Wallander Jan L, Bann Carla M, Biasini Fred J, Goudar Shivaprasad S, Pasha Omrana, Chomba Elwyn, McClure Elizabeth, Carlo Waldemar A
University of California, Merced, CA, USA.
J Child Psychol Psychiatry. 2014 Nov;55(11):1251-9. doi: 10.1111/jcpp.12247. Epub 2014 May 9.
Previous research has indicated positive effects of early developmental intervention (EDI) on the development of children in developing countries. Few studies, however, have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation. Also, birth asphyxia as a risk condition has not been well studied. To address these limitations, we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India, Pakistan, and Zambia.
Children with and without birth asphyxia were randomized to EDI or control intervention, which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months. Development was assessed in 376 children at ages 12, 24, and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition.
Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities, regardless of risk condition, maternal resources, child gender, or country. Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities, but were not statistically different between intervention conditions. Developmental differences were observed first at 36 months of age.
Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions. EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty.
先前的研究表明，早期发育干预（EDI）对发展中国家儿童的发育有积极影响。然而，很少有研究纵向考察何时可能观察到差异治疗效果，以及不同的结果是否与接触不同的风险因素和实施国家有关。此外，出生窒息作为一种风险状况尚未得到充分研究。为了解决这些局限性，我们进行了一项随机对照试验，以检验以下假设：在印度、巴基斯坦和赞比亚农村地区的儿童中，接受早期发育干预的儿童与接受健康教育干预的儿童相比，将有不同的发育轨迹。
有或无出生窒息的儿童被随机分配到早期发育干预组或对照组，干预由接受培训的父母实施，他们在孩子1个月大之前开始每两周进行一次家访，并持续到36个月。在12、24和36个月时，使用贝利婴儿发育量表和年龄与阶段问卷对376名儿童的发育情况进行评估，评估人员对干预分配和风险状况不知情。
纵向混合模型分析表明，无论风险状况、母亲资源、儿童性别或国家如何，早期发育干预在36个月内都能使认知能力得到更好的发展。心理运动发育和家长报告的总体发育情况与认知能力呈现相似趋势，但在不同干预组之间没有统计学差异。发育差异首先在36个月时观察到。
早期发育干预有望改善发展中国家面临各种风险状况的儿童的发育。早期发育干预应成为解决长期结果和贫困代际传递问题的一项重要方法。
