Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.
University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.
Infect Dis Poverty. 2022 Jun 6;11(1):66. doi: 10.1186/s40249-022-00985-x.
Unsafe drinking water, poor sanitation and hygiene, exposure to household air pollution and low cognitive and socio-emotional stimulation are risk factors affecting children in low- and middle-income countries. We implemented an integrated home-environmental intervention package (IHIP), comprising a kitchen sink, hygiene education and a certified improved biomass cookstove, and an early child development (ECD) programme to improve children´s health and developmental outcomes in the rural high-altitude Andes of Peru.
We conducted a one-year cluster-randomised controlled trial among 317 children < 36 months divided into 4 arms (IHIP + ECD, IHIP, ECD, and Control) and 40 clusters (10 clusters per arm). ECD status (socio-emotional, fine and gross motor, communication, cognitive skills, and an overall performance) measured with the Peruvian Infant Development Scale and the occurrence of self-reported child diarrhoea from caretakers were primary outcomes. Secondary outcomes included the occurrence of acute respiratory infections and the presence of thermo-tolerant faecal bacteria in drinking water. The trial was powered to compare each intervention against its control arm but it did not allow pairwise comparisons among the four arms. Primary analysis followed the intention-to-treat principle. For the statistical analysis, we employed generalised estimating equation models with robust standard errors and an independent correlation structure.
We obtained ECD information from 101 children who received the ECD intervention (individually and combined with IHIP) and 102 controls. Children who received the ECD intervention performed better in all the domains compared to controls. We found differences in the overall performance (64 vs. 39%, odd ratio (OR): 2.8; 95% confidence interval (CI): 1.6-4.9) and the cognitive domain (62 vs 46%, OR: 1.9; 95% CI: 1.1-3.5). Data analysis of child morbidity included 154 children who received the IHIP intervention (individually and combined with ECD) and 156 controls. We recorded 110,666 child-days of information on diarrhoea morbidity and observed 1.3 mean episodes per child-year in the children who received the IHIP intervention and 1.1 episodes in the controls. This corresponded to an incidence risk ratio of 1.2 (95% CI: 0.8-1.7).
Child stimulation improved developmental status in children, but there was no health benefit associated with the home-environmental intervention. Limited year-round access to running water at home and the possible contamination of drinking water after boiling were two potential factors linked to the lack of effect of the home-environmental intervention. Potential interactions between ECD and home-environmental interventions need to be further investigated.
ISRCTN, ISRCTN-26548981. Registered 15 January 2018-Retrospectively registered, https://doi.org/10.1186/ISRCTN26548981 .
不安全的饮用水、卫生条件差和环境卫生差、家庭空气污染暴露以及认知和社会情感刺激不足是影响中低收入国家儿童的风险因素。我们实施了一个综合家庭环境干预包（IHIP），包括一个厨房水槽、卫生教育和一个经过认证的改良生物质炉灶，以及一个早期儿童发展（ECD）方案，以改善秘鲁农村高海拔安第斯地区儿童的健康和发展结果。
我们在 317 名 <36 个月的儿童中进行了为期一年的整群随机对照试验，分为 4 组（IHIP+ECD、IHIP、ECD 和对照组）和 40 个组（每组 10 个组）。ECD 状态（社会情感、精细和粗大运动、沟通、认知技能和整体表现）使用秘鲁婴儿发育量表进行测量，儿童腹泻的发生由护理人员报告。主要结果是认知能力、社会情感、精细和粗大运动、沟通、认知技能和整体表现。次要结果包括急性呼吸道感染的发生和饮用水中耐热粪便细菌的存在。该试验的目的是比较每个干预措施与对照措施，但不允许对四组之间进行两两比较。主要分析遵循意向治疗原则。对于统计分析，我们使用广义估计方程模型，采用稳健标准误差和独立相关结构。
我们从接受 ECD 干预（单独和联合 IHIP）的 101 名儿童和 102 名对照组获得了 ECD 信息。接受 ECD 干预的儿童在所有领域的表现均优于对照组。我们发现整体表现（64%比 39%，比值比（OR）：2.8；95%置信区间（CI）：1.6-4.9）和认知领域（62%比 46%，OR：1.9；95% CI：1.1-3.5）存在差异。儿童发病数据分析包括接受 IHIP 干预（单独和联合 ECD）的 154 名儿童和 156 名对照组。我们记录了 154 名儿童的 110666 天腹泻发病信息，接受 IHIP 干预的儿童平均每年每儿童发生 1.3 个病例，对照组为 1.1 个病例。这相当于发病率风险比为 1.2（95%CI：0.8-1.7）。
儿童刺激改善了儿童的发育状况，但家庭环境干预措施对健康没有益处。家中全年有限地获得自来水和煮沸后饮用水可能受到污染，这是与家庭环境干预措施缺乏效果相关的两个潜在因素。ECD 和家庭环境干预措施之间的潜在相互作用需要进一步研究。
ISRCTN，ISRCTN-26548981。2018 年 1 月 15 日注册-回顾性注册，https://doi.org/10.1186/ISRCTN26548981。
