International Food Policy Research Institute, Washington, DC.
J Nutr. 2018 Mar 1;148(3):445-452. doi: 10.1093/jn/nxx063.
Food-assisted maternal and child health and nutrition (FA-MCHN) programs are widely used to address undernutrition, but little is known about their effectiveness in improving child linear growth.
We assessed the impact of Burundi's Tubaramure FA-MCHN program on linear growth. The program targeted women and their children during the first 1000 d and included 1) food rations, 2) strengthening of health services and promotion of their use, and 3) behavior change communication (BCC). A second objective was to assess the differential effect when varying the timing and duration of receiving food rations.
We used a 4-arm, cluster-randomized controlled study to assess program impact with the use of cluster fixed-effects double-difference models with repeated cross-sectional data (baseline and follow-up 4 y later with ∼3550 children in each round). Treatment arms received food rations (corn-soy blend and micronutrient-fortified vegetable oil) for the first 1000 d (T24), from pregnancy through the child reaching 18 mo (T18), or from birth through the child reaching 24 mo ["no food during pregnancy" (TNFP)]. All treatment arms received BCC for the first 1000 d. The control arm received no food rations or BCC.
Stunting (height-for-age z score <2 SDs) increased markedly from baseline to follow-up, but Tubaramure had a significant (P < 0.05) beneficial effect in the T24 [7.4 percentage points (pp); P < 0.05], T18 (5.7 pp; P < 0.05), and TNFP (4.6; P = 0.09) arms; the differences in effect across arms were not significant (P > 0.01). Secondary analyses showed that the effect was limited to children whose mother and head of household had some primary education and who lived in households with above-median assets.
FA-MCHN programs are an effective development tool to improve child linear growth and can protect children from political and economic shocks in vulnerable countries such as Burundi. A better understanding of how to improve the nutritional status of children in the worst-off households is needed. This trial was registered at www.clinicaltrials.gov as NCT01072279.
食品辅助母婴健康和营养（FA-MCHN）计划被广泛用于解决营养不良问题，但对于其改善儿童线性生长的效果知之甚少。
我们评估了布隆迪的 Tubaramure FA-MCHN 计划对线性生长的影响。该计划针对妇女及其子女在生命最初 1000 天内开展，包括 1）食品配给，2）加强卫生服务并促进其利用，以及 3）行为改变沟通（BCC）。第二个目标是评估在改变接受食品配给的时间和持续时间时的差异效果。
我们使用 4 臂、集群随机对照研究，利用使用集群固定效应双重差分模型和重复横截面数据（每轮有 3550 名儿童的基线和 4 年后的随访）来评估该计划的效果。治疗组在生命最初 1000 天内（T24）接受食品配给（玉米-大豆混合物和强化微量营养素的植物油），从妊娠到儿童达到 18 个月（T18），或从出生到儿童达到 24 个月（“妊娠期间无食品”（TNFP））。所有治疗组在生命最初 1000 天内接受 BCC。对照组未接受食品配给或 BCC。
从基线到随访，生长迟缓（身高年龄 z 分数<2SD）显著增加，但 Tubaramure 在 T24 臂[7.4 个百分点（pp）；P<0.05]、T18 臂（5.7 pp；P<0.05）和 TNFP 臂（4.6；P=0.09）中具有显著（P<0.05）的有益效果；臂间的效果差异不显著（P>0.01）。二次分析表明，该效果仅限于母亲和户主具有一些小学教育且居住在资产高于中位数的家庭的儿童。
FA-MCHN 计划是改善儿童线性生长的有效发展工具，可以保护布隆迪等脆弱国家的儿童免受政治和经济冲击。需要更好地了解如何改善最贫困家庭儿童的营养状况。该试验在 www.clinicaltrials.gov 上注册为 NCT01072279。
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