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首页> 外文期刊>Frontiers in Public Health >A Multi-Sectoral Approach Improves Early Child Development in a Disadvantaged Community in Peru: Role of Community Gardens, Nutrition Workshops and Enhanced Caregiver-Child Interaction: Project “Wawa Illari”
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A Multi-Sectoral Approach Improves Early Child Development in a Disadvantaged Community in Peru: Role of Community Gardens, Nutrition Workshops and Enhanced Caregiver-Child Interaction: Project “Wawa Illari”

机译：多部门方法改善了秘鲁弱势群体的早期儿童发展：社区花园，营养厂房和加强照顾者儿童互动的作用：项目“Wawa Illari”

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Background: Multi-dimensional monitoring evaluation and learning strategies are needed to address the complex set of factors that affect early child development in marginalized populations, but few studies have explored their effectiveness. Objective: To compare improvement of health and development of children 0–3 years between intervention communities (IC) and control communities (CC) from peripheral settlements of Lima. Sequential interventions included: (1) home and community gardens, (2) conscious nutrition, and (3) parenting workshops following the International Child Development Program (ICDP). Methods: Interventions were delivered by community health promoters (CHPs) using a “step-by-step” learning system. Both IC and CC were monitored before the interventions began, at 8 and 12 months ( n = 113 IC and 127 CC children). Data were collected on household characteristics, diet, food security, health indicators (history of diarrhea and respiratory infections, hemoglobin, intestinal parasites, anthropometry), caregiver-child interactions and stress, and achievement of Pan-American Health Organization age-specific developmental milestones. Stepwise multiple logistic regressions were used to determine if the interventions affected food insecurity, as well as motor, social/cognitive and language delays. Results: At baseline, 2.6% were categorized as “suspected developmental delay” and 14.2% were on “alert for development delay.” Food insecurity, diarrhea and respiratory infections were lowered following the interventions. Through the “step-by-step” approach, caregivers in IC gained skills in gardening, conscious nutrition and parenting that reduced the risk of food insecurity [Adjusted Risk Ratio = 0.20 (95% CI: 0.08–0.51)] and language delay [0.39 (0.19–0.82)] but not motor or social/cognitive delay. Use of a multiple micronutrient supplement decreased the risk of motor delay [0.12 (0.03–0.56)], but more pets were associated with higher risk of motor [3.24 (1.47–7.14)] and social/cognitive delay [2.72 (1.33–5.55)], and of food insecurity [1.73 (1.13–2.66)]. Conclusion: The combined interventions delivered by CHPs helped to mitigate the impact of adversity on food insecurity and language delay. Additional improvements may have been detected if the interventions had continued for a longer time. Our results indicate that control of infections and pets may be needed to achieve measurable results for motor and social/cognitive development. Continuous monitoring facilitated adjusting implementation strategies and achieving positive developmental outcomes.
机译：背景：需要多维监测评估和学习策略来解决影响边缘化人口中早期儿童发展的复杂因素，但少数研究探讨了其效力。目的：比较0 - 3年间干预社区（IC）与控制社区（CC）从利马解决方面的健康和发展的改善。顺序干预包括：（1）家庭和社区花园，（2）有意识营养，（3）国际儿童发展计划（ICDP）之后的育儿研讨会。方法：使用“逐步”学习系统，通过社区卫生启动子（CHPS）提供干预措施。在干预措施开始之前监测IC和CC，在8和12个月（N = 113 IC和127个CC儿童）之前进行监测。采用家庭特征，饮食，粮食安全，健康指标（腹泻和呼吸道感染，血红蛋白，肠道寄生虫，人类学），照顾者儿童的相互作用和压力，以及实现泛美卫生组织年龄特异性发展里程碑。逐步多个逻辑回归用于确定干预措施是否影响了粮食不安全，以及电机，社会/认知和语言延误。结果：在基线时，2.6％被分类为“怀疑发育延迟”，14.2％是“开发延误警报”。在干预措施之后降低了食物不安全，腹泻和呼吸道感染。通过“逐步”方法，在园艺，有意识的营养和养育方面的IC获得技巧，减少了食物不安全风险[调整风险比率= 0.20（95％CI：0.08-0.51）]和语言延迟[ 0.39（0.19-0.82）]但不是电机或社会/认知延迟。使用多种微量营养素补充剂降低了电动机延迟的风险[0.12（0.03-0.56）]，但更多的宠物与电动机的风险更高相关[3.24（1.47-7.14）]和社会/认知延迟[2.72（1.33-5.55 ）]，食物不安全[1.73（1.13-2.66）]。结论：CHPS交付的合并干预措施有助于减轻逆境对粮食不安全和语言延误的影响。如果干预措施持续较长的时间，可能会检测到其他改进。我们的结果表明，可能需要控制感染和宠物的控制，以实现运动和社会/认知发展的可衡量结果。持续监测有助于调整实施策略和实现积极发展成果。

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