Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial
Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial
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DOI：
10.1016/s0140-6736(05)66426-4
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发表时间：
2005-05-28
期刊：
影响因子：
168.9
通讯作者：
Black, RE
中科院分区：
文献类型：
--
作者：
Penny, ME;Creed-Kanashiro, HM;Black, RE
背景 营养不良是一半儿童死亡的根本原因。许多计划试图解决这个问题，但缺乏减少儿童营养不良的有效方法的证据。方法我们在秘鲁的一个贫困城郊地区（即棚户区）进行了一项整群随机试验，进行教育干预。在形成性研究的指导下，干预措施旨在提高现有营养教育的质量和覆盖范围，并在六个政府卫生机构（与六个控制机构相比）引入认证系统。主要结果指标是生长情况，通过 18 个月时的体重、身长以及年龄别体重和年龄别身长的 Z 分数来衡量。主要次要结果是接受推荐喂养方式的儿童的百分比以及 6、9、12 和 18 个月时 24 小时膳食中从补充食品中摄入的能量、铁和锌。分析是按意向治疗进行的。结果 我们纳入了一个出生队列，其中包括来自干预中心服务区的 187 名婴儿和来自对照区的 190 名婴儿。干预地区的护理人员比对照卫生机构的护理人员更有可能从卫生服务机构获得营养建议（31 人中的 16 人 [52%] vs 37 人中的 9 人 [24%]，p=0.02）。 6 个月时，干预地区在午餐时吃营养丰富的浓稠食物（推荐的辅食喂养方式）的婴儿数量多于对照组（157 名婴儿中有 48 名[31%]，147 名婴儿中有 29 名[20%]；组间差异为 19 名[11%]，p=0.03）。干预地区未能满足能量饮食需求的儿童较少（8个月：170人中的30人[18%] vs 167人中的45人[27%]，p=0.04；12个月时：168人中的64人[38%] vs 167人中的82人[49%]，p=0.043）、铁（8个月：170人中的155人[91%] vs 170人中） 167 中的 161 [96%]、9 个月：163 中的 152 [93%] vs 166 中的 165 [99%]，p=0.047），以及锌（9 个月：163 中的 125 [77%] vs 166 中的 145 [87%]，p=0.012）。与干预组中的儿童相比，对照组儿童在 18 个月时更有可能出现生长迟缓（即，年龄身长低于参考人群中位数不到 2 个标准差）（165 名儿童中有 26 名 [16%]，171 名儿童中有 8 名 [5%]；调整后优势比为 3.04 [95% CI 1.21-7.64]）。干预区域的体重增加、身长增加和 Z 分数的调整后平均变化均明显好于对照区域。 解释 在食物获取不是限制因素的地区，通过卫生服务改善营养教育可以降低儿童生长发育迟缓的患病率。
Background Malnutrition is the underlying cause of half of child mortality. Many programmes attempt to remedy this issue but there is a lack of evidence on effective ways to decrease child malnutrition.Methods We did a cluster-randomised trial of an educational intervention in a poor periurban area (ie, shanty town) of Peru. Guided by formative research, the intervention aimed to enhance the quality and coverage of existing nutrition education and to introduce an accreditation system in six government health facilities compared with six control facilities. The primary outcome measure was growth that was measured by weight, length, and Z scores for weight-for-age and length-for-age at age 18 months. Main secondary outcomes were the percentage of children receiving recommended feeding practices and the 24-h dietary intake of energy, iron, and zinc from complementary food at ages 6, 9, 12, and 18 months. Analysis was by intention to treat.Findings We enrolled a birth cohort of 187 infants from the catchment areas of intervention centres and 190 from control areas. Caregivers in intervention areas were more likely to report receiving nutrition advice from the health service than were caregivers in control health facilities (16 [52%] of 31 vs 9 [24%] of 37, p=0.02). At 6 months more babies in intervention areas were fed nutrient-dense thick foods at lunch (a recommended complementary feeding practice) than were controls (48 [31%] of 157 vs 29 [20%] of 147; difference between groups 19 [11%], p=0.03). Fewer children in intervention areas failed to meet dietary requirements for energy (8 months: 30 [18%] of 170 vs 45 [27%] of 167, p=0.04; 12 months: 64 [38%] of 168 vs 82 [49%] of 167, p=0.043), iron (8 months: 155 [91%] of 170 vs 161 [96%] of 167, 9 months: 152 [93%] of 163 vs 165 [99%] of 166, p=0.047), and zinc (9 months: 125 [77%] of 163 vs 145 [87%] of 166, p=0.012) than did controls. Children in control areas were more likely to have stunted growth (ie, length for age less than 2 SD below the reference population median) at 18 months than children in intervention groups (26 [16%] of 165 vs 8 [5%] of 171; adjusted odds ratio 3.04 [95% CI 1.21-7.64]). Adjusted mean changes in weight gain, length gain, and Z scores were all significantly better in the intervention area than in the control area.Interpretation Improvement of nutrition education delivered through health services can decrease the prevalence of stunted growth in childhood in areas where access to food is not a limiting factor.