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Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial.
改善水、卫生和个人卫生 (WASH) 和改善补充喂养对津巴布韦农村艾滋病毒阴性母亲所生儿童早期神经发育的独立和综合影响: 集群随机试验的子研究。

摘要

BACKGROUND:Globally, nearly 250 million children (43% of all children under 5 years of age) are at risk of compromised neurodevelopment due to poverty, stunting, and lack of stimulation. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved infant and young child feeding (IYCF) on early child development (ECD) among children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. METHODS AND FINDINGS:SHINE was a cluster-randomized community-based 2×2 factorial trial. A total of 5,280 pregnant women were enrolled from 211 clusters (defined as the catchment area of 1-4 village health workers [VHWs] employed by the Zimbabwean Ministry of Health and Child Care). Clusters were randomly allocated to standard of care, IYCF (20 g of small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counseling), WASH (ventilated improved pit latrine, handwashing stations, chlorine, liquid soap, and play yard), and WASH + IYCF. Primary outcomes were child length-for-age Z-score and hemoglobin concentration at 18 months of age. Children who completed the 18-month visit and turned 2 years (102-112 weeks) between March 1, 2016, and April 30, 2017, were eligible for the ECD substudy. We prespecified that primary inferences would be drawn from findings of children born to HIV-negative mothers; these results are presented in this paper. A total of 1,655 HIV-unexposed children (64% of those eligible) were recruited into the ECD substudy from 206 clusters and evaluated for ECD at 2 years of age using the Malawi Developmental Assessment Tool (MDAT) to assess gross motor, fine motor, language, and social skills; the MacArthur-Bates Communicative Development Inventories (CDI) to assess vocabulary and grammar; the A-not-B test to assess object permanence; and a self-control task. Outcomes were analyzed in the intention-to-treat population. For all ECD outcomes, there was not a statistical interaction between the IYCF and WASH interventions, so we estimated the effects of the interventions by comparing the 2 IYCF groups with the 2 non-IYCF groups and the 2 WASH groups with the 2 non-WASH groups. The mean (95% CI) total MDAT score was modestly higher in the IYCF groups compared to the non-IYCF groups in unadjusted analysis: 1.35 (0.24, 2.46; p = 0.017); this difference did not persist in adjusted analysis: 0.79 (-0.22, 1.68; p = 0.057). There was no evidence of impact of the IYCF intervention on the CDI, A-not-B, or self-control tests. Among children in the WASH groups compared to those in the non-WASH groups, mean scores were not different for the MDAT, A-not-B, or self-control tests; mean CDI score was not different in unadjusted analysis (0.99 [95% CI -1.18, 3.17]) but was higher in children in the WASH groups in adjusted analysis (1.81 [0.01, 3.61]). The main limitation of the study was the specific time window for substudy recruitment, meaning not all children from the main trial were enrolled. CONCLUSIONS:We found little evidence that the IYCF and WASH interventions implemented in SHINE caused clinically important improvements in child development at 2 years of age. Interventions that directly target neurodevelopment (e.g., early stimulation) or that more comprehensively address the multifactorial nature of neurodevelopment may be required to support healthy development of vulnerable children. TRIAL REGISTRATION:ClinicalTrials.gov NCT01824940.

