Division of Women and Child Health, Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan;
Medical College, Aga Khan University, Nairobi, Kenya; and.
Pediatrics. 2015 May;135(5):e1247-57. doi: 10.1542/peds.2014-2335. Epub 2015 Apr 13.
To investigate whether a responsive stimulation intervention delivered to caregivers of young children either alone or integrated with nutrition interventions would benefit parenting skills and emotional availability to promote children's development and growth compared with either a nutrition intervention alone or the usual standard of care.
A cluster randomized factorial effectiveness trial was implemented in an impoverished community in Pakistan. The 4 trial arms were control (usual standard of care), responsive stimulation (responsive care and stimulation), enhanced nutrition (education and multiple micronutrients), and a combination of both enriched interventions. The 4 intervention packages were delivered by community health workers to 1489 mother-infant dyads in the first 2 years of life. Parenting skills and emotional availability indexed by mother-child interaction, caregiving environment, knowledge and practices pertaining to early childhood care and feeding, and maternal depressive symptoms were assessed at multiple intervals. An intention-to-treat factorial analysis was conducted.
Intervention groups were comparable at baseline. Responsive stimulation significantly benefitted parenting skills with large effect sizes on mother-child interaction (Cohen's d 0.8), caregiving environment (Cohen's d 0.9-1.0), and knowledge and practices (Cohen's d 0.7-1.1) compared with small-modest significant effects as a result of nutrition intervention on mother-child interaction and caregiving environment only (Cohen's d 0.4 and 0.2, respectively). The combined intervention had a small significant effect on decreasing maternal depressive symptoms over time (Cohen's d 0-0.2).
A responsive stimulation intervention can promote positive caregiving behaviors among impoverished families. Additional research is needed on interventions to reduce maternal depressive symptoms.
研究针对幼儿照料者的反应性刺激干预措施，无论是单独实施还是与营养干预措施相结合，是否会比单纯的营养干预或常规护理标准更有益于育儿技能和情感可及性，从而促进儿童的发展和成长。
在巴基斯坦一个贫困社区实施了一项集群随机因子有效性试验。试验的 4 个处理组为对照组（常规护理标准）、反应性刺激组（反应性护理和刺激）、强化营养组（教育和多种微量营养素）以及两者相结合的强化干预组。4 个干预方案由社区卫生工作者在生命的头 2 年提供给 1489 对母婴对。通过母婴互动、照护环境、与儿童早期护理和喂养相关的知识和实践以及产妇抑郁症状等指标评估育儿技能和情感可及性。进行了意向性治疗因子分析。
干预组在基线时具有可比性。与营养干预对母婴互动和照护环境仅有适度的显著效果（Cohen's d 分别为 0.4 和 0.2）相比，反应性刺激显著有益于育儿技能，对母婴互动（Cohen's d 0.8）、照护环境（Cohen's d 0.9-1.0）和知识与实践（Cohen's d 0.7-1.1）均产生了较大的效应量。联合干预对减少产妇抑郁症状随时间的变化具有较小但显著的效果（Cohen's d 为 0-0.2）。
反应性刺激干预措施可以促进贫困家庭的积极照护行为。需要进一步研究干预措施以减少产妇抑郁症状。
