IntraHealth International, Dushanbe, Tajikistan.
IntraHealth International, Chapel Hill, NC, USA.
Glob Health Sci Pract. 2021 Mar 15;9(Suppl 1):S137-S150. doi: 10.9745/GHSP-D-20-00325.
Childhood malnutrition is a nationally-recognized problem in Tajikistan. In 2017, 6% of children under 5 years were wasted and 18% were stunted. Through the Tajikistan Health and Nutrition Activity (THNA), funded by the U.S. Agency for International Development's Feed the Future, IntraHealth International trained 1,370 volunteer community health workers (CHWs) and 500 community agricultural workers (CAWs) in 500 rural communities to improve nutrition among children and pregnant and breastfeeding women. CHWs and CAWs mutually encourage health behavior change, reinforce better agricultural practices, and promote maternal and child health and nutritious diets through household visits, community events, and peer support groups. CHWs refer children with malnutrition and diarrhea and pregnant women who are not registered for antenatal care to health facilities. THNA supported CHWs/CAWs through peer learning, refresher trainings, supportive supervision, and quarterly material incentives. We observed gains in knowledge, attitudes, and practices across health; nutrition; water, sanitation, and hygiene (WASH); and agriculture in target communities. From 2016 to 2019, we observed statistically significant (<.05) improvements in children receiving a minimum acceptable diet; children with diarrhea receiving more liquids; women making 4 or more antenatal care visits; women reporting improved WASH; and farmers demonstrating improved agricultural practices. A February 2020 screening of 94.6% of children under 5 years in target communities found the prevalence of children with signs of wasting at 2.2%. Partnerships between CHWs, CAWs, and rural health workers facilitated these results. Paired agricultural and health interventions proved successful in improving nutrition of children and may be applicable in other contexts. Although effective in delivering interventions, CHWs/CAWs experience attrition, need motivation, and require intensive support. Assuming responsibility for this community-based volunteer workforce presents a major challenge for Tajikistan's national and local governments.
塔吉克斯坦存在全国性的儿童营养不良问题。2017 年，5 岁以下儿童中，6%消瘦，18%发育迟缓。通过美国国际开发署“未来粮食计划”供资的塔吉克斯坦健康与营养活动，国际健康组织在 500 个农村社区培训了 1370 名志愿社区卫生工作者和 500 名社区农业工作者，以改善儿童和孕妇及哺乳期妇女的营养状况。社区卫生工作者和社区农业工作者相互鼓励改变健康行为，加强更好的农业做法，并通过家访、社区活动和同伴支持小组促进母婴健康和营养饮食。社区卫生工作者和社区农业工作者将营养不良和腹泻儿童以及未登记产前护理的孕妇转介到卫生机构。THNA 通过同伴学习、进修培训、支持性监督和季度物资激励措施为社区卫生工作者/社区农业工作者提供支持。我们观察到目标社区在健康、营养、水、环境卫生和个人卫生以及农业方面的知识、态度和做法均有提高。2016 年至 2019 年，我们观察到接受最低可接受饮食的儿童、腹泻儿童接受更多液体、接受 4 次或更多产前护理就诊的妇女、报告改善水环境卫生和个人卫生的妇女以及展示改善农业做法的农民数量均有统计学意义的（<0.05）提高。2020 年 2 月对目标社区 94.6%的 5 岁以下儿童进行的筛查发现，消瘦儿童的比例为 2.2%。社区卫生工作者、社区农业工作者和农村卫生工作者之间的伙伴关系促成了这些结果。农业和卫生方面的配对干预措施已被证明在改善儿童营养方面是有效的，并且可能适用于其他情况。虽然社区卫生工作者和社区农业工作者在实施干预措施方面很有效，但他们也面临着人员流失、需要激励和强化支持的问题。承担这一社区志愿人员队伍的责任对塔吉克斯坦的国家和地方政府来说是一个重大挑战。
