Effects in Middle Childhood of Early Exposure to Water and Sanitation Interventions

项目摘要/摘要 全世界数以亿计的儿童生活在贫困中，因此面临着贫穷的水和 卫生设施(洗澡)、营养不足和照料不足。暴露在这些风险因素中会导致 身体和精神健康以及认知发展的延迟，这可能会产生终生后果。水, 环境卫生和个人卫生干预措施有可能积极影响儿童的发展轨迹 通过改变父母的护理做法，减少肠道病原体感染，从而提高质量 年幼儿童所处的环境。 这项研究使用了一种严格的方法-多臂随机对照试验(RCT)-来测试 通过综合干预措施促进水、环境卫生和个人卫生的创新方案的有效性 解决孟加拉国的长期营养不良和儿童发育不良问题。建议的科学前提是 这项研究很有说服力，因为干预对儿童发展结果有一致的短期影响 跨越多个发展领域(研究结果发表在2018年《柳叶刀》儿童和青少年健康杂志上)，以及 因此，这项研究有可能也会对儿童中期产生影响。这项研究有很高的 科学严谨程度，因为我们使用了基于分组的随机对照试验(CRCT)。此外，我们 正在使用对三个时间点的儿童发展成果进行高质量测量的数据，以及 关于母亲福祉和干预吸纳的信息。 我们获得了后续数据收集的资金，现在正在寻求资金来覆盖人员进行分析 现有数据。这项拟议的研究的目标是确定有效的早期干预的组成部分 一直持续到童年中期。我们的指导性假设是，显示出早期影响的干预措施将继续 在这一后续时间段内有更好的儿童结局。我们的目标是检查洗涤的影响 以及对5-8岁儿童的发育和生长的营养干预。我们假设 所有的干预措施都将显示出对儿童发展和成长的益处，但这些干预措施与干预措施相结合 治疗将对任何一只手臂产生更大的影响。另一个目标是检查 洗涤和营养干预对照顾者心理健康和照看实践的中间结果 当孩子5-8岁的时候。我们假设所有的洗涤干预手臂都会对 照顾者的心理健康和照看实践。 这项拟议的研究具有重要意义，因为它有可能为干预、规划和 为生活在低收入国家的数亿儿童制定政策。建议的工作具有创新性。 在检查计划的长期效果时，干预措施的独特组合，以及高质量 在多个时间点进行成果评估。这项研究有一种严格的方法，允许因果关系 对干预设计的解释和直接应用。

Project Summary/Abstract Hundreds of millions of children worldwide live in poverty, and are consequently exposed to poor water and sanitation (WASH), inadequate nutrition, and insufficient caregiving. Exposure to these risk factors then causes delays in physical and mental health, and cognitive development, which can have lifelong consequences. Water, sanitation and hygiene interventions have the potential to positively affect the developmental trajectories of children by altering parental care practices and reducing enteric pathogen infection, thereby improving the quality of the environment in which young children are living. This study uses a rigorous approach – a multi-arm randomized-controlled trial (RCT) – to test the effectiveness of an innovative program promoting water, sanitation and hygiene with combined interventions to address chronic malnutrition and poor child development in Bangladesh. The scientific premise of the proposed study is strong because the intervention had consistent short-term impacts on child development outcomes across multiple domains of development (findings published in Lancet Child and Adolescent Health, 2018), and thus there is the potential that the study will also result in effects in middle childhood. The study has a high degree of scientific rigor because we use a cluster-based, randomized controlled trial (cRCT). Furthermore, we are using data with high quality measurements of child development outcomes at three time points, as well as information on maternal well-being and intervention uptake. We obtained funding for follow-up data collection, and are now seeking funding to cover personnel to analyze the existing data. The goal of the proposed study is to identify the components of an impactful early intervention that persist into mid-childhood. Our guiding hypothesis is that interventions that showed early impact will continue to have improved child outcomes at this follow-up time period. Our goals are to examine the impact of the WASH and nutrition interventions on child development and growth in children 5-8 years of age. We hypothesize that all intervention arms will show benefits to child development and growth, but that that the arms with combined treatments will have greater effects on any of the individual arms. Another goal is to examine the effects of the WASH and nutrition interventions on intermediate outcomes of caregiver mental health and caregiving practices when children are 5-8 years of age. We hypothesize that all WASH intervention arms will show benefits to caregiver mental health and caregiving practices. This proposed research is significant because it has the potential to inform interventions, programs, and policies for the hundreds of millions of children living in low-income countries. The proposed work is innovative in its examination of longer-term effects of a program, a unique combination of interventions, and high quality outcome assessments at multiple time points. The study has a rigorous approach, allowing for causal interpretation and direct application to intervention design.