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Effects of Supplementation and Stimulation on Child Development: the MAHAY study

补充和刺激对儿童发育的影响：MAHAY 研究

基本信息

批准号：
9768486
负责人：
LIA C. H. FERNALD
金额：
$ 6.85万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-23 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9768486
关键词：
Address Age Age-Months Agreement Breast Feeding Caregivers Child Child Care Child Development Child Rearing Child Support Chronic Collaborations Communities Control Groups Cost Effectiveness Analysis Counseling Crowding Data Data Analyses Data Collection Development Developmental Delay Disorders Diet Education Effectiveness Effectiveness of Interventions Enrollment Environment Epidemiology Exposure to Family Feedback Fortified Food Funding Goals Growth Growth and Development function Height High Prevalence Home environment Home visitation Household Housing Human Resources Hygiene Impact evaluation Individual Intention Intervention Intervention Trial Knowledge Lactation Length Lipids Madagascar Malnutrition Measurement Mental Health Micronutrients Monitor Morbidity - disease rate Motor Neighborhoods Nutrient Nutritional Outcome Policies Poverty Pregnant Women Prevalence Preventive Protocols documentation Psyche structure Publishing Randomized Controlled Trials Reporting Research Social Development Source Supplementation Testing Universities Woman Work World Bank arm base behavior change cognitive development cost cost effective cost effectiveness design developmental psychology early childhood economic cost effective intervention evidence base executive function experience feeding food security improved in utero innovation instrument intervention program low and middle-income countries low income country nutrition nutrition education nutritional supplementation physical conditioning population health pregnant primary outcome programs relative cost relative effectiveness response secondary outcome sound tailored messaging therapy development treatment arm

项目摘要

Project Summary/Abstract Over half of the world's children suffer from poor nutrition, and as a consequence they experience delays in physical and mental health, and cognitive development. Adverse environments, with limited access to stimulating settings and activities, unstable or crowded housing, and unsafe neighborhoods, also contribute to delays in growth and development. Despite evidence of the potential effectiveness of interventions in early childhood to promote growth and development, there is little evidence on the effectiveness of combined interventions operating at-scale, or on the sustainability of impacts. This study uses a multi-arm randomized-controlled trial (RCT) to test the cost-effectiveness of combined interventions to address chronic malnutrition and poor child development in Madagascar. The arms of the trial are: (T0) existing program with monthly growth monitoring and nutritional/hygiene education; (T1) T0 + home visits for intensive nutrition counseling within a behavior change framework; (T2) T1 + lipid-based supplementation (LNS) for children 6-18 months old; (T3) T2 + LNS supplementation of pregnant/lactating women; and (T4) T1 + intensive home visiting program to support child development. There are 25 communities in each trial arm (n=1250 pregnant women, n=1250 children 0-6 months old, and n=1250 children 6-12 months old). Primary outcomes include growth (length/height-for-age z-scores) and child development (mental, motor and social development and executive functioning). Secondary outcomes include caregiver reported child morbidity, household food security and diet diversity, maternal knowledge of child care and feeding and hygiene practices, quality of maternal-child interaction, and home stimulation practices. We will estimate unadjusted and adjusted intention-to-treat effects. This study builds on an existing multi-arm intervention trial in Madagascar. The proposed study includes analysis of data collected two years after program implementation began to estimate the impact of the different combinations of interventions. The study will build the evidence on the program effects and cost-effectiveness of different nutrition and child development strategies in varying combinations as preventive instruments in tackling long-term malnutrition and developmental delays. This study will be among the first to examine the relative effectiveness and cost- effectiveness of different packages on growth and child development outcomes in the context of a large-scale program.

项目总结/摘要世界上有一半以上的儿童营养不良，因此，他们的生活受到延误。身心健康和认知发展。不利的环境，获得刺激的机会有限环境和活动，不稳定或拥挤的住房，以及不安全的社区，也有助于延迟促进经济增长和发展。尽管有证据表明，在幼儿期采取干预措施，虽然联合干预有助于促进增长和发展，但几乎没有证据表明联合干预的有效性，规模经营，或影响的可持续性。本研究采用多组随机对照试验（RCT）来检验联合治疗的成本-效果在马达加斯加采取干预措施解决长期营养不良和儿童发育不良问题。审判的武器是：（T0）现有方案，每月进行生长监测和营养/卫生教育;（T1）T0 +家庭在行为改变框架内进行强化营养咨询访问;（T2）T1 +基于脂质 6-18个月儿童补充LNS;（T3）孕妇/哺乳期T2 + LNS补充（T4）T1 +强化家访方案，以支持儿童发展。共有25个社区在每个试验组中（n=1250名孕妇，n=1250名0-6个月大的儿童，n=1250名6-12个月大的儿童旧）。主要结果包括生长（身高/年龄z分数）和儿童发育（心理、运动社会发展和执行职能）。次要结局包括看护者报告的儿童发病率、家庭粮食安全和饮食多样性、产妇对儿童保育和喂养以及卫生的了解实践，母婴互动的质量，和家庭激励的做法。我们将估计未经调整，调整意向治疗效果。这项研究建立在马达加斯加现有的多组干预试验的基础上。拟议的研究包括对方案实施两年后收集的数据进行分析，干预措施的组合。本研究将为不同营养和儿童的计划效果和成本效益提供证据发展战略以不同的组合作为解决长期营养不良问题的预防手段，发育迟缓这项研究将是第一批研究相对有效性和成本的研究之一，在大规模儿童教育背景下不同的成长和儿童发展成果一揽子计划的有效性程序.