Impact on birth weight and child growth of Participatory Learning and Action women's groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal.
Impact on birth weight and child growth of Participatory Learning and Action women's groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal.
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DOI：
10.1371/journal.pone.0194064
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Costello A
中科院分区：
文献类型：
--
作者：
Saville NM;Shrestha BP;Style S;Harris-Fry H;Beard BJ;Sen A;Jha S;Rai A;Paudel V;Sah R;Paudel P;Copas A;Bhandari B;Neupane R;Morrison J;Gram L;Pulkki-Brännström AM;Skordis-Worrall J;Basnet M;de Pee S;Hall A;Harthan J;Thondoo M;Klingberg S;Messick J;Manandhar DS;Osrin D;Costello A
怀孕期间营养不良导致出生体重低、生长不良和代际营养不良。我们在尼泊尔Dhanusha和Mahottari的平原地区进行了一项非盲随机分组对照试验，以评估基于社区的参与性学习和行动（PLA）妇女团体对0-16个月儿童出生体重和年龄别体重z评分的影响，有和没有向孕妇提供食物或现金转移。我们将每组20个集群随机分配给四个组（平均种群/集群= 6150）。所有年龄在10-49岁的已婚妇女，没有做过输卵管结扎术，丈夫也没有做过输精管切除术，都接受了错过月经的监测。在2013年12月29日至2015年2月28日期间，我们招募了25，092名孕妇进行监测和干预：仅PLA（n = 5626）; PLA+食物（10公斤/月强化小麦-大豆“超级谷物”，n = 6884）; PLA加现金（NPR 750 - 7.5美元/月，n = 7 272）;控制（现有政府方案，n = 5 310）。539个解放军团体讨论并实施了改善低出生体重、孕期营养和洗手的战略。主要结局是分娩后72小时内的出生体重和终点（0-16个月）的年龄别体重z评分。只有在2014年6月4日至2015年6月20日期间出生的永久居民的儿童有资格进行意向治疗分析（n = 10936），而移民妇女和干预措施运行16周之前出生的儿童被排除在外。试验状态：已完成。在解放军加上粮食/现金武器中，94-97%的孕妇参加了团体活动，在怀孕期间平均接受四次转运。在解放军唯一的兵种中，49%的孕妇参加了团体活动。由于动乱，出生体重的应答率较低，为22%（n = 2087），但基线营养和饮食措施的应答率超过83%（n = 9242）。与对照组（n = 464）相比，PLA加食物组的平均出生体重显著高出78·0 g（95% CI 13.9，142.0; n = 626），仅PLA组和PLA+现金组的差异不显著（28.9 g）（95% CI-37统计7，95.4; n = 488）和50.5 g（95% CI-15统计0，116.1; n = 509）。在终点时，0-16个月（平均年龄9个月）儿童的平均年龄别体重z评分与对照组（n = 2091）相比无显著差异。年龄别体重z评分的差异如下：仅PLA-0统计026（95% CI-0统计117，0·065; n = 2095）; PLA+现金-0统计045（95% CI-0统计133，0·044; n = 2545）; PLA+食物-0统计033（95% CI-0统计121，0·056; n = 2507）。在许多次要结果测试，与对照组相比，更多的机构分娩（OR：1.46 95% CI 1.03，2.06; n = 2651）和更少的初乳丢弃（OR：0.71 95% CI 0.54，0.93; n = 2548）被发现在解放军加食品武器，但没有在解放军单独或解放军加现金武器。PLA妇女组在怀孕期间的食物补充剂比PLA加现金或PLA单独增加出生体重，但差异并不持久。建议在整个千日期间进行营养干预。ISRCTN75964374。
Undernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0–16 months of community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers to pregnant women. We randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10–49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya ‘Super Cereal’, n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0–16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed. In PLA plus food/cash arms, 94–97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0–16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms. Food supplements in pregnancy with PLA women’s groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition interventions throughout the thousand-day period are recommended. ISRCTN75964374.
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影响因子：
34.3
作者：
Devakumar, Delan;Chaube, Shiva Shankar;Wells, Jonathan C. K.;Saville, Naomi M.;Ayres, Jon G.;Manandhar, Dharma S.;Costello, Anthony;Osrin, David
通讯作者：
Osrin, David
影响因子：
2.7
作者：
Crowe S;Seal A;Grijalva-Eternod C;Kerac M
通讯作者：
Kerac M
影响因子：
13.6
作者：
Korpe PS;Petri WA Jr
通讯作者：
Petri WA Jr
影响因子：
2.8
作者：
Girard, Amy Webb;Olude, Oluwafunke
通讯作者：
Olude, Oluwafunke
影响因子：
7.7
作者：
Barker, DJP;Eriksson, JG;Osmond, C
通讯作者：
Osmond, C