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

摘要 令人担忧的是，世界各地有大量幼儿发育迟缓 一生中都会有不可挽回的后果。最近的估计显示，2.5亿名5岁以下的儿童 10岁的儿童没有达到其发展潜力，1.51亿人发育迟缓。 生长发育迟缓的决定因素是多因素的，包括生物、 行为、社会和环境条件，但综合方法的证据基础很小 解决相互交织的因素。我们的小组最近发现鸡蛋干预对人类健康的显著影响 幼儿生长以及营养和脑发育的生物标记物。对重要心理社会的影响 然而，没有对儿童发展指标进行评估。基于这些发现和我们的飞行员的发现 基于群体的、多成分干预的研究(Grani Byen，海地克里奥尔语中“生长良好”的意思)，我们建议 一项更大的随机对照试验，以检查更广泛的鸡蛋干预结果，添加 心理教育、父母教养对鸡蛋的干预，以及对生物、行为和社会因素的调节。 将在海地海地角进行的三臂纵向RCT，我们小组在那里有九年的 研究经验、已建立的合作伙伴关系和强大的研究基础设施。它代表了 全球资源匮乏的城市环境，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。这项试验将比较以下几组在减少 幼儿发育迟缓与促进全面发展：1)多组分大剂量干预 (积极的育儿、营养、卫生+6个月内每天一只鸡蛋)；2)营养干预(每只鸡蛋一只 6个月的一天)；以及3)标准的良好婴儿护理。婴儿将在6-8个月大和 纵向跟踪了一年。具体目标是： 目标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，并测试其对发育的影响。假设一：线性增长将增加0.30 与标准护理相比，每天接受一个鸡蛋治疗的儿童的LAZ。假设2：儿童接受 与标准护理相比，EGG干预将有更好的认知、运动和语言发展。 问题1(探索性)：基于鸡蛋的干预是否会影响社会情绪发展？ 目标2(主要)：与仅使用鸡蛋相比，研究Grani Byen的增量收益 关于儿童成长和发展的主要结果的标准护理小组。假设3：儿童 与卵子干预相比，接受格兰迪-拜恩治疗的母亲将线性增长增加0.10LAZ。 假设4：接受格兰迪拜恩治疗的母亲的孩子在儿童认知，语言， 运动和社会情绪发展，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)。探索干预措施对儿童生长发育的影响途径 描述生物(营养生物标记物、骨龄和肠道)的相加和协同作用 疾病)、心理社会(有反应的父母教养、认知刺激)和环境(卫生和 卫生、饮食)因素。 这项研究通过召集一个跨学科的团队来扩展这项早期的工作 生物和社会科学与海地合作者结成伙伴关系。我们将合并方法和 概念，以产生对几个高度优先领域的综合观点，包括社会、经济和 影响婴幼儿大脑发育和功能的生物学因素及营养 儿童，骨骼健康的决定因素；以及与赤贫成长相关的创伤应激。

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.