Supporting child growth and development through integrated, responsive parenting, nutrition and hygiene

通过综合、响应式的育儿、营养和卫生支持儿童的成长和发展

• 批准号: 9887899
• 负责人: Lora Lynn Iannotti
• 金额: $ 61.76万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-06 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9887899
• 关键词: 5 year old; Affect; Age; Age-Months; Animal Sources; Area; Behavior; Behavioral; Biological; Biological Factors; Biological Markers; Biological Sciences; Brain; Cessation of life; Child; Child Behavior; Child Development; Child Nutrition; Child Rearing; Child Support; Childhood; Cognition; Cognitive; Communities; Complementary Feeding; Complex; Data; Development; Diet; Dietary Intervention; Disease; Economic Factors; Economics; Ecuador; Effectiveness; Emotional; Enrollment; Enteral; Face; Food; Growth; Growth and Development function; Haiti; Haitian; Height; Hygiene; Impairment; Infant; Infant Care; Intervention; Language; Language Development; Length; Longevity; Mediating; Methods; Mothers; Motor; National Institute of Child Health and Human Development; Nutrient; Outcome; Parents; Pathway interactions; Personal Satisfaction; Pilot Projects; Population; Poverty; Randomized Controlled Trials; Reproducibility; Research; Research Infrastructure; Resources; Risk Factors; Sanitation; Site; Social Sciences; Supplementation; Testing; Water; Work; World Health; arm; base; bone age; bone health; burden of illness; diarrheal disease; disorder risk; economic evaluation; egg; evidence base; experience; infection risk; insight; multi-component intervention; nutrition; pediatric trauma; primary outcome; psychoeducational; psychosocial; social; social factors; standard care; traumatic stress; trend

ABSTRACT A disturbingly high number of young children around the world experience stunted growth and development with irreparable consequences through the lifespan. Recent estimates show 250 million children less than five years of age are not reaching their developmental potential, and 151 million have stunted growth.1,2 Determinants of stunted growth and development are multi-factorial, including interactions between biological, behavioral, social, and environmental conditions, yet the evidence-base is minimal for integrated approaches to tackle the interwoven factors. Our group recently found significant impacts from an egg intervention on young child growth and biomarkers of nutrition and brain development. The effects on important psychosocial indictors of child development, however, were not assessed. Building on these findings and those of our pilot study of a group-based, multicomponent intervention (Grandi Byen, Haitian Creole for “grow well”), we propose a larger RCT to examine a greater breadth of egg intervention outcomes, the synergistic effects of adding psychoeducational parenting to the egg intervention, and mediating biological, behavioral and social factors. The 3-arm longitudinal RCT, to be carried out in Cap-Haitien, Haiti, where our group has nine years of research experience, established partnerships, and a strong research infrastructure. It is representative of resource-poor urban contexts globally, where parents face common economic and environmental challenges to child growth and development. The trial will compare the following groups for effectiveness in reducing young child stunted growth and enhancing overall development: 1) multicomponent Grandi Byen intervention (responsive parenting, nutrition, hygiene + one egg per day for 6 months); 2) nutrition intervention (one egg per day for 6 months); and 3) standard well-baby care. Infants will be enrolled between 6-8 months of age and followed longitudinally for one year. The specific aims are: Aim 1 (primary): To demonstrate the reproducibility and feasibility of egg-based interventions in reducing childhood stunting, and test its impact on development. Hypothesis 1: Linear growth will be increased by 0.30 LAZ in children receiving one egg per day compared to standard care. Hypothesis 2: Children receiving the egg intervention will have better cognitive, motor and language development compared to standard care. Question 1 (exploratory): Does an egg-based intervention impact social-emotional development? Aim 2 (primary): To investigate the incremental benefit of Grandi Byen compared to egg only and standard care groups on primary outcomes of child growth and development. Hypothesis 3: Children of mothers receiving Grandi Byen will increase linear growth by 0.10 LAZ compared to the egg intervention. Hypothesis 4: Children of mothers receiving Grandi Byen will have higher scores on child cognition, language, motor, and socio-emotional development, with an effect size of 0.36 on cognition, compared to standard care. An economic evaluation will be conducted to compare the efficiency of the interventions. Aim 3 (secondary). To explore pathways of intervention impacts on child growth and development by delineating the additive and synergistic effects of biological (nutrient biomarkers, bone age, and enteric disease), psychosocial (responsive parenting, cognitive stimulation), and environmental (hygiene and sanitation, diet) factors. This study expands upon this earlier work by bringing together a transdisciplinary team spanning the biological and social sciences to work in partnership with Haitian collaborators. We will merge methods and concepts to produce comprehensive perspectives on several high priority areas including social, economic and biological factors that impact child brain development and function, nutrition among infants and very young children, determinants of bone health; and traumatic stress associated with growing up in abject poverty.

抽象的 世界各地有数量惊人的幼儿出现生长发育不良 最近的估计显示，有 2.5 亿儿童不到五岁。 岁数尚未达到其发育潜力，1.51 亿人发育迟缓。1,2 生长发育不良的决定因素是多因素的，包括生物、 行为、社会和环境条件，但综合方法的证据基础很少 为了解决这些相互交织的因素，我们的小组最近发现鸡蛋干预对健康产生了重大影响。 幼儿生长以及营养和大脑发育的生物标志物对重要社会心理的影响。 然而，没有根据这些调查结果和我们的试点结果对儿童发展指标进行评估。 基于团体的多成分干预研究（Grandi Byen，海地克里奥尔语“成长得好”），我们建议 更大范围的随机对照试验来检查更广泛的鸡蛋干预结果，添加的协同效应 对卵子进行心理教育育儿干预，并调节生物、行为和社会因素。 三臂纵向随机对照试验将在海地海地角进行，我们小组在那里进行了九年的研究 它代表了研究经验、建立的合作伙伴关系和强大的研究基础设施。 全球资源匮乏的城市环境，父母面临共同的经济和环境挑战 该试验将比较以下组在减少儿童生长和发育方面的有效性。 幼儿生长发育迟缓和促进全面发展：1）多成分 Grandi Byen 干预 （响应性育儿、营养、卫生+每天一颗鸡蛋，持续 6 个月）；2）营养干预（每个鸡蛋一颗）； 6 个月）；以及 3） 6-8 个月大的婴儿将参加标准的婴儿护理。 纵向跟踪一年的具体目标是： 目标 1（主要）：证明以鸡蛋为基础的干预措施在减少 儿童发育迟缓，并检验其对发育的影响 假设1：线性生长会增加0.30。 每天接受一颗鸡蛋的儿童与标准护理相比的 LAZ。 假设 2：接受鸡蛋治疗的儿童。 与标准护理相比，卵子干预将具有更好的认知、运动和语言发育。 问题 1（探索性）：以鸡蛋为基础的干预措施是否会影响社交情感发展？ 目标 2（主要）：调查 Grandi Byen 与仅鸡蛋和鸡蛋相比的增量益处 标准护理组对儿童生长发育主要结果的影响 假设 3：儿童 与卵子干预相比，接受 Grandi Byen 的母亲的线性生长将增加 0.10 LAZ。 假设 4：接受 Grandi Byen 的母亲的孩子在儿童认知、语言、 与标准护理相比，运动和社会情感发展对认知的影响大小为 0.36。 将进行经济评估以比较干预措施的效率。 目标 3（次要）：探索干预措施对儿童成长和发展的影响途径。 描述生物（营养生物标志物、骨龄和肠溶）的累加和协同效应 疾病）、社会心理（回应性养育、认知刺激）和环境（卫生和 卫生、饮食）因素。 这项研究通过汇集跨学科团队来扩展这项早期工作 我们将与海地合作者合作，融合生物和社会科学的方法和方法。 概念，对社会、经济和社会等几个高度优先领域产生全面的观点 影响儿童大脑发育和功能的生物因素、婴儿和幼儿的营养 儿童、骨骼健康的决定因素；以及与在赤贫中成长相关的创伤性压力。