Interdisciplinary interventions for stunting and wasting in Zimbabwe, Zambia and Pakistan

营养不良造成几乎一半的儿童死亡，并对教育、经济和健康产生深远影响。我们重点关注发育不良和消瘦，这是营养不良的主要形式，不能简单地用粮食短缺来解释。发育迟缓或身高降低会损害成年后的长期教育成就和收入潜力，有多种根本原因，但几乎没有有效的预防策略。最严重的消瘦表现为严重急性营养不良，儿童在医院或出院后死亡的风险很高。为了让儿童生存、茁壮成长并过上富裕的生活，我们需要新的方法来解决营养不良问题。我们的目标是加强伙伴关系，利用传统营养学科以外的专门知识，并在津巴布韦、赞比亚和巴基斯坦这三个儿童营养不良负担沉重的国家开展长期研究方案。我们的目标是通过寻找预防发育迟缓和治疗消瘦的新方法来改善儿童的生存、健康和潜力，帮助实现可持续发展目标。我们的长期研究计划有三个目标。我们的首要目标是了解相互作用导致营养不良的环境、社会和生物因素网络，以便我们能够找到最有希望的干预目标。我们的第二个目标是利用这一学习来评估营养不良的新战略。我们将设计通常不一起使用的干预措施，并测试其有效性，首先是小型试点研究，然后是旨在预防发育迟缓和治疗浪费的大型临床试验。我们的第三个目标是利用我们的研究成果来影响政策和发展计划，以便有效地扩大新的干预措施，减少营养不良。我们计划利用目前的赠款机会加强与每个国家的联系，通过合作会议和共同的工作计划建立更多的南南合作，并聘请营养领域以外的新调查人员。我们将开展四个试点项目，以确定解决营养不良问题的新办法，这将开始为我们的长期方案提供信息。首先，我们将召集人类、动物和环境健康方面的专家，讨论牲畜所有权对发育迟缓的风险和益处，并开始设计未来的干预措施，以增加牲畜所有权的积极影响，同时减轻负面影响。第二，我们将与社会科学家合作，评估孩子从SAM中恢复的母亲的态度和行为。加强母亲照顾子女的能力可能有助于在出院后提供一揽子护理，以改善SAM儿童的长期结局。第三，我们将探索给予高剂量维生素D是否是改善赞比亚和津巴布韦SAM儿童康复的有希望的策略，正如我们最近在巴基斯坦发现的那样。我们将在我们的实验室中使用从SAM儿童住院和出院时收集的血液样本测量维生素D，以了解维生素D缺乏是否部分解释了他们的不良结果。如果是这样，高剂量的维生素D应该在未来的试验中进行评估。最后，我们将进行一项试点研究，以治疗母亲抑郁症作为改善儿童成长的一种方式。产妇心理健康状况不佳会影响生育和喂养做法，并增加儿童发育迟缓的风险。由受过培训的非专业工作人员提供以解决问题疗法为基础的社区干预措施，治疗常见的精神障碍非常有效，但目前主要在城市地区使用。我们将开展试点工作，看看这种干预措施是否对津巴布韦农村的母亲有效，以及它是否是改善儿童生长和发育的有希望的方法。

Undernutrition underlies almost half of all child deaths and has far-reaching educational, economic and health impacts. We focus on stunting and wasting, the major forms of undernutrition, which are not explained simply by shortage of food. Stunting, or reduced height, impairs long-term educational attainment and earning potential in adulthood and has multiple underlying causes, but few effective preventive strategies. Wasting in its most serious form presents as severe acute malnutrition (SAM) and children have a high risk of dying in hospital or after discharge home. For children to survive, thrive and lead prosperous lives, we need new ways to tackle undernutrition. We aim to strengthen partnerships, draw on expertise beyond traditional nutrition disciplines, and conduct a long-term programme of research in three countries with a high burden of child undernutrition - Zimbabwe, Zambia and Pakistan. Our ambition is to improve child survival, health and potential by finding new ways of preventing stunting and treating wasting, to help reach the Sustainable Development Goals.Our long-term research programme has three aims. Our first aim is to understand the network of environmental, social and biological factors that interact to cause undernutrition so we can find the most promising targets for intervention. Our second aim is to use this learning to evaluate new strategies for undernutrition. We will design packages of interventions that are often not used together, and test their effectiveness, first in small pilot studies and then in large clinical trials aimed at preventing stunting and treating wasting. Our third aim is to use the findings we generate to influence policy and development programmes so that new interventions are scaled up effectively to reduce undernutrition.We plan to use this current grant opportunity to strengthen links with each country, build more south-south cooperation through collaborative meetings and a shared programme of work, and engage new investigators from outside the nutrition field. We will conduct four pilot projects to identify new approaches to undernutrition, which will start to inform our long-term programme. First, we will bring together experts in human, animal and environmental health to discuss the risks and benefits of livestock ownership for stunting and start to design a future intervention that increases the positive effects of livestock ownership whilst mitigating the negative effects. Second, we will work with social scientists to evaluate the attitudes and behaviours of mothers whose children are recovering from SAM. Strengthening the capacity of mothers to look after their children might help to deliver a package of care after discharge from hospital to improve the long-term outcomes of children with SAM. Third, we will explore whether giving high-dose vitamin D is a promising strategy to improve recovery of children with SAM in Zambia and Zimbabwe, as we recently found in Pakistan. We will measure vitamin D in our laboratory using blood samples collected from children with SAM during hospital admission and at discharge, to see whether vitamin D deficiency partly explains their poor outcomes. If so, high-dose vitamin D should be evaluated in a future trial. Finally, we will conduct a pilot study to treat maternal depression as a way of improving child growth. Poor maternal mental health can compromise caregiving and feeding practices and increases the risk of child stunting. Treatment of common mental disorders using a community-based intervention based on problem solving therapy, delivered by trained lay workers, is highly effective but is mostly used in urban areas currently. We will conduct pilot work to see if this intervention works for mothers in rural Zimbabwe, and whether it is a promising approach to improve child growth and development.