International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
BMC Public Health. 2012 Aug 7;12:622. doi: 10.1186/1471-2458-12-622.
Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers' child-rearing practices in a community-based trial with severely malnourished Bangladeshi children.
Severely underweight children (n = 507), 6-24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150-300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome.
322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p < 0.001 for all). The PS group benefitted 2.4 points compared with CH (p = 0.035), 3.3 points compared with CC (p = 0.004), and 2.9 points compared with FS (p = 0.006). Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p < 0.001 for all).
Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.
育儿课程可有效提升育儿实践和儿童发展。本研究评估了一种基于社区的、针对严重营养不良孟加拉国儿童的心理社会刺激（PS）干预措施对家庭环境质量和母亲育儿实践的影响，该干预措施同时结合了心理社会刺激和食物补充。
6-24 个月大的严重体重不足儿童（n=507）被随机分配到五个组：PS 组、食物补充组（FS）、PS+FS 组、诊所对照组（CC）和医院对照组（CH）。PS 组包括六个月内每两周一次的社区诊所随访，由一名游戏指导员演示游戏活动，并提供儿童发展和育儿实践教育。FS 组在三个月内提供基于谷物的补充剂（150-300 千卡/天）。所有组都接受医疗护理、微量营养素补充和生长监测。母亲在基线和六个月后接受家庭观察测量环境（HOME）清单和育儿问卷评估结果。
322 名儿童完成了研究。干预六个月后，PS+FS 和 PS 组在 HOME 总分方面受益（根据比较组，效应大小从 0.66 到 0.33 标准差不等）。PS+FS 和 PS 组在两个 HOME 子量表中也受益：母亲参与（效应大小：0.8 至 0.55 标准差）和游戏材料（效应大小：0.46 至 0.6 标准差），以及育儿实践评分（效应大小：1.5 至 1.1 标准差）。PS+FS 组 HOME 总分比 CH 组多 4.0 分，比 CC 组多 4.8 分，比 FS 组多 4.5 分（所有 p 值均<0.001）。PS 组比 CH 组多 2.4 分（p=0.035），比 CC 组多 3.3 分（p=0.004），比 FS 组多 2.9 分（p=0.006）。PS+FS 组的育儿实践评分提高了 7.7、6.4 和 6.6 分，PS 组提高了 8.5、7.2 和 7.4 分，分别比 CH、CC 和 FS 组多（所有 p 值均<0.001）。
通过基于社区的心理社会刺激（PS），无论是否结合食物补充，都可以改善严重营养不良儿童的母亲的育儿实践和家庭环境质量。这可能对促进儿童发展很重要。
