Wallander Jan L, Biasini Fred J, Thorsten Vanessa, Dhaded Sangappa M, de Jong Desiree M, Chomba Elwyn, Pasha Omrana, Goudar Shivaprasad, Wallace Dennis, Chakraborty Hrishikesh, Wright Linda L, McClure Elizabeth, Carlo Waldemar A
Psychological Sciences and Health Sciences Research Institute, University of California, Merced, CA, USA.
BMC Pediatr. 2014 Oct 25;14:281. doi: 10.1186/1471-2431-14-281.
The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose.
Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates.
Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose.
Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.
在多个国家进行的大量对照试验中均报告了早期发育干预（EDI）对儿童早期发育的积极影响。确定EDI疗效的一个重要方面是剂量与结果的关联程度。然而，很少有EDI研究进行过此类分析。这项观察性队列研究考察了在三个低收入和中低收入国家实施EDI时治疗剂量与儿童发育之间的关联，以及与治疗剂量相关的人口统计学和儿童健康因素。
在印度、巴基斯坦和赞比亚农村社区出生的婴儿（78名男性，67名女性）在生命的前36个月接受了由培训师每两周进行一次家访的家长实施的EDI。在36个月龄时，使用贝利婴儿发展量表第二版的智力发展指数（MDI）和心理运动发展指数（PDI）来测量结果。治疗剂量通过完成的家访次数以及家长报告的家访期间指定发育刺激活动的实施情况来衡量。社会人口统计学、产前、围产期和儿童健康变量作为相关因素进行测量。
平均家访剂量超过91%，母亲们平均在62.5%的日子里让孩子参与活动。较高的家访剂量与较高的MDI显著相关（剂量五分位数1 - 2合并的平均值 = 97.8，五分位数3 - 5合并的平均值 = 103.4，p = 0.0017）。较高的治疗剂量通常也与更高的平均PDI相关，但这种关系是非线性的。地点、社会人口统计学和儿童健康变量与治疗剂量相关。
在生命的前36个月接受更高剂量的EDI通常与更好的发育结果相关。当在3年中接受≥91%的每两周一次家访且≥67%的日子里参与项目活动时，会出现更高的益处。确保以足够高的剂量实施EDI以达到预期效果很重要。为此，可以识别出接受较低剂量风险较高的群体，可能需要特别关注以确保获得足够的效果。
