Psychosocial stimulation improves the development of undernourished children in rural Bangladesh
Psychosocial stimulation improves the development of undernourished children in rural Bangladesh
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DOI：
10.1093/jn/136.10.2645
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发表时间：
2006-10-01
影响因子：
4.2
通讯作者：
Grantham-McGregor, Sally M.
中科院分区：
文献类型：
--
作者：
Hamadani, Jena D.;Huda, Syed N.;Grantham-McGregor, Sally M.
幼儿营养不良与智力发育不良有关，影响了孟加拉国45%的儿童。虽然有限的证据表明，心理社会刺激可以减少赤字，但孟加拉国没有此类干预措施的报告。孟加拉国综合营养计划（BINP）通过社区营养中心（CNCs）为营养不良儿童提供营养补充。在一项随机对照试验中，我们在营养不良儿童的治疗中加入了心理社会刺激，以评估对儿童发育和生长以及母亲知识的影响。20名CNCs被随机分配到干预组或对照组，每组107名儿童。我们还研究了来自同一村庄的107名未经干预的营养较好的儿童。干预前后的测量包括儿童的身高，体重，贝利量表评估的发展，测试期间的行为评级，以及母亲育儿知识的问卷调查。干预措施包括家访和与母亲和儿童的小组会议，为期12个月。干预有利于儿童的心理发展（4.6 ± 2.0，P = 0.02），发声（0.48 +/- 0.23，P = 0.04），合作（0.45 ± 0.16，P = 0.005）、对检查者的反应（0.50 ± 0.15，P= 0.001）、情绪基调（0.33 ± 0.15，P = 0.03）和母亲的知识（3.5 ± 0.49，P < 0.001）。最后，营养不良的对照组的精神状况较差，（-4.6 +/- 2.0，P= 0.02）和运动（-6.6 +/- 2.2，P= 0.003）发育受到更多抑制（-0.35 +/- 0.16，P = 0.03），较模糊（-0.57 +/- 0.16，P < 0.001），合作性差（-0.48 +/- 0.17，P = 0.005），发声少（-0.76 +/- 0.23，P= 0.001）。干预儿童仅在运动发育方面得分较低（-4.4 +/-2.3，P = 0.049）。两组营养不良儿童的营养状况都没有改善，表明治疗没有效果。总之，在BINP中增加儿童发展活动改善了儿童的发展和行为及其母亲的知识;然而，需要进一步审查生长缺乏改善的情况。
Undernutrition in early childhood is associated with poor mental development and affects 45% of children in Bangladesh. Although limited evidence shows that psychosocial stimulation can reduce the deficits, no such interventions have been reported from Bangladesh. The Bangladesh Integrated Nutrition Program (BINP) has provided nutrition supplementation to undernourished children through community nutrition centers (CNCs). We added psychosocial stimulation to the treatment of undernourished children in a randomized controlled trial to assess the effects on children's development and growth and mothers' knowledge. Twenty CNCs were randomly assigned to intervention or control groups with 107 children in each group. We also studied 107 nonintervened better-nourished children from the same villages. Pre- and postintervention measurements included children's height, weight, development assessed on Bayley Scales, behavior ratings during the test, and a questionnaire on mothers' knowledge of childrearing. The intervention comprised home visits and group meetings with mothers and children for 12 mo. Intervention benefited children's mental development (4.6 +/- 2.0, P = 0.02), vocalization (0.48 +/- 0.23, P = 0.04), cooperation (0.45 +/- 0.16, P = 0.005), response-to-examiner (0.50 +/- 0.15, P= 0.001), emotional tone (0.33 +/- 0.15, P = 0.03), and mothers' knowledge (3.5 +/- 0.49, P < 0.001). At the end, undernourished controls had poorer mental (-4.6 +/- 2.0, P= 0.02) and motor (-6.6 +/- 2.2, P= 0.003) development, were more inhibited (-0.35 +/- 0.16, P = 0.03), fussier (-0.57 +/- 0.16, P < 0.001), less cooperative (-0.48 +/- 0.17, P = 0.005), and less vocal (-0.76 +/- 0.23, P= 0.001) than better-nourished children. Intervened children scored lower only in motor development (-4.4 +/- 2.3, P = 0.049). Neither group of undernourished children improved in nutritional status, indicating that treatment had no effect. In conclusion, adding child development activities to the BINP improved children's development and behavior and their mothers' knowledge; however, the lack of improvement in growth needs to be examined further.