El-Sayed Hesham, Martines Jose, Rakha Mona, Zekry Osama, Abdel-Hak Mona, Abbas Hanan
Departments of aPediatrics bFamily Medicine, Faculty of Medicine, Suez Canal University, Ismailia cMinistry of Health and Population, Cairo, Egypt dDepartment of Child and Adolescent Health and Development, World Health Organization (WHO), Geneva, Switzerland.
J Egypt Public Health Assoc. 2014 Apr;89(1):1-8. doi: 10.1097/01.EPX.0000443990.46047.a6.
The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC).
To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth.
A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length.
CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004).
Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.
母乳喂养儿童的辅食添加是否充足及时机是否恰当，对儿童的最佳生长发育至关重要。人们已做出相当大的努力来改善儿童出生后头两年的辅食添加情况。其中之一就是世界卫生组织的辅食添加咨询课程（CFC）。
评估世界卫生组织CFC课程对初级保健医生的知识和咨询能力、对看护者的知识以及对医生建议的依从性及其喂养行为，以及对儿童生长的效果。
在40个初级保健中心开展了一项单盲随机对照研究，这些中心根据其位于农村或城市地区的位置分成匹配组，并对选定的医生进行儿童疾病综合管理培训。从每组中随机选择一个中心，让其医生接受营养咨询方面的CFC培训，将匹配的中心作为对照。该研究纳入了40名初级保健中心医生和480对母婴（6 - 18个月）。在与经过培训的卫生工作者初次咨询后的2周、90天和180天内，对招募的母婴对进行家访。使用专门的问卷收集关于医疗保健提供者的营养咨询知识和实践（咨询技能）、母亲对基本营养咨询建议的知识、母亲对推荐喂养行为的依从性、儿童饮食摄入以及体重和身长增加情况的信息。
接受CFC培训的医生更有可能进行营养咨询并提供更恰当的建议。这体现在母亲对辅食添加信息的回忆有所改善，干预组的情况优于对照组。咨询6个月后，干预组儿童的体重增加明显高于对照组（0.96千克对0.78千克；P = 0.038）。招募时年龄在12 - 18个月的干预组儿童，其身长增加的迟缓情况明显少于对照组（身高/年龄Z评分；0.23对0.04；P = 0.004）。
营养咨询培训提高了初级保健医生的咨询能力，并使母亲在辅食添加方面的知识和行为得到改善。反过来，这促进了儿童的生长。我们建议广泛且定期地利用CFC课程，以提高为母亲提供辅食添加咨询的卫生工作者的知识和技能。
