Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial

被引:74
作者
Nahar, B. [1 ,2 ]
Hossain, M. I. [2 ]
Hamadani, J. D. [2 ]
Ahmed, T. [2 ]
Huda, S. N. [3 ]
Grantham-McGregor, S. M. [4 ]
Persson, L. A. [1 ]
机构
[1] Uppsala Univ, Dept Womens & Childrens Hlth, SE-75185 Uppsala, Sweden
[2] Int Ctr Diarrhoeal Dis Res, Dhaka 1000, Bangladesh
[3] Univ Dhaka, INFS, Dhaka 1000, Bangladesh
[4] UCL, Inst Child Hlth, CIHD, London, England
关键词
malnutrition; community-based intervention; psychosocial stimulation; food supplementation; Bangladesh; children; UNDERNOURISHED JAMAICAN CHILDREN; NUTRITIONAL SUPPLEMENTATION; ZINC SUPPLEMENTATION; MENTAL-DEVELOPMENT; BIRTH-WEIGHT; INFANTS; INTERVENTIONS; EDUCATION; COGNITION; IMPROVES;
D O I
10.1038/ejcn.2012.13
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background/Objective: Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children. Subjects/Methods: Severely underweight hospitalised children aged 6-24 months (n = 507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS_FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure. Results: Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group*session interaction P = 0.037, effect size = 0.37 s.d.) and weight-for-age Z-score (group*session interaction P = 0.02, effect size 0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth. Conclusion: Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status. European Journal of Clinical Nutrition (2012) 66, 701-709; doi: 10.1038/ejcn.2012.13; published online 22 February 2012
引用
收藏
页码:701 / 709
页数:9
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