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 世界各地的幼儿数量令人惊讶，经历了发育迟缓的成长和发展 在整个生命周期内都无法弥补。最近的估计显示2.5亿儿童少于五个 年龄没有达到其发育潜力，1.51亿个发育迟缓。1,2 发育迟缓的生长和发展的决定因素是多因素的，包括生物学之间的相互作用 行为，社会和环境条件，但循证库对于综合方法的最低 解决交织的因素。我们的小组最近发现鸡蛋干预对 幼儿成长和营养和大脑发育的生物标志物。对重要社会心理的影响 但是，没有评估儿童发展的指控者。在这些发现和我们的飞行员的基础上建立 研究基于小组的多组分干预措施（海地的克里奥尔（Haitian Creole for``成长良好'''），我们建议 更大的RCT检查卵干预结果的更广度，这是添加的协同作用 卵干预的心理教育育儿，并介导生物学，行为和社会因素。 3臂纵向RCT将在海地的卡普哈蒂安（Cap-Haitien）进行，我们的小组有9年 研究经验，建立的伙伴关系和强大的研究基础设施。它是代表 全球资源贫乏的城市环境，父母面临常见的经济和环境挑战 致儿童成长和成长。该试验将比较以下小组的有效性降低 幼儿发育不良增长并增强了整体发展：1）多组分Grandi Byen干预 （反应迅速的育儿，营养，卫生 +每天一个鸡蛋持续6个月）； 2）营养干预（每卵 一天持续6个月）； 3）标准保健护理。婴儿将在6-8个月之间注册 紧随其后的是一年。具体目的是： 目标1（主要）：证明基于鸡蛋的干预措施的可重复性和可行性 童年的阻碍，并测试其对发展的影响。假设1：线性生长将增加0.30 与标准护理相比，每天接受一个鸡蛋的儿童的LAZ。假设2：接受 与标准护理相比，鸡蛋干预将具有更好的认知，运动和语言发展。 问题1（探索性）：基于鸡蛋的干预是否会影响社会情感发展？ AIM 2（主要）：研究仅与鸡蛋相比，Grandi Byen的增量益处 关于儿童成长和发育的主要结果的标准护理小组。假设3： 与鸡蛋干预相比，接受Grandi Byen的母亲将使线性生长增加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的效果大小为0.36。 将进行经济评估，以比较干预措施的效率。 目标3（次要）。探索干预途径对儿童成长和成长的影响 描述生物学的添加剂和协同作用（养分生物标志物，骨骼年龄，并进入 疾病），社会心理（反应式育儿，认知刺激）和环境（卫生和卫生 卫生，饮食）因素。 这项研究通过将跨学科团队汇总在一起，扩展了这项较早的工作 生物学和社会科学与海地合作者合作。我们将合并方法和 概念以在社会，经济和 影响儿童大脑发育和功能，婴儿和非常年轻的营养的生物学因素 儿童，确定骨骼健康；与在贫困中成长有关的创伤压力。