Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.
Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.
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肯尼亚农村地区促进儿童发展的基于小组的养育干预措施：一项多臂、随机分组的社区有效性试验
DOI：
10.1016/s2214-109x(20)30469-1
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发表时间：
2021-03
期刊：
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通讯作者：
Alu E
中科院分区：
文献类型：
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作者：
Luoto JE;Lopez Garcia I;Aboud FE;Singla DR;Fernald LCH;Pitchik HO;Saya UY;Otieno R;Alu E
儿童早期发展（ECD）计划可以帮助解决低收入和中等收入国家中43%的5岁以下儿童的早期不利条件，这些儿童的发展受到影响。我们的目的是测试两个基于组的交付模式的有效性，综合幼儿发展响应刺激和营养教育干预使用肯尼亚的社区卫生志愿者网络。我们在肯尼亚西部60个村庄（集群）的三个农村县实施了一项多臂、集群随机社区有效性试验。合格的参与者是年龄在15岁或15岁以上的母亲或女性主要照顾者，其子女在入学时为6-24个月。如果已婚或有固定的关系，父亲或18岁或以上的男性照顾者也有资格。村庄被随机分配（1：1：1）到三个组之一：组只交付16个两周一次的会议;混合交付结合12个小组会议与四个家访;和一个对照组。干预组的村庄被随机分配（1：1）邀请或不邀请父亲和男性照顾者参加。在基线和干预后立即对家庭进行了调查。评估者被蒙。主要结果是儿童认知和语言发展（Bayley婴儿发展量表第三版评分），社会情感发展（Wolke量表评分）和父母刺激（家庭观察测量环境清单）。该试验在ClinicalTrials.gov注册，NCT 03548558。在2018年10月1日至11月12日期间，入组并随机分配了1152对母子（n=376组仅干预，n=400混合分娩干预，n=376对照组）。在11个月的终点调查（2019年8月5日至10月31日）中，对1070个家庭的主要结局进行了评估（仅n=346组，n=373混合分娩，n=351比较）。在终点线，仅分组村庄的儿童比对照村庄的儿童具有更高的认知（效应量0.52 SD [95%CI 0.21 - 0.83]）、接受性语言（0.42 SD [0.08 - 0.77]）和社会情感评分（0.23 SD [0.03 - 0.44]）。混合分娩村庄的儿童比对照村庄的儿童有更高的认知（0.34 SD [0.05 - 0.62]）和社会情感评分（0.22 SD [0.05 - 0.38]）;语言评分没有差异。与对照组中的那些村庄相比，单独组（0·80 SD [0·49-1·11]）和混合分娩村庄（0·77 SD [0·49-1·05]）的父母刺激也有所改善。将父亲纳入干预对任何主要结果都没有可测量的影响。由经过培训的社区卫生志愿者在母婴小组中提供的育儿干预措施可以有效地促进资源匮乏环境中的儿童发展，并具有很大的推广潜力。
Early childhood development (ECD) programmes can help address early disadvantages for the 43% of children younger than 5 years in low-income and middle-income countries who have compromised development. We aimed to test the effectiveness of two group-based delivery models for an integrated ECD responsive stimulation and nutrition education intervention using Kenya’s network of community health volunteers. We implemented a multi-arm, cluster-randomised community effectiveness trial in three rural subcounties across 60 villages (clusters) in western Kenya. Eligible participants were mothers or female primary caregivers aged 15 years or older with children aged 6–24 months at enrolment. If married or in established relationships, fathers or male caregivers aged 18 years or older were also eligible. Villages were randomly assigned (1:1:1) to one of three groups: group-only delivery with 16 fortnightly sessions; mixed delivery combining 12 group sessions with four home visits; and a comparison group. Villages in the intervention groups were randomly assigned (1:1) to invite or not invite fathers and male caregivers to participate. Households were surveyed at baseline and immediately post-intervention. Assessors were masked. Primary outcomes were child cognitive and language development (score on the Bayley Scales of Infant Development third edition), socioemotional development (score on the Wolke scale), and parental stimulation (Home Observation for Measurement of the Environment inventory). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03548558. Between Oct 1 and Nov 12, 2018, 1152 mother–child dyads were enrolled and randomly assigned (n=376 group-only intervention, n=400 mixed-delivery intervention, n=376 comparison group). At the 11-month endline survey (Aug 5–Oct 31, 2019), 1070 households were assessed for the primary outcomes (n=346 group only, n=373 mixed delivery, n=351 comparison). Children in group-only villages had higher cognitive (effect size 0·52 SD [95% CI 0·21–0·83]), receptive language (0·42 SD [0·08–0·77]), and socioemotional scores (0·23 SD [0·03–0·44]) than children in comparison villages at endline. Children in mixed-delivery villages had higher cognitive (0·34 SD [0·05–0·62]) and socioemotional scores (0·22 SD [0·05–0·38]) than children in comparison villages; there was no difference in language scores. Parental stimulation also improved for group-only (0·80 SD [0·49–1·11]) and mixed-delivery villages (0·77 SD [0·49–1·05]) compared with the villages in the comparison group. Including fathers in the intervention had no measurable effect on any of the primary outcomes. Parenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability.