背景:需要营养康复单元(NRU)治疗的严重急性营养不良(SAM)儿童在出院后通常发育和营养结局较差。Kusamala计划是一项4天的医院咨询计划,旨在为SAM儿童的看护人提供营养,水,卫生,卫生和社会心理刺激,旨在改善这些结果。
目的:目的是评估Kusamala计划对NRU出院后6个月SAM儿童的儿童发育和营养状况的影响。另一个目的是定性地了解参与干预的护理人员的看法和经验。
方法:对照顾者及其6-59个月大的SAM儿童进行了一项整群随机对照试验,马拉维。该试验的主要结果是根据马拉维发育评估工具(MDAT)的儿童发育,精细电机,语言,和社会领域。还对参与试验的一部分护理人员进行了定性部分,包括焦点小组讨论和深入访谈。
结果:68名看护者和儿童被纳入按星期分组,随机分配到比较组,104名被分配到干预组。儿童发育没有差异,比较组的平均MDAT复合z评分为-1.2(95%CI:-2.1,-0.22),干预组的平均MDAT复合z评分为-1.1(95%CI:-1.9,-0.40)(P=0.93).对20名护理人员进行的质量评估表明,库萨马拉方案的3个模块是适当的,它们尽可能多地应用了在家里学到的许多经验教训。
结论:Kusamala计划没有改善发育或营养结果,然而,根据定性结果,护理人员对其给予了积极的评价。未来的研究应该评估对照顾者和SAM儿童的更密集的干预措施。该试验已在www上注册。clinicaltrials.gov作为NCT03072433。
BACKGROUND: Children with severe acute malnutrition (SAM) who require nutritional rehabilitation unit (NRU) treatment often have poor developmental and nutritional outcomes following discharge. The Kusamala Program is a 4-d hospital-based counseling program for caregivers of children with SAM that integrates nutrition, water, sanitation, and hygiene and psychosocial stimulation, aimed at improving these outcomes.
OBJECTIVE: The aim was to evaluate the effects of the Kusamala Program on child development and nutritional status in children with SAM 6 mo after NRU discharge. The other aim was to qualitatively understand perceptions and experiences of caregivers who participated in the intervention.
METHODS: A cluster-randomized controlled trial was conducted with caregivers and their children 6-59 mo of age with SAM admitted to the Moyo NRU in Blantyre, Malawi. The primary outcome of the trial was child development according to Malawi Developmental Assessment Tool (MDAT) composite z-scores of gross motor, fine motor, language, and social domains. A qualitative component with focus group discussions and in-depth interviews was also completed with a subset of caregivers who participated in the trial.
RESULTS: Sixty-eight caregivers and children were enrolled to clusters by week and randomly assigned to the comparison arm and 104 to the intervention arm. There were no differences in child development, with mean MDAT composite z-scores in the comparison arm of -1.2 (95% CI: -2.1, -0.22) and in the intervention arm of -1.1 (95% CI: -1.9, -0.40) (P = 0.93). The qualitative evaluation with 20 caregivers indicated that the 3 modules of the Kusamala Program were appropriate and that they applied many of the lessons learned at home as much as possible.
CONCLUSIONS: The Kusamala Program did not result in improved developmental or nutritional outcomes, yet it was viewed positively by caregivers according to qualitative results. Future research should evaluate more intensive interventions for caregivers and children with SAM. This trial was registered at www.clinicaltrials.gov as NCT03072433.