Ruel Marie T, Menon Purnima, Habicht Jean-Pierre, Loechl Cornelia, Bergeron Gilles, Pelto Gretel, Arimond Mary, Maluccio John, Michaud Lesly, Hankebo Bekele
Food Consumption and Nutrition Division, International Food Policy Research Institute, Washington, DC 20006, USA.
Lancet. 2008 Feb 16;371(9612):588-95. doi: 10.1016/S0140-6736(08)60271-8.
Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition.
We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6-23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6-60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12-41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. This study is registered with ClinicalTrials.gov, number NCT00210418.
There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4-6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0.14 Z scores (height for age; p=0.07), and +0.24 Z scores (weight for age and weight for height; p<0.0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition.
The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model.
以食物辅助的母婴健康与营养项目通常针对5岁以下体重不足的儿童。先前的证据表明，在儿童出现营养不良之前，更早地开展营养干预措施，可能对减少儿童期营养不良更为有效。
我们采用整群随机试验，比较世界宣明会的两项母婴健康与营养项目，其中包括行为改变及沟通部分：一种预防模式，针对所有6至23个月大的儿童；以及一种康复模式，针对体重不足（年龄别体重Z评分＜-2）的6至60个月大的儿童。两种模式均以孕妇和哺乳期妇女为目标人群。社区群组（n = 20）根据服务可及性及其他因素进行配对，并随机分配至每种模式。通过两次横断面调查（基线调查和3年后调查），我们对12至41个月大儿童（每次调查约1500名儿童）的营养不良差异进行了测试。分析采用意向性分析，通过社区层面的两两比较以及调整聚类效应、儿童年龄和性别的儿童层面分析。本研究已在ClinicalTrials.gov注册，注册号为NCT00210418。
基线时项目组之间无差异。随访时，预防组社区的发育迟缓、体重不足和消瘦（使用世卫组织2006年参考数据）比康复组社区低4 - 6个百分点；平均人体测量指标年龄别身高高0.14个Z评分（p = 0.07），年龄别体重和身高别体重高0.24个Z评分（p＜0.0001）。在6至23个月全程接受预防项目的儿童中，该效果比在此期间接受较短疗程的儿童更为明显。两个项目的实施质量无差异；母婴健康与营养服务的使用情况也无差异。
预防项目在减少儿童期营养不良方面比传统的康复模式更有效。
