Mutai Beatrice C, Were Fredrick, Aluvaala Jalemba, John-Stewart Grace, Maleche-Obimbo E
Department of Paediatrics & Child Health, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
Department of Global Health, Medicine, Epidemiology and Paediatrics, University of Washington, Washington State, United States of America.
PLOS Glob Public Health. 2025 Jul 9;5(7):e0004818. doi: 10.1371/journal.pgph.0004818. eCollection 2025.
Severe acute malnutrition (SAM) accounts for 1 million deaths globally each year. Ready-to-use Therapeutic Food (RUTF), recommended for treatment, is often replaced with low-nutrient home foods. We sought to determine the effect of enhanced caregiver counselling, using a dramatized video with contextualized demonstrations of local high-nutrient food (video-drama) and telephone messages on high-nutrient foods (SMS), on children's dietary diversity scores (DDS), weight gain, and caregiver knowledge. This randomised trial enrolled 213 severely malnourished children and caregivers at Mbagathi Hospital in Nairobi. Children were randomised to 3 study arms: standard of care (SOC) (children received RUTF, caregivers received routine nutrition counselling); intervention arm A (caregivers watched the video-drama at enrolment, 1- and 6-weeks post-enrolment plus SOC); and intervention arm B (caregivers received weekly SMS, watched the video-drama plus SOC). Primary outcome was DDS, secondary outcomes were weight gain and caregiver knowledge. Median DDS, mean rate of weight gain and caregiver knowledge were compared between trial arms using Kruskal-Wallis and ANOVA tests, respectively. Children's median age at enrolment was 12 months (IQR 8.0, 16.0), 50.7% were female, 74.6% were breastfeeding and 78.9% were on RUTF. Median caregiver age was 28 years (IQR 24.5, 32.0) and 98% were female. Post-intervention, children in arms A and B had significantly higher median DDS at 5 (IQR 4, 5) versus 4 (IQR 3, 5) in SOC arm (p < 0.001)]. Mean caregiver knowledge was significantly higher in arm A (4.53[±1.17)] and arm B (4.27[±1.04]) compared to 3.77(±0.91) in SOC (p < 0.001). Mean rate of weight gain was similar across study arms [7.60 g/kg/day in intervention arms, 7.30 g/kg/day for SOC (p-value 0.31)]. Video-drama enhanced SOC counselling of local high-nutrient foods, improved children's DDS and caregiver knowledge, but did not improve short-term weight gain. Weekly SMS did not provide additional benefits to the video-drama.
重度急性营养不良（SAM）每年在全球导致100万人死亡。推荐用于治疗的即食治疗性食品（RUTF）常常被低营养的家庭食物所替代。我们试图确定强化照料者咨询的效果，具体方式为使用一段配有当地高营养食物情境化演示的戏剧化视频（视频戏剧）以及关于高营养食物的电话信息（短信），观察其对儿童饮食多样性得分（DDS）、体重增加以及照料者知识水平的影响。这项随机试验在内罗毕的姆巴加蒂医院招募了213名重度营养不良的儿童及其照料者。儿童被随机分为3个研究组：标准护理组（SOC）（儿童接受RUTF，照料者接受常规营养咨询）；干预组A（照料者在入组时、入组后1周和6周观看视频戏剧并加上SOC）；干预组B（照料者每周接收短信，观看视频戏剧并加上SOC）。主要结局是DDS，次要结局是体重增加和照料者知识水平。分别使用Kruskal - Wallis检验和方差分析在各试验组之间比较DDS中位数、体重增加平均速率和照料者知识水平。儿童入组时的年龄中位数为12个月（四分位间距8.0，16.0），50.7%为女性，74.6%正在接受母乳喂养，78.9%正在食用RUTF。照料者年龄中位数为28岁（四分位间距24.5，32.0），98%为女性。干预后，A组和B组儿童在第5周时的DDS中位数显著高于SOC组的4（四分位间距3，5），分别为5（四分位间距4，5）（p < 0.001）。与SOC组的3.77（±0.91）相比，A组（4.53[±1.17]）和B组（4.27[±1.04]）的照料者知识平均水平显著更高（p < 0.001）。各研究组的体重增加平均速率相似[干预组为7.60克/千克/天，SOC组为7.30克/千克/天（p值0.31）]。视频戏剧强化了对当地高营养食物的SOC咨询，改善了儿童的DDS和照料者知识水平，但未改善短期体重增加。每周短信对比视频戏剧未带来额外益处。
