背景:先前的研究表明,早期发育干预(EDI)对发展中国家儿童发育的积极影响。很少有研究,然而,纵向研究了何时可以观察到不同的治疗效果,以及差异结果是否与暴露于不同的风险因素和实施国家相关。此外,出生窒息作为一种危险状况还没有得到很好的研究。为了解决这些限制,我们进行了一项随机对照试验,以检验以下假设:在印度农村地区的儿童中,将有不同的发育轨迹有利于接受EDI的儿童与健康教育干预的儿童。巴基斯坦,赞比亚。
方法:有和没有出生窒息的儿童随机接受EDI或对照干预,这是由父母实施的,他们接受了在1个月儿童之前开始的双周家访培训,并持续到36个月。使用Bayley婴儿发育量表和年龄和阶段问卷对376名12、24和36个月的儿童进行了发育评估,评估人员对干预分配和风险状况视而不见。
结果:纵向混合模型分析表明,EDI导致认知能力在36个月内得到更好的发展,无论风险状况如何,孕产妇资源,儿童性别,或国家。精神运动发育和父母报告的一般发育显示出与认知能力相似的趋势,但干预条件之间没有统计学差异。在36月龄时首先观察到发育差异。
结论:早期发育干预有望改善发展中国家儿童在各种风险条件下的发育。EDI应该是开始解决长期成果和贫困代际传播的一种突出方法。
BACKGROUND: Previous research has indicated positive effects of early developmental intervention (EDI) on the development of children in developing countries. Few studies, however, have examined longitudinally when differential treatment effects may be observed and whether differential outcomes are associated with exposure to different risk factors and country of implementation. Also, birth asphyxia as a risk condition has not been well studied. To address these limitations, we conducted a randomized controlled trial to test the hypothesis that there will be differential developmental trajectories favoring those who receive EDI versus a health education intervention in children in rural areas of India, Pakistan, and Zambia.
METHODS: Children with and without birth asphyxia were randomized to EDI or control intervention, which was implemented by parents who received training in biweekly home visits initiated before child age 1 month and continuing until 36 months. Development was assessed in 376 children at ages 12, 24, and 36 months using the Bayley Scales of Infant Development and Ages & Stages Questionnaire administered by evaluators blind to intervention assignment and risk condition.
RESULTS: Longitudinal mixed model analysis indicated that EDI resulted in better development over 36 months in cognitive abilities, regardless of risk condition, maternal resources, child gender, or country. Psychomotor development and parent-reported general development showed similar trends as for cognitive abilities, but were not statistically different between intervention conditions. Developmental differences were observed first at 36 months of age.
CONCLUSIONS: Early developmental intervention has promise for improving development in children across developing countries when exposed to various risk conditions. EDI should be one prominent approach used to begin to address long-term outcomes and intergenerational transmission of poverty.