Martinez Boris, Webb Meghan Farley, Gonzalez Ana, Douglas Kate, Grazioso Maria Del Pilar, Rohloff Peter
Wuqu' Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Guatemala.
Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
BMJ Paediatr Open. 2018 Apr 27;2(1):e000213. doi: 10.1136/bmjpo-2017-000213. eCollection 2018.
OBJECTIVE/BACKGROUND: Guatemala's indigenous Maya population has one of the highest rates of childhood stunting in the world. The goal of this study was to examine the impact of an intensive, individualised approach to complementary feeding education for caregivers on feeding practices and growth over usual care.
An individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcome data.
Rural Maya communities in Guatemala.
324 children aged 6-24 months with a height-for-age Z score of less than or equal to -2.5 SD were randomised, 161 to the intervention and 163 to usual care.
Community health workers conducted home visits for 6 months, providing usual care or usual care plus individualised caregiver education.
The main outcome was change in length/height-for-age Z score. Secondary outcomes were changes in complementary feeding indicators.
Data were analysed for 296 subjects (intervention 145, usual care 151). There was a non-significant trend to improved growth in the intervention arm (length/height-for-age Z score change difference 0.07(95% CI -0.04 to 0.18)). The intervention led to a 22% improvement in minimum dietary diversity (RR 1.22, 95% CI 1.11 to 1.35) and a 23% improvement in minimal acceptable diet (RR 1.23, 95% CI 1.08 to 1.40) over usual care.
Complementary feeding outcomes improved in the intervention arm, and a non-significant trend towards improved linear growth was observed. Community health workers in a low-resource rural environment can implement individualised caregiver complementary feeding education with significant improvements in child dietary quality over standard approaches.
NCT02509936. Stage: Results.
目的/背景：危地马拉的玛雅原住民儿童发育迟缓率位居世界前列。本研究旨在探讨针对照料者的强化、个性化辅食喂养教育对喂养行为及生长发育（相较于常规护理）的影响。
一项个体随机（1:1分配比例）、平行组优效性试验，收集结局数据的研究人员设盲。
危地马拉的农村玛雅社区。
324名年龄在6至24个月、年龄别身高Z评分小于或等于-2.5标准差的儿童被随机分组，161名接受干预，163名接受常规护理。
社区卫生工作者进行为期6个月的家访，提供常规护理或常规护理加个性化照料者教育。
主要结局为年龄别身长/身高Z评分的变化。次要结局为辅食喂养指标的变化。
对296名受试者（干预组145名，常规护理组151名）的数据进行了分析。干预组有生长改善的非显著趋势（年龄别身长/身高Z评分变化差异为0.07(95%CI -0.04至0.18)）。与常规护理相比，干预使最低饮食多样性提高了22%（RR 1.22，95%CI 1.11至1.35），使最低可接受饮食提高了23%（RR 1.23，95%CI 1.08至1.40）。
干预组的辅食喂养结局得到改善，且观察到线性生长有非显著改善趋势。在资源匮乏的农村环境中，社区卫生工作者可以实施个性化照料者辅食喂养教育，相较于标准方法，儿童饮食质量有显著改善。
NCT02509936。阶段：结果。
