Ekjut, Chakradharpur, Jharkhand, India.
Public Health Resource Society, New Delhi, India.
BMC Public Health. 2019 Jul 18;19(1):962. doi: 10.1186/s12889-019-7274-3.
India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women's groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits.
We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation's primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children.
We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51-0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59-0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96-1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55-0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47-0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57-0.93).
Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches.
The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.
印度面临着儿童营养不足的高负担。我们评估了两种在印度东部恰尔康得和奥迪沙邦农村减少 3 岁以下儿童营养不良的社区策略的效果：（1）每月与妇女团体进行参与式学习和行动（PLA）会议，随后进行家访；（2）6 个月至 3 岁儿童的托儿所，结合每月 PLA 会议和家访。
我们在一项非随机对照研究中对这些策略进行了测试，该研究采用了基线和终线横断面调查。我们有目的地选择了恰尔康得和奥迪沙邦的五个街区，并将每个街区分为三个区域。区域 1 作为对照。在区域 2 中，经过培训的当地女性工作人员在家中为 3 岁以下儿童的母亲提供 PLA 会议和咨询。在区域 3 中，工作人员为 6 个月至 3 岁的儿童举办 PLA 会议、家访，并开设了提供食物和生长监测的托儿所。我们对所有研究区域进行了普查，并在基线和终线随机抽取了 4668 名 3 岁以下儿童及其母亲进行访谈和人体测量。评估的主要结果是与区域 1 相比，区域 2 和 3 中 3 岁以下儿童的消瘦情况，调整了区域之间的基线差异。其他结果包括儿童消瘦、体重不足、发育迟缓、预防和寻求护理的做法。
我们对基线时抽样的 3 岁以下儿童的母亲进行了 83%（3868/4668）的访谈，对终线时进行了 76%（3563/4668）的访谈。在区域 2（PLA 和家访）中，3 岁以下儿童的消瘦减少了 34%（调整后的优势比[aOR]：0.66，95%：0.51-0.88），体重不足减少了 25%（aOR：0.75，95% CI：0.59-0.95），发育迟缓没有变化（aOR：1.23，95% CI：0.96-1.57）。在区域 3（PLA、家访、托儿所）中，消瘦减少了 27%（aOR：0.73，95% CI：0.55-0.97），体重不足减少了 40%（aOR：0.60，95% CI：0.47-0.75），发育迟缓减少了 27%（aOR：0.73，95% CI：0.57-0.93）。
托儿所、PLA 会议和家访减少了印度东部农村地区 3 岁以下儿童的营养不良。这些干预措施可以通过政府计划来扩大规模，该计划旨在加强家庭访问和社区动员，同时利用认证社会卫生活动家，并通过促进托儿所的努力来实现。
该评估于 2019 年 1 月 30 日在 Current Controlled Trials 中以 ISCRTN89911047 号进行了回顾性注册。
