International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Sweden.
J Pediatr Gastroenterol Nutr. 2011 Sep;53(3):310-9. doi: 10.1097/MPG.0b013e31821dca49.
The aim of the present study was to assess the effects of community-based follow-up care, food supplementation, and/or psychosocial stimulation on the recovery of severely underweight children.
A total of 507 severely underweight children (weight-for-age z score <-3) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research, Bangladesh, were randomly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea: fortnightly follow-up care at the International Center for Diarrheal Disease Research, Bangladesh Hospital, including growth monitoring, health education, and micronutrient supplementation (group H-C, n = 102); fortnightly follow-up at community clinics, using the same treatment regimen as group H-C (group C-C, n = 99); community-based follow-up as per group C-C plus cereal-based supplementary food (SF) (group C-SF, n = 101); follow-up as per group C-C plus psychosocial stimulation (PS) (group C-PS, n = 102); or follow-up as per group C-C plus both SF and PS (group C-SF + PS, n = 103).
There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was greater in groups C-SF, C-SF + PS, and C-PS than in C-C and H-C; P < 0.05. Rates of weight gain were greater in groups C-SF + PS, C-SF, and C-PS (0.88-1.01 kg) compared with groups C-C and H-C (0.63-0.76 kg), P < 0.05. Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weight-for-length z score were greater in groups that received SF (P < 0.05) and linear growth was greater among children managed in the community (P = 0.002).
Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances nutritional recovery. Community-based service delivery, especially including SF, permits better rehabilitation of greater numbers of severely underweight children.
本研究旨在评估以社区为基础的随访护理、食物补充和/或心理社会刺激对严重体重不足儿童康复的影响。
共有 507 名严重体重不足的儿童（年龄 6 至 24 个月，体重与年龄 z 评分 <-3），在孟加拉国国际腹泻病研究中心住院治疗，一旦从腹泻中康复，他们被随机分配到以下方案中的 1 个方案，进行为期 3 个月的治疗：在孟加拉国国际腹泻病研究中心医院进行每两周一次的随访护理，包括生长监测、健康教育和微量营养素补充（H-C 组，n = 102）；在社区诊所进行每两周一次的随访，采用与 H-C 组相同的治疗方案（C-C 组，n = 99）；按照 C-C 组进行社区为基础的随访，同时提供基于谷物的补充食品（SF）（C-SF 组，n = 101）；按照 C-C 组进行随访，同时提供心理社会刺激（PS）（C-PS 组，n = 102）；或按照 C-C 组进行随访，同时提供 SF 和 PS（C-SF + PS 组，n = 103）。
治疗组之间的基线特征没有显著差异。C-SF、C-SF + PS 和 C-PS 组的预约随访就诊率高于 C-C 和 H-C 组；P < 0.05。与 C-C 和 H-C 组（0.63-0.76 kg）相比，C-SF + PS、C-SF 和 C-PS 组（0.88-1.01 kg）的体重增长率更高，P < 0.05。治疗成分的三因素协方差分析表明，接受 SF 的组体重增加和体重年龄 z 评分和体重长度 z 评分的变化更大（P < 0.05），社区管理的儿童线性生长更大（P = 0.002）。
将随访服务定位在社区中可以增加随访就诊率，并促进更好的线性生长；提供 SF，无论是否提供 PS，都可以增加就诊率并促进营养恢复。基于社区的服务提供，特别是包括 SF，可以更好地康复更多严重体重不足的儿童。
