Effects of integrated child development and nutrition interventions on child development and nutritional status
Effects of integrated child development and nutrition interventions on child development and nutritional status
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DOI：
10.1111/nyas.12284
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发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Walker, Susan
中科院分区：
文献类型：
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作者：
Grantham-McGregor, Sally M.;Fernald, Lia C. H.;Walker, Susan
我们系统地审查了将儿童发展部分与营养部分相结合的干预措施的效果；在某些情况下，营养干预措施还包括促进健康的部分。只有同时具有儿童发育和营养结果并被评为中等到良好质量的论文才被纳入。确定了11项疗效试验和2项非随机试验，以及8项方案评估。只有6项试验分别和合并检查了干预措施。试验表明，营养干预通常有益于营养状况，有时还有利于儿童的发展。刺激一直有利于儿童的发展。当干预措施结合起来时，没有任何显著的效果损失，但几乎没有证据表明营养和刺激之间在儿童发展方面存在协同作用。在干预后，只有三项试验对儿童进行了跟踪调查。所有规模的项目评估都是综合干预措施。五名儿童受益于儿童发展，但一名儿童没有，两名儿童出现缺陷。一般而言，大规模计划对营养状况几乎没有好处。我们发现，没有对大规模增加健康和营养服务的刺激进行严格的评估，因此迫切需要这些评估。还需要为现有的扩大方案建立质量控制机制，并确定其长期效果。还需要确定方案结束后对儿童是否有任何持续的好处。
We conducted a systematic review of studies that examined the effect of interventions combining a child development component with a nutrition one; in some cases the nutrition interventions also included health-promotion components. Only papers with both child development and nutrition outcomes and rated asmoderate-to-good quality were included. Eleven efficacy and two nonrandomized trials, and eight program evaluations were identified. Only six trials examined interventions separately and combined. The trials showed nutritional interventions usually benefited nutritional status and sometimes benefited child development. Stimulation consistently benefited child development. There was no significant loss of any effect when interventions were combined, but there was little evidence of synergistic interaction between nutrition and stimulation on child development. Only three trials followed up the children after intervention. All at-scale program evaluations were combined interventions. Five benefited child development, but one did not, and two showed deficits. There was generally little benefit of at-scale programs to nutritional status. We found no rigorous evaluations of adding stimulation to health and nutrition services at scale and there is an urgent need for them. There is also a need to establish quality-control mechanisms for existing scaled-up programs and to determine their long-term effects. There is also a need to determine if there are any sustained benefits for the children after programs finish.