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Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial
Oleh:
Ruel, Maria T.
;
Menon, Purnima
;
Habicht, Jean-Pierre
;
Loechl, Cornelia
;
Bergeron, Gilles
;
Pelto, Gretel H.
;
Arimond, Mary
;
Maluccio, John A.
;
Michaud, Lesly
;
Hankebo, Bekele
Jenis:
Article from Journal - ilmiah internasional
Dalam koleksi:
The Lancet (keterangan: ada di Proquest) vol. 371 no. 9612 (Feb. 2008)
,
page 588.
Ketersediaan
Perpustakaan FK
Nomor Panggil:
L01.K.2008.02
Non-tandon:
1 (dapat dipinjam: 0)
Tandon:
tidak ada
Lihat Detail Induk
Isi artikel
Background Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition. Methods We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6–23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6–60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12–41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. Findings There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4–6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0·14 Z scores (height for age; p=0·07), and +0·24 Z scores (weight for age and weight for height; p<0·0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition. Interpretation The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model.
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