综合多层次幼儿发展干预对照顾者知识和行为的影响：坦桑尼亚 Malezi 项目的准实验评估。
Effectiveness of an integrated multilevel early child development intervention on caregiver knowledge and behavior: a quasi-experimental evaluation of the Malezi program in Tanzania.
机构信息
Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania.
Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, USA.
出版信息
BMC Public Health. 2023 Jan 4;23(1):19. doi: 10.1186/s12889-022-14956-2.
BACKGROUND
The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.
METHODS
This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0-24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF's Care for Child Development package, used ECD videos in home- and facility-based sessions with caregivers. We used McNemar's testing (pre-post pairs) within intervention group to describe how the intervention was associated with change in five outcomes: ECD knowledge, early stimulation, father engagement, responsive care, and environment safety. Logistic regression was used to describe the relative benefits of the combined intervention package (RMV-ECD) compared to radio messaging (RM).
RESULTS
In the RMV-ECD arm, all outcomes at endline except environment safety significantly improved after the intervention with the largest change seen in ECD knowledge (35.8% increase, p < .0001) and the smallest in father engagement (6.7%, p = .015). In the RM arm, ECD knowledge (5.7%, p = .031) and environment safety (18.1%, p = <.0001) improved. High measures of parenting stress were associated with lower likelihood of having good ECD knowledge (AOR 0.50, 95%CI: 0.35, 0.71), father engagement (AOR 0.72, 95%CI: 0.52, 0.99) and responsive care (AOR 0.31, 95%CI: 0.18, 0.54).
CONCLUSIONS
An intervention that includes mass media, educational video content and CHWs who counsel caregivers in their homes and health facilities was associated with significant improvements in ECD parenting knowledge and behaviors but a relationship with responsive care could not be established. The less costly mass media-only intervention was associated with improved parenting knowledge and household environment safety. Parenting interventions targeting young children could be improved by incorporating more messaging and caregiver coaching in managing parental stress.
TRIAL REGISTRATION
NCT05244161 (17/02/2022); retrospectively registered with the US National Institutes of Health ClinicalTrials.gov.
背景
儿童早期发展（ECD）的照护质量和亲子关系至关重要，且已有研究表明其具有可改变性。本研究评估了坦桑尼亚的一个 ECD 项目，评估了单独的 ECD 广播信息（RM）和结合广播信息/视频辅助工具/ECD（RMV-ECD）干预的效果。
方法
本项为期 9 个月的、在坦噶区四个地区进行的、有对照的前后评估研究，招募了 0-24 个月儿童的照护者。ECD 广播信息在当地受欢迎的电台每天至少播放 10 次，覆盖所有研究地区。在两个地区，经过联合国儿童基金会儿童关怀发展包培训的社区卫生工作者（CHW）在家中和医疗机构中使用 ECD 视频与照护者进行互动。我们使用 McNemar 检验（干预前后配对）描述干预如何与以下五个结果的变化相关联：ECD 知识、早期刺激、父亲参与、响应性护理和环境安全。使用逻辑回归描述与 RMV-ECD 相比，联合干预方案（RMV-ECD）的相对益处。
结果
在 RMV-ECD 组中，除环境安全外，所有终点结果在干预后均显著改善，ECD 知识的变化最大（增加 35.8%，p<0.0001），父亲参与的变化最小（增加 6.7%，p=0.015）。在 RM 组中，ECD 知识（增加 5.7%，p=0.031）和环境安全（增加 18.1%，p<.0001）也有所改善。高育儿压力与 ECD 知识（优势比 0.50，95%置信区间：0.35，0.71）、父亲参与（优势比 0.72，95%置信区间：0.52，0.99）和响应性护理（优势比 0.31，95%置信区间：0.18，0.54）的可能性降低有关。
结论
包括大众媒体、教育视频内容和在家庭和医疗机构中为照护者提供咨询的 CHW 的干预措施，与 ECD 育儿知识和行为的显著改善有关，但与响应性护理的关系尚无法确定。成本较低的大众媒体干预措施与改善育儿知识和家庭环境安全有关。针对幼儿的育儿干预措施可以通过增加信息传递和照护者辅导来管理父母压力，从而得到改善。
试验注册
NCT05244161（2022 年 2 月 17 日）；美国国立卫生研究院临床试验.gov 网站进行了回顾性注册。
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