UNASSIGNED: The SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat.
UNASSIGNED: 1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4-75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15-83%, p = 0.002) compared to children in the control groups.
UNASSIGNED: The lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.
■通过平行整群随机试验评估SPRING干预措施。在巴基斯坦,集群是20个联盟理事会(UC),而在印度,24个卫生分中心的集水区。试验参与者是通过每月2次家访的监测系统招募的活产婴儿的母婴二叉。主要结果是精神运动的BSID-III综合评分,认知和语言发展加上身高的年龄z得分(HAZ),在18个月大时评估。分析是通过意向治疗。
■对印度的1,443名儿童进行了18个月大的评估,对巴基斯坦的1,016名儿童进行了评估。设置对ECD结果或增长均无影响。在印度,SPRING干预组中在12个月大时接受符合WHO最低可接受标准的饮食的儿童百分比高出35%(95%CI:4-75%,p=0.023),巴基斯坦高出45%(95%CI:15-83%,p=0.002)与对照组中的儿童相比。
■缺乏影响是由实施因素的缺点来解释的。吸取了重要的教训。如果没有额外的资源和重新组织其目标以包括新任务,将额外的任务集成到已经过载的CW工作负载中是不可能成功的。非政府组织模式最有可能扩大规模,因为很少有国家建立了诸如LHW计划之类的基础设施。它将需要认真注意建立强有力的行政和管理系统,以支持其实施。