PDF(Pubmed)
Abstract：
UNASSIGNED: Almost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs.
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.
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.
摘要：
■近2.5亿儿童未能充分发挥其成长或发展潜力，将他们困在持续不利的循环中。有强有力的证据表明，以父母为中心的面对面干预措施可以改善发育结果；挑战是在大范围内实现这些目标。SPRING（结合营养和游戏的可持续计划）旨在通过制定可行的负担得起的计划来解决这一问题，该计划由社区工人（CW）每月进行家访，并在计划环境中大规模测试两种不同的交付模式。在巴基斯坦,SPRING已嵌入现有的女性卫生工作者（LHW）每月的家访中。在印度,它是由一个民间社会/非政府组织（CSO/NGO）提供的，该组织培训了新的CW干部。
■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。
■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。
