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

早期接触水和卫生干预措施对童年中期的影响

• 批准号: 10040591
• 负责人: LIA C. H. FERNALD
• 金额: $ 6.74万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10040591
• 关键词: 2 year old; 8 year old; Address; Affect; Bangladesh; Caregivers; Caring; Child; Child Development; Child Health; Childhood; Chronic; Cognition; Cognitive; Collaborations; Combined Modality Therapy; Community Health Aides; Data; Data Collection; Defecation; Development; Dietary Intervention; Early Intervention; Environment; Environmental Risk Factor; Evaluation; Exclusive Breastfeeding; Exposure to; Family; Feces; Food; Funding; Goals; Grant; Growth and Development function; Hand; Handwashing; Health; Household; Human Resources; Hygiene; Impact evaluation; Individual; Intervention; Language; Latrine; Learning; Malnutrition; Measurement; Measures; Mental Health; Mothers; Outcome; Outcome Assessment; Personal Communication; Personal Satisfaction; Physiological; Policies; Poverty; Publishing; Randomized Controlled Trials; Reporting; Research; Risk Factors; Sample Size; Sanitation; Shapes; Soaps; Stress; Time; Training; Visit; Water; Work; abuse neglect; acute infection; adolescent health; arm; base; caregiving; chronic infection; cognitive development; depressive symptoms; diarrheal disease; direct application; early childhood; effectiveness testing; enteric infection; experience; follow-up; food insecurity; food preparation; group intervention; improved; innovation; international center; intervention program; low and middle-income countries; low income country; middle childhood; nutrition; physical conditioning; programs; psychologic; therapy design; therapy development; treatment arm; uptake

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.

项目总结/摘要 全世界有数亿儿童生活在贫困之中，因此面临着劣质水和 卫生（WASH），营养不足，缺乏营养。暴露于这些危险因素， 身心健康和认知发展的延迟，这可能造成终身后果。水、 环境卫生和个人卫生干预措施有可能积极影响 通过改变父母的护理方式和减少肠道病原体感染，从而提高儿童的质量， 儿童生活的环境。 本研究采用严格的方法-多组随机对照试验（RCT）-来测试 一项创新方案的有效性，通过综合干预措施促进水、环境卫生和个人卫生， 解决孟加拉国的长期营养不良和儿童发育不良问题。提出的科学前提 这项研究是强有力的，因为干预措施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《柳叶刀儿童和青少年健康》，2018年），以及 因此，这项研究也有可能对儿童中期产生影响。这项研究具有很高的 因为我们使用的是基于聚类的随机对照试验（cRCT）。而且我们 在三个时间点使用高质量的儿童发展结果测量数据，以及 关于孕产妇福祉和采取干预措施的信息。 我们获得了后续数据收集的资金，现在正在寻求资金，以支付人员分析 现有的数据。拟议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下去 在随访期间改善儿童的结局。我们的目标是审查讲卫生运动的影响 对5-8岁儿童的发育和生长采取营养干预措施。我们假设 所有干预组都将显示出对儿童发育和生长的益处，但 治疗将对任何单独的臂具有更大的影响。另一个目标是检查 WASH和营养干预措施对照顾者心理健康和照顾做法的中间结果 当孩子5-8岁时。我们假设，所有WASH干预武器将显示出效益， 照顾者心理健康和照顾实践。 这项拟议的研究意义重大，因为它有可能为干预措施、方案和 为生活在低收入国家的数亿儿童制定政策。建议的工作是创新的 在其审查的长期影响的计划，一个独特的组合干预措施，和高质量 在多个时间点进行结果评估。这项研究采用了严格的方法，考虑到因果关系， 解释和直接应用于干预设计。