State Health Resource Centre, Chhattisgarh, Raipur, India.
BMC Pediatr. 2023 Apr 13;23(1):171. doi: 10.1186/s12887-023-03993-4.
A large proportion of young children in developing countries receive inadequate feeding and face frequent infections. Global research has established the need for improving feeding practices and management of child illnesses. Interventions involving home visits by community health workers (CHWs) for caregiver education have been attempted in many countries. Indian government rolled out an intervention called home-based care of young children (HBYC) in 2018 but no studies exist of its scaled-up implementation. The current study was aimed at assessing the coverage of HBYC in Chhattisgarh state where it has been implemented through 67,000 rural CHWs known as Mitanins.
This cross-sectional study was based on a primary household survey. Households with children in 7-36 months age were eligible for survey. A multi-stage sample of 2646 households was covered. Descriptive analyses were performed and key indicators were reported with 95% confidence intervals. To find out the association between caregiver practices and receiving advice from the CHWs, multivariate regression models were applied.
Overall, 85.1% children in 7-36 months age received at least one home visit from a CHW within the preceding three months. Complementary feeding had been initiated for 67% of children at six months age and the rate was 87% at eight months age. Around one-third of the children were fed less than three times a day. Around 41% households added oil in child's food the preceding day. CHWs were contacted in 73%, 69% and 61% cases of diarrhea, fever and respiratory infections respectively in children. Among those contacting a CHW for diarrhea, 88% received oral rehydration. The adjusted models showed that receiving advice from CHWs was significantly associated with timely initiation of complementary feeding, increasing the frequency of feeding, increasing diet diversity, addition of oil, weighing and consumption of food received from government's supplementary nutrition programme.
Along with improving food security of households, covering a large share of young children population with quality home visits under scaled-up CHW programmes can be the key to achieving improvements in complementary feeding and child care practices in developing countries.
发展中国家有很大一部分幼儿得不到充分的喂养，且经常受到感染。全球研究已经证实需要改善喂养方式和儿童疾病管理。许多国家已经尝试过通过社区卫生工作者（CHW）家访为照顾者提供教育的干预措施。印度政府于 2018 年推出了一项名为幼儿家庭护理（HBYC）的干预措施，但没有关于其扩大实施的研究。本研究旨在评估在恰蒂斯加尔邦实施的 HBYC 的覆盖范围，该邦通过 67000 名名为 Mitanins 的农村 CHW 实施该措施。
本横断面研究基于一项主要的家庭调查。7-36 个月龄儿童的家庭有资格参加调查。调查涵盖了 2646 户家庭的多阶段样本。进行描述性分析，并报告关键指标，置信区间为 95%。为了找出照顾者做法与接受 CHW 建议之间的关系，应用了多变量回归模型。
总体而言，在过去三个月内，85.1%的 7-36 个月龄儿童至少接受过一次 CHW 的家访。67%的儿童在六个月大时开始接受补充喂养，8 个月大时的比例为 87%。大约三分之一的儿童每天进食次数少于三次。大约 41%的家庭在前一天给孩子的食物中添加了油。在儿童腹泻、发热和呼吸道感染的情况下，分别有 73%、69%和 61%的家庭联系了 CHW。在因腹泻联系 CHW 的家庭中，88%的家庭接受了口服补液。调整后的模型表明，接受 CHW 的建议与及时开始补充喂养、增加喂养频率、增加饮食多样性、添加油、称重和食用政府补充营养计划提供的食物显著相关。
在提高家庭粮食安全的同时，通过扩大 CHW 计划为大量幼儿提供高质量的家访，可以成为改善发展中国家补充喂养和儿童护理实践的关键。
