Supporting child growth and development through integrated, responsive parenting, nutrition and hygiene

摘要 世界各地有大量幼儿生长发育迟缓，令人不安 在整个生命周期中造成无法弥补的后果。最近的估计显示，2.5亿儿童不到5岁 1.51亿人发育迟缓。1，2 生长发育迟缓的决定因素是多方面的，包括生物、 行为，社会和环境条件，但证据基础是最小的综合方法 来解决这些相互交织的因素。我们的研究小组最近发现，鸡蛋干预对 幼儿生长和营养和大脑发育的生物标志物。对重要的心理社会影响 然而，没有评估儿童发展指标。根据这些发现和我们的试点 一项基于群体、多成分干预研究（Grandi Byen，海地克里奥尔语中“生长良好”的意思），我们建议 一个更大的随机对照试验，以检查鸡蛋干预结果的更大范围， 心理教育父母的鸡蛋干预，并调解生物，行为和社会因素。 三臂纵向随机对照试验将在海地海地角进行，我们的小组在那里进行了九年的研究。 研究经验，建立合作伙伴关系，以及强大的研究基础设施。其代表了 全球资源贫乏的城市环境，父母面临共同的经济和环境挑战 对儿童成长和发展的影响。该试验将比较以下组在减少 幼儿发育迟缓和促进全面发展：1）多组分Grandi Byen干预 （响应式育儿、营养、卫生+每天一个鸡蛋，持续6个月）; 2）营养干预（每天一个鸡蛋， 6个月）;和3）标准良好的婴儿护理。将招募6-8个月大的婴儿， 纵向跟踪一年。具体目标是： 目的1（主要）：证明以鸡蛋为基础的干预措施在减少 儿童发育迟缓，并测试其对发展的影响。假设1：线性增长将增加0.30 与标准护理相比，每天接受一个鸡蛋的儿童的LAZ。假设2：儿童接受 与标准护理相比，鸡蛋干预将具有更好的认知，运动和语言发育。 问题1（探索性）：基于鸡蛋的干预是否会影响社会情感发展？ 目的2（主要）：研究Grandi Byen与仅使用鸡蛋相比的增量获益， 儿童成长和发展的主要成果的标准护理小组。假设3：儿童 与鸡蛋干预相比，接受Grandi Byen的母亲将增加0.10 LAZ的线性生长。 假设4：接受Grandi Byen的母亲的孩子在儿童认知，语言， 运动和社会情感发展，与标准护理相比，对认知的影响大小为0.36。 将进行经济评估，以比较干预措施的效率。 目标3（次要）。探讨干预措施对儿童生长发育的影响途径， 描述生物学（营养生物标志物、骨龄和肠 疾病），心理社会（响应式养育，认知刺激）和环境（卫生和 卫生、饮食）因素。 这项研究扩展了这一早期的工作，汇集了一个跨学科的团队， 生物和社会科学与海地合作者合作。我们将合并方法， 提出概念，就若干高度优先领域，包括社会、经济和 影响儿童大脑发育和功能的生物因素，婴儿和幼儿的营养 儿童，骨骼健康的决定因素;以及与赤贫中长大有关的创伤压力。

ABSTRACT A disturbingly high number of young children around the world experience stunted growth and development with irreparable consequences through the lifespan. Recent estimates show 250 million children less than five years of age are not reaching their developmental potential, and 151 million have stunted growth.1,2 Determinants of stunted growth and development are multi-factorial, including interactions between biological, behavioral, social, and environmental conditions, yet the evidence-base is minimal for integrated approaches to tackle the interwoven factors. Our group recently found significant impacts from an egg intervention on young child growth and biomarkers of nutrition and brain development. The effects on important psychosocial indictors of child development, however, were not assessed. Building on these findings and those of our pilot study of a group-based, multicomponent intervention (Grandi Byen, Haitian Creole for “grow well”), we propose a larger RCT to examine a greater breadth of egg intervention outcomes, the synergistic effects of adding psychoeducational parenting to the egg intervention, and mediating biological, behavioral and social factors. The 3-arm longitudinal RCT, to be carried out in Cap-Haitien, Haiti, where our group has nine years of research experience, established partnerships, and a strong research infrastructure. It is representative of resource-poor urban contexts globally, where parents face common economic and environmental challenges to child growth and development. The trial will compare the following groups for effectiveness in reducing young child stunted growth and enhancing overall development: 1) multicomponent Grandi Byen intervention (responsive parenting, nutrition, hygiene + one egg per day for 6 months); 2) nutrition intervention (one egg per day for 6 months); and 3) standard well-baby care. Infants will be enrolled between 6-8 months of age and followed longitudinally for one year. The specific aims are: Aim 1 (primary): To demonstrate the reproducibility and feasibility of egg-based interventions in reducing childhood stunting, and test its impact on development. Hypothesis 1: Linear growth will be increased by 0.30 LAZ in children receiving one egg per day compared to standard care. Hypothesis 2: Children receiving the egg intervention will have better cognitive, motor and language development compared to standard care. Question 1 (exploratory): Does an egg-based intervention impact social-emotional development? Aim 2 (primary): To investigate the incremental benefit of Grandi Byen compared to egg only and standard care groups on primary outcomes of child growth and development. Hypothesis 3: Children of mothers receiving Grandi Byen will increase linear growth by 0.10 LAZ compared to the egg intervention. Hypothesis 4: Children of mothers receiving Grandi Byen will have higher scores on child cognition, language, motor, and socio-emotional development, with an effect size of 0.36 on cognition, compared to standard care. An economic evaluation will be conducted to compare the efficiency of the interventions. Aim 3 (secondary). To explore pathways of intervention impacts on child growth and development by delineating the additive and synergistic effects of biological (nutrient biomarkers, bone age, and enteric disease), psychosocial (responsive parenting, cognitive stimulation), and environmental (hygiene and sanitation, diet) factors. This study expands upon this earlier work by bringing together a transdisciplinary team spanning the biological and social sciences to work in partnership with Haitian collaborators. We will merge methods and concepts to produce comprehensive perspectives on several high priority areas including social, economic and biological factors that impact child brain development and function, nutrition among infants and very young children, determinants of bone health; and traumatic stress associated with growing up in abject poverty.