Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan
Cost effectiveness of responsive stimulation and nutrition interventions on early child development outcomes in Pakistan
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DOI：
10.1111/nyas.12367
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发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Bhutta, Zulfiqar A.
中科院分区：
文献类型：
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作者：
Gowani, Saima;Yousafzai, Aisha K.;Bhutta, Zulfiqar A.
早期儿童项目被认为是改善儿童健康和教育成果的一种方式。然而，发展中国家很少有研究计算高质量的早期儿童干预措施的有效性。估计这类干预措施的相关成本的人就更少了。本研究着眼于一项针对巴基斯坦信德省农村出生至24个月儿童的集群随机有效性试验的成本和有效性。响应性刺激和/或强化营养干预措施已纳入巴基斯坦妇女保健工作者方案。结果表明，接受反应性刺激的儿童在24个月时的发育结果明显优于仅接受强化营养干预的儿童。对结果的成本效益分析证实，在促进儿童早期发育方面，包括反应性刺激在内的早期儿童干预措施比单独的营养干预更具成本效益。在提供基本保健和营养护理的现有社区服务中纳入响应性刺激干预措施的费用约为每个儿童每月4美元。我们讨论了这些发现，并就未来早期儿童发展项目的规模和成本提出了建议。
Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs.