在孟加拉国城市地区利用社会安全网平台开展的育儿与营养教育项目对儿童发育和成长的影响：一项整群随机对照试验
Effect of a parenting and nutrition education programme on development and growth of children using a social safety-net platform in urban Bangladesh: a cluster randomized controlled trial.
作者信息
Hossain Sheikh Jamal, Rahman Syed Moshfiqur, Fisher Jane, Rahman Anisur, Tofail Fahmida, Hamadani Jena Derakhshani
机构信息
Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Sweden.
International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
出版信息
Lancet Reg Health Southeast Asia. 2024 Mar 19;25:100388. doi: 10.1016/j.lansea.2024.100388. eCollection 2024 Jun.
BACKGROUND
Although sustainable development goals mandate for quality early childhood development (ECD) interventions for children <8 years, little occurs for children <3 years, especially in urban settings in low-and-middle-income countries (LMICs). Our primary objective was to measure the effect of an ECD-focused parenting and nutrition education on children's development through home visits using a social safety net platform of urban Bangladesh.
METHODS
A cluster randomized controlled trial was conducted with mothers of children aged 6-16 months in 20 clusters across the Rangpur city, Bangladesh. The intervention group received fortnightly ECD-focused parenting and nutrition education at homes by local Community Health Workers (CHWs) for one year. Bayley-III was used to measure children's cognitive, language and motor development. Data were analyzed using intention to treat. ClinicalTrials.gov Identifier: NCT03753646.
FINDINGS
Out of 599 mother-child dyads, 56.6% mothers were aged 25 years old. After one year, the intervened children had higher cognitive [Effect size Cohen's d; 0.42 SD (95% CI: 0.58-0.25)], language (0.38 SD, 95% CI: 0.55-0.22) and motor (0.17 SD, 95% CI: 0.01-0.34) development. In the intervention group, mothers experienced less violence [Odds ratio; 0.6 (95% CI: 0.4-1.0)] and fathers engaged more (0.23 SD, CI: 0.39-0.06) in ECD activities with their children compared to the comparison group. Total home stimulation and mothers' knowledge on child care were also improved in the intervention. But the children's growth was not improved.
INTERPRETATION
This ECD programme improves the development of children of young mothers in urban settings using a social safety-net platform. The evidence may help in increasing ECD coverage in urban areas in LMICs.
FUNDING
Grand Challenges Canada, Saving Brains Programme Grant Number: SB-1810-20176.
背景
尽管可持续发展目标要求为8岁以下儿童提供优质的幼儿发展（ECD）干预措施，但针对3岁以下儿童的干预措施却很少，尤其是在低收入和中等收入国家（LMICs）的城市地区。我们的主要目标是通过孟加拉国城市地区的社会安全网平台进行家访，来衡量以ECD为重点的育儿和营养教育对儿童发展的影响。
方法
在孟加拉国朗布尔市的20个社区，对6-16个月大儿童的母亲进行了一项整群随机对照试验。干预组由当地社区卫生工作者（CHWs）每两周在家中提供一次以ECD为重点的育儿和营养教育，为期一年。使用贝利婴幼儿发展量表第三版（Bayley-III）来测量儿童的认知、语言和运动发展。数据采用意向性分析。ClinicalTrials.gov标识符：NCT03753646。
结果
在599对母婴中，56.6%的母亲年龄在25岁及以上。一年后，接受干预的儿童在认知（效应量科恩d值；0.42标准差，95%置信区间：0.58-0.25）、语言（0.38标准差，95%置信区间：0.55-0.22）和运动（0.17标准差，95%置信区间：0.01-0.34）发展方面表现更好。在干预组中，与对照组相比，母亲遭受的暴力更少（优势比；0.6，95%置信区间：0.4-1.0），父亲与孩子一起参与ECD活动的程度更高（0.23标准差，置信区间：0.39-0.06）。干预组的家庭总刺激和母亲的育儿知识也有所改善。但儿童的生长情况没有改善。
解读
该ECD项目利用社会安全网平台改善了城市地区年轻母亲的孩子的发展。这一证据可能有助于提高LMICs城市地区的ECD覆盖率。
资金来源
加拿大重大挑战项目，拯救大脑计划资助编号：SB-1810-20176。
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