-child interaction, delay cognitive, motor, and social-emotional competencies among children. Child development may also be threatened by repeated exposure to fecal pathogens within the home. In Peru, despite recent economic growth, enormous disparities persist in cognitive development and educational achievement among low and high socioeconomic groups.

The goal of our study is to develop and test a home-based early childhood development (ECD) intervention. The project is a multidisciplinary collaboration between the Bloomberg School of Public Health, the Krieger School of Arts and Sciences, the Peabody Institute, and the Whiting School of Engineering. The envisioned intervention will incorporate safe play and song-based learning for young children. Toys will have easy-to-disinfect surfaces to reduce pathogen exposure.  The study involves formative research that employs in-depth interviews, observations, and participatory design workshops, to inform intervention design, followed by pre-testing of all intervention components, training of community health workers and implementation in the context of a field trial.

PI Mentor: Elli Leontsini

For my Global Health Established Field Placement, I worked on a formative research project to develop an early childhood development intervention in Lima, Peru from July to December 2018. My particular role was to coordinate and conduct key-informant interviews with daycare instructors from Cuna Más, a Peruvian governmental initiative dedicated to providing early childhood development to underserved regions in Peru. Given the fact that the participants were employed by the Peruvian government, I first needed to gain official approval apart from Johns Hopkins and PRISMA IRB approval. This process took over three months and involved personally submitting study documentation, several visits to the Cuna Más headquarters, miscommunication, presentations to the technical offices, and visits to each Cuna Más daycare for final approval. The approval process was not ideal, and I often felt frustrated with the fact that it took about up 60% of my time abroad. However, I learned an important lesson in patience and a greater understanding of collaborating with institutions such as the Peruvian government.

While waiting for governmental approval to begin my part of the study, I spent most of my time in the field, learning from and shadowing the field workers. They were working on a norovirus/sapovirus study that involved daily surveillance and sample collection from study participants. As such, I accompanied the field workers and became more acquainted with both the field itself (which was large, without any street signs or directions) and the community. With the field workers, I often got invited into people’s homes while surveillance data was being collected. Although I technically could not conduct surveillance myself, I was able to help out with other forms of data collection, such as height and weight measurement. I was always so surprised by how welcoming each participant was, especially since I was new and very obviously not a local. Their receptiveness to people entering their homes and private spaces made me realize the importance of hiring locally and forming strong relationships with the community you are working with; many of the field workers were actually community members themselves.

I realized that while the field team and community members were used to having students from the US come to the field to do work, these students rarely spoke Spanish. As such, my ability to speak and understand Spanish was especially welcome. I learned how important it was to speak the local language, not just for data collection, but also to form a strong and dynamic relationship with the field team, many of whom did not start opening up to me until they realized I could effectively communicate with them. This ability to speak Spanish, paired with the fact that I viewed the field staff as experts and collaborators, helped move my project forward. I had originally focused on finding a practicum in a Spanish-speaking country because I already had experience with Spanish. My time in Peru only reinforced my belief that putting any level of effort into the local language would only help foster productive work environments. I hope to continue improving my Spanish by working with/in Spanish speaking countries in the future.

Overall, my GHEFP experience did not exactly go according to plan—but I’m glad it didn’t, and a part of me thinks that was the point. At the end of the day, I was able to apply the skills I had learned in my classes and left with what I needed to write my capstone. However, the most rewarding part of the experience was working with all of the locals who supported me in the field (both field staff and the community) and practicing flexibility, understanding, and patience—all of which are essential to succeeding in the global health field.

Conducting a key informant interview with Cuna Más daycare instructor


Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

August 2019



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