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

项目摘要/摘要 世界上超过一半的儿童患有营养不良，因此他们经历了 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是造成延误的原因 成长和发展。尽管有证据表明，在儿童早期进行干预可能有效 为了促进增长和发展，几乎没有证据表明联合干预措施的有效性 规模经营，或影响的可持续性。 本研究采用多臂随机对照试验(RCT)来检验联合治疗的成本-效果。 马达加斯加解决慢性营养不良和儿童发育不良问题的干预措施。审判的武器 是：(T0)现有计划，每月进行生长监测和营养/卫生教育；(T1)t0家庭 访问行为改变框架内的强化营养咨询；(T2)T1基于脂类 6-18个月儿童补充(LNS)；(T3)T2孕期/哺乳期补充LNS 妇女；和(T4)T1强化家访计划，以支持儿童发展。有25个社区 在每个试验组(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 旧的)。主要结果包括生长(身高/年龄z分数)和儿童发展(智力、运动 以及社会发展和行政职能)。次要结果包括照顾者报告的儿童 发病率、家庭粮食安全和饮食多样性、产妇的育儿知识、喂养和卫生 实践、母子互动的质量和家庭刺激实践。我们将估计未调整的和 调整后的意向治疗效果。 这项研究建立在马达加斯加现有的多臂干预试验的基础上。拟议的研究包括 对计划实施两年后收集的数据进行分析，估计不同 干预措施的组合。 这项研究将为不同营养和儿童的计划效果和成本效益建立证据 不同组合的发展战略，作为解决长期营养不良和 发育迟缓。这项研究将是第一批检查相对有效性和成本的研究之一- 在大规模环境下不同一揽子计划对生长和儿童发展成果的有效性 程序。

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.