Nshimyiryo Alphonse, Barnhart Dale A, Nemerimana Mathieu, Beck Kathryn, Wilson Kim, Mutaganzwa Christine, Bigirumwami Olivier, Shema Evelyne, Uwamahoro Alphonsine, Itangishaka Cécile, Havugarurema Silas, Sayinzoga Felix, Baganizi Erick, Magge Hema, Kirk Catherine M
Partners In Health/Inshuti Mu Buzima, Kigali P.O. Box 3432, Rwanda.
Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
Healthcare (Basel). 2024 Nov 26;12(23):2368. doi: 10.3390/healthcare12232368.
Children born small or sick are at risk of death and poor development, but many lack access to preventative follow-up services. We assessed the impact of Pediatric Development Clinics (PDC), which provide structured follow-up after discharge from hospital neonatal care units, on children's survival, nutrition and development in rural Rwanda.
This quasi-experimental study compared a historic control group to children receiving PDC in Kayonza and Kirehe districts. Study populations in both districts included children born preterm or with birthweight < 2000 g and discharged alive. Kirehe additionally included children with hypoxic ischemic encephalopathy (HIE). Home-based cross-sectional surveys were conducted in Kayonza among children with expected chronological age 11-36 months in 2014 (controls) and 2018 (PDC group) and in Kirehe among children with expected chronological age 17-39 months in 2018 (controls) and 2019 (PDC group). Outcomes were measured using anthropometrics and the Ages and Stages Questionnaires. We used weighted logistic regression to control for confounding and differential non-participation.
PDC children ( = 464/812, 57.1%) were significantly more likely to participate in surveys (83.0% vs. 65.5%), have very low birthweight (27.6% vs. 19.0%), and be younger at the survey (26.2 vs. 31.1 months). 6.9% ( = 56) died before the survey. PDC was associated with reduced odds of death (aOR = 0.49, 95% CI: 0.26-0.92) and reduced odds of developmental delay (aOR = 0.48, 95% CI: 0.30-0.77). In Kayonza, PDC was associated with reduced stunting (aOR = 0.52, 95% CI: 0.28-0.98). PDC was not associated with reduced underweight or wasting.
PDC was associated with improved survival and development among children born preterm, with low birthweight, or with HIE. Increased access to PDC, scale-up across Rwanda, and implementation of similar services and early intervention in other low-resource settings could support children born small or sick.
出生时体重过轻或患有疾病的儿童面临死亡和发育不良的风险，但许多儿童无法获得预防性后续服务。我们评估了儿科发育诊所（PDC）对卢旺达农村地区儿童生存、营养和发育的影响，该诊所为医院新生儿护理病房出院后的儿童提供结构化后续服务。
这项准实验研究将一个历史对照组与卡扬扎和基雷赫地区接受PDC服务的儿童进行了比较。两个地区的研究人群均包括早产或出生体重<2000g且存活出院的儿童。基雷赫地区还纳入了患有缺氧缺血性脑病（HIE）的儿童。2014年（对照组）和2018年（PDC组）在卡扬扎对预期实足年龄为11 - 36个月的儿童进行了家庭横断面调查，2018年（对照组）和2019年（PDC组）在基雷赫对预期实足年龄为17 - 39个月的儿童进行了调查。使用人体测量学和年龄与发育阶段问卷来测量结果。我们使用加权逻辑回归来控制混杂因素和不同的未参与情况。
接受PDC服务的儿童（n = 464/812，57.1%）参与调查的可能性显著更高（83.0%对65.5%），出生体重极低的比例更高（27.6%对19.0%），且调查时年龄更小（26.2个月对31.1个月）。6.9%（n = 56）在调查前死亡。PDC与死亡几率降低（调整后比值比[aOR]=0.49，95%置信区间[CI]：0.26 - 0.92）和发育迟缓几率降低（aOR = 0.48，95% CI：0.30 - 0.77）相关。在卡扬扎，PDC与发育迟缓几率降低相关（aOR = 0.52，95% CI：0.28 - 0.98）。PDC与体重不足或消瘦几率降低无关。
PDC与早产、低出生体重或患有HIE的儿童的生存和发育改善相关。增加获得PDC服务的机会、在卢旺达扩大规模以及在其他资源匮乏地区实施类似服务和早期干预可以支持出生时体重过轻或患有疾病的儿童。
