Martinez Sebastian, Johannsen Julia, Gertner Gaston, Franco Jorge, Perez Exposito Ana B, Bartolini Rosario M, Condori Irma, Ayllón Jhovanna Flores, Llanque Ramiro, Alvarado Nohora, Lunstedt Christian, Ferrufino Cecilia, Reinaga Teresa, Chumacero Mauricio, Foronda Carlos, Albarracin Santiago, Aguilar Ana Maria
Inter-American Development Bank (IDB), Washington, DC, USA.
Instituto de Investigación Nutricional, La Molina, Peru.
BMJ Glob Health. 2018 May 26;3(3):e000687. doi: 10.1136/bmjgh-2017-000687. eCollection 2018.
Stunting affects child survival and is a key indicator of child well-being. Therefore, reducing stunting is a global goal. Improving infant and young child feeding (IYCF) practices is a recommended approach to reduce the risk of mortality and ameliorate nutritional status. Behavioural change interventions have the potential to improve IYCF practices.
We evaluated the effectiveness of an innovative behavioural change strategy on caregiver's knowledge, IYCF practices and nutritional status of children from low-income households in El Alto, Bolivia. Home visits used culturally adapted participatory play strategies to promote recommended IYCF practices. A total of 2014 households with children younger than 12 months at baseline were randomly assigned to treatment and control groups.
Caregiver knowledge and IYCF practices improved by 0.2 SD, as did food expenditures on recommended foods and dietary diversity. No significant effects were detected on anthropometric indicators or anaemia. Treatment compliance was 88% of households at enrolment and 66% at completion.
Participatory play-based behavioural change strategies are a promising delivery model to improve recommended IYCF practices. After 30 months of intervention, we found sustained positive effects on caregiver's knowledge and IYCF practices but no effect on nutritional status. Despite the lack of effect on linear growth and anaemia, our results highlight the relevance of implementing interventions that improve IYCF practices due to their importance for early development and prevention of obesity. Other contextual variables, apart from diet, that could be limiting children's growth potential in this population need to be identified to design holistic approaches that improve child well-being and human capital.
发育迟缓影响儿童生存，是儿童健康的关键指标。因此，减少发育迟缓是一项全球目标。改善婴幼儿喂养（IYCF）做法是降低死亡风险和改善营养状况的推荐方法。行为改变干预措施有可能改善婴幼儿喂养做法。
我们评估了一种创新的行为改变策略对玻利维亚埃尔阿尔托低收入家庭照料者的知识、婴幼儿喂养做法以及儿童营养状况的有效性。家访采用了根据文化调整的参与式游戏策略，以促进推荐的婴幼儿喂养做法。共有2014户在基线时孩子年龄小于12个月的家庭被随机分为治疗组和对照组。
照料者的知识和婴幼儿喂养做法提高了0.2个标准差，推荐食物的食品支出和饮食多样性也有所提高。在人体测量指标或贫血方面未检测到显著影响。入组时治疗依从率为88%的家庭，完成时为66%。
基于参与式游戏的行为改变策略是改善推荐的婴幼儿喂养做法的一种有前景的实施模式。经过30个月的干预，我们发现对照料者的知识和婴幼儿喂养做法有持续的积极影响，但对营养状况没有影响。尽管对线性生长和贫血没有影响，但我们的结果凸显了实施改善婴幼儿喂养做法干预措施的相关性，因为这些措施对早期发育和预防肥胖很重要。除了饮食之外，还需要确定可能限制该人群儿童生长潜力的其他背景变量，以设计改善儿童健康和人力资本的整体方法。
