Zaman Shakila, Ashraf Rifat N, Martines José
Health Services Academy, Islamabad, Pakistan.
J Health Popul Nutr. 2008 Jun;26(2):210-22.
Malnutrition is common among children aged 6-24 months in developing countries. It increases the risk of mortality. Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children. A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children. Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries. The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques. The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices, and reducing growth faltering in children aged 6-24 months. A cluster-randomized controlled trial was carried out. The method used in this study was a replica of the method in a similar study in Pelotas, Brazil. Forty health centres were paired, and one centre of each pair was randomly allocated to the intervention group, and the other to the control group. The Integrated Management of Childhood Illness (IMCI) module-'Counsel the mother'-was used for training health workers in the health centres in the intervention group. Data from 36 paired health centres and 375 mothers and their children aged 6-24 months recruited from these health centres following consultation with health workers were included in analysis. Independent observers, masked to the intervention status, examined the performance of health workers within the first month after training. Mother-child pairs were visited at home within two weeks, 45 days, and 180 days after recruitment. Information was recorded on the feeding practices, recall of the recommendations of health workers, and sociodemographic variables at these home-visits. Weight and length of the child were measured at each contact. The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group. The mothers' recall of the recommendation of health workers and reported infant-feeding practices were also significantly better in the intervention group than in the control group, even 180 days after the recruitment consultation. Growth faltering was less in the intervention group, with the largest effect observed among children in the age-group of 12 + months. These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers. Improved feeding practices of counselled mothers can, in turn, reduce growth faltering in their children.
营养不良在发展中国家6至24个月大的儿童中很常见。它会增加死亡风险。改善婴儿喂养的干预措施有望减少这些儿童中的营养不良现象。巴西的一项研究表明，对卫生工作者进行沟通和咨询技能培训，在改善幼儿营养状况方面取得了成功。有人提出疑问，巴西该研究中使用的方法在应用于其他国家时是否也会有效。本研究的目的是通过适当的营养促进技术减少幼儿生长发育迟缓。该研究的目标是确定培训卫生工作者营养咨询对提高他们的沟通技能和工作表现、改善喂养方式以及减少6至24个月大儿童生长发育迟缓的效果。开展了一项整群随机对照试验。本研究使用的方法是巴西佩洛塔斯一项类似研究方法的复制品。40个卫生中心配对，每对中的一个中心被随机分配到干预组，另一个分配到对照组。在干预组的卫生中心，使用儿童疾病综合管理（IMCI）模块“向母亲咨询”对卫生工作者进行培训。分析纳入了来自36对配对卫生中心以及与卫生工作者协商后从这些卫生中心招募的375名母亲及其6至24个月大孩子的数据。对干预状态不知情的独立观察员在培训后的第一个月内检查了卫生工作者的工作表现。在招募后的两周、45天和180天对母婴对进行了家访。在这些家访中记录了喂养方式、对卫生工作者建议的回忆以及社会人口学变量。每次接触时都测量了儿童的体重和身长。干预组卫生工作者的沟通技能和咨询表现明显优于对照组。即使在招募咨询180天后，干预组母亲对卫生工作者建议的回忆以及报告的婴儿喂养方式也明显优于对照组。干预组生长发育迟缓情况较少，在12个月及以上年龄组的儿童中观察到的效果最大。这些结果表明，IMCI喂养咨询培训可以提高卫生工作者的沟通技能和工作表现。接受咨询的母亲改善喂养方式，进而可以减少其子女的生长发育迟缓。