译文

背景: 在全球范围内,近 2.5亿儿童 (占所有 5 岁以下儿童的 43%) 因贫困、发育迟缓和缺乏刺激而面临神经发育受损的风险。我们测试了改善水、卫生和个人卫生 (WASH) 和改善婴幼儿喂养 (IYCF) 对早期儿童发育 (ECD) 的独立和综合影响在津巴布韦农村参加环境卫生婴儿营养功效 (SHINE) 试验的儿童中。方法和结果: SHINE 是一项基于社区的集群随机 2 × 2 因子试验。共有 5,280 名孕妇从 211 个集群 (定义为津巴布韦卫生和儿童保健部雇用的 1-4 名乡村卫生工作者 [VHWs] 的集水区) 中被招募。集群被随机分配到护理标准,IYCF (从 6 个月到 18 个月每天 20 克少量基于脂质的营养补充剂加上补充喂养咨询), 清洗 (通风改良坑厕所、洗手站、氯、液体肥皂和游戏场),并清洗 IYCF。主要结果是 18 个月大时的儿童年龄长度 Z 评分和血红蛋白浓度。在 2016年3月1日至 2017年4月30日期间完成 18 个月访问并满 2 岁 (102-112 周) 的儿童有资格进行 ECD 亚研究。我们预先确定,主要推论将来自艾滋病毒阴性母亲所生儿童的调查结果; 这些结果在本文中呈现。共有 1,655 名未感染艾滋病毒的儿童 (符合条件的 64%) 被招募到 206 个集群的 ECD 子研究中,并在 2 岁时使用马拉维发展评估工具 (MDAT) 对 ECD 进行评估,以评估粗大运动、精细运动、语言, 和社交技巧; 麦克阿瑟-贝茨交流发展目录(CDI) 评估词汇和语法; 评估对象持久性的 A-nob 测试; 和自我控制任务。在意向治疗人群中分析结果。对于所有 ECD 结果,IYCF 和 WASH 干预之间没有统计上的相互作用, 因此,我们通过比较 2 个 IYCF 组和 2 个非 IYCF 组以及 2 个非 WASH 组来估计干预的效果。在未经调整的分析中,与非 IYCF 组相比,IYCF 组的 MDAT 总分的平均值 (95% CI) 略高: 1.35 (0.24,2.46; p = 0.017); 这种差异在调整后的分析中没有持续存在: 0.79 (-0.22,1.68; p = 0.057)。没有证据表明 IYCF 干预对 CDI 、 A-not-B 或自身对照测试有影响。在 WASH 组的儿童与非 WASH 组的儿童中,MDAT 、 A-not-B 或自我控制测试的平均得分没有差异; 在未经调整的分析中,平均 CDI 得分没有差异 (0.99 [95% CI-1.18,3.17]),但在调整的分析中,WASH 组的儿童 CDI 得分更高(1.81 [0.01,3.61])。该研究的主要限制是子研究招募的具体时间窗口,这意味着并非所有来自主要试验的儿童都被招募。结论: 我们发现很少证据表明在 SHINE 中实施的 IYCF 和 WASH 干预措施在 2 岁时对儿童发育造成了临床上重要的改善。可能需要直接针对神经发育的干预措施 (例如,早期刺激) 或更全面地解决神经发育的多因素性质,以支持弱势儿童的健康发展。试用注册: ClinicalTrials.gov nct01824940。

Complementary feeding

儿科 喂养 临床研究术语
概述  :  

随着体格生长、消化道功能和神经心理发育的逐渐成熟以及对营养素需要量的增加,婴幼儿需要经历由出生时的纯乳类向成人固体食物转换的过渡时期。通常从婴儿满6月龄开始到24月龄完成。过渡时期的食物,是指除人乳或配方奶(兽乳)外,所添加的富含能量和各种营养素的固体、半固体(泥糊状)食物,又称“辅食”或“断乳食物”。此时,也是儿童快速生长和发育的阶段,对营养缺乏和过量十分敏感,并且暴露于新食物、口味和喂养经历的重要改变。适宜的营养和喂养不仅关系到近期的生长发育,也有益于成年后慢性疾病的预防。这一年龄段婴幼

complementary    英 [ˌkɒmplɪˈmentri]  美 [ˌkɑːmplɪˈmentri]

释    义   adj. 补足的;(基因序列等)互补的;补充医学的;辅助性的;互补色的;余角的

例    句   Our purposes are different from yours, however, complementary, and considered by us, of the animal kingdom, just as important. 我们的目的与你们的不同,然而,我们认为其对动物王国的互补性是同样重要的。


feeding    英 [ˈfiːdɪŋ]  美 [ˈfiːdɪŋ]

释    义   n. 饲养;吃;输送

adj. 供给饲料的;摄取食物的

v. 饲养(feed的ing形式)

例    句   I have seen people feeding them by hand, and they seem to like the attention.我看到过人们用手喂食这些动物,它们看起来很喜欢这种照料。

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