Khan Muhammad Amir, Owais Syeda Somyyah, Blacklock Claire, Anil Shirin, Ishaq Sehrish, Maqbool Shazia, Khan Haroon Jehangir, Minhas Fareed A, Walley John
Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan.
Project Manager, Association for Social Development, Islamabad, Pakistan.
BJGP Open. 2017 Jan 9;1(1):bjgpopen17X100677. doi: 10.3399/bjgpopen17X100677.
Early childhood developmental delay is associated with significant disadvantage in adult life. In Pakistan, high prevalence of developmental delay is associated with poverty, under-nutrition, and maternal depression.
To assess the effectiveness of an early child development counselling intervention delivered at private GP clinics, in poor urban communities.
DESIGN & SETTING: A clustered randomised trial in Pakistan.
The intervention was developed following a period of formative research, and in consultation with local experts. A total of 2112 mother-child pairs will be recruited at 32 clinics, from within the locality (cluster); 16 clinics per arm. A primary care counselling intervention (promoting child development, nutrition, and maternal mental health) will be delivered at 6 weeks, 3, 6, and 9 months of the child's age. Monitoring, assessment, and treatment will also be performed at quarterly visits in intervention clinics. Primary outcome is the developmental delay at 12 months (ASQ-3 scores). Secondary outcomes are stunting rate, and maternal depression (PHQ-9 score). In addition, a process evaluation and costing study will be conducted.
This trial will be the first to assess an early child development intervention, delivered in private GP clinics for poor urban communities in Pakistan. If found to be effective, this public-private model may offer a more sustainable, and feasible option for populations in poor urban settings, where private GP clinics are the most accessible provider of primary health care. There is scope for scale-up at provincial level, should the intervention be effective.
The trial has been registered with the Current Controlled Trials ISRCTN48032200.
儿童早期发育迟缓与成年后的显著劣势相关。在巴基斯坦，发育迟缓的高患病率与贫困、营养不良和母亲抑郁有关。
评估在城市贫困社区的私人全科医生诊所提供的儿童早期发育咨询干预措施的有效性。
巴基斯坦的一项整群随机试验。
在进行了一段时间的形成性研究并咨询当地专家后制定了干预措施。将从当地（群组）的32家诊所招募总共2112对母婴；每组16家诊所。将在儿童6周、3个月、6个月和9个月大时提供初级保健咨询干预（促进儿童发育、营养和母亲心理健康）。干预诊所还将每季度进行监测、评估和治疗。主要结局是12个月时的发育迟缓（ASQ-3评分）。次要结局是发育迟缓率和母亲抑郁（PHQ-9评分）。此外，还将进行过程评估和成本研究。
该试验将是首次评估在巴基斯坦城市贫困社区的私人全科医生诊所提供的儿童早期发育干预措施。如果被证明有效，这种公私合作模式可能为城市贫困地区的人群提供一种更可持续、更可行的选择，因为在这些地区，私人全科医生诊所是最容易获得的初级卫生保健提供者。如果干预措施有效，在省级层面有扩大规模的空间。
该试验已在当前对照试验ISRCTN48032200注册。
