Child play and caregiver support to promote convalescence following severe acute malnutrition in Zimbabwe: The Tamba-SAM pilot study

IF 2.8 2区 医学 Q3 NUTRITION & DIETETICS
Jacqueline Kabongo, Louisa Mudawarima, Florence D. Majo, Anesu Dzikiti, Joice Tome, Bernard Chasekwa, Batsirai Mutasa, Lloyd Dzapasi, Epiphania Munetsi, Isabella Cordani, Robert Ntozini, Lisa F. Langhaug, Mutsa Bwakura-Dangarembizi, Andrew J. Prendergast
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引用次数: 0

Abstract

Children hospitalised for severe acute malnutrition (SAM) have a high risk of mortality, relapse and rehospitalisation following hospital discharge. Current approaches fail to promote convalescence, or to address the underlying social determinants of SAM, meaning that restoration of long-term health, growth and neurodevelopment is not achieved. Although guidelines recommend play and stimulation to promote recovery, most caregivers are not supported to do this at home. We set out to evaluate the feasibility and acceptability of a codesigned intervention package aimed at providing child stimulation through play, and strengthening caregiver capabilities through problem-solving skills, peer support and income-generating activities. We evaluated the intervention in two phases, enroling 30 caregiver–child pairs from paediatric wards in Harare, Zimbabwe, once children who had been hospitalised with SAM were ready for discharge. Children were median 17.8 months old, and 28.6% had human immunodeficiency virus. Trained intervention facilitators (IFs)—lay workers whose own children had previously had SAM—delivered the intervention over 12 weeks with nurse supervision. Qualitative interviews with caregivers and IFs showed that the intervention was feasible and acceptable. Participants reported benefiting from the psychosocial support and counselling, and several started income-generating projects. Caregivers appreciated the concept of play and caregiver–child interaction, and all reported practising what they had learned. By Week 12, caregiver mental health and caregiver–child interaction improved significantly. Overall, the intervention was feasible, acceptable and showed promise in modifying caregiver knowledge, attitudes and practice. An efficacy trial is now needed to evaluate whether the intervention can improve child convalescence following complicated SAM.

Abstract Image

Abstract Image

津巴布韦儿童游戏和护理人员支持促进严重急性营养不良后的康复:Tamba-SAM 试点研究
因严重急性营养不良(SAM)而住院治疗的儿童死亡率很高,出院后复发和再次住院的风险也很高。目前的治疗方法无法促进康复,也无法解决严重急性营养不良的潜在社会决定因素,这意味着无法恢复长期健康、生长和神经发育。尽管指南建议通过游戏和刺激来促进康复,但大多数护理人员在家中并没有得到这方面的支持。我们着手评估了一套经编码设计的干预方案的可行性和可接受性,该方案旨在通过游戏为儿童提供刺激,并通过解决问题的技能、同伴支持和创收活动来增强照顾者的能力。我们分两个阶段对干预措施进行了评估,在津巴布韦哈拉雷儿科病房招募了 30 对照顾者-儿童组合,他们都是因患严重急性呼吸系统综合症住院治疗的儿童,即将出院。儿童的中位年龄为 17.8 个月,28.6% 的儿童感染了人类免疫缺陷病毒。经过培训的干预促进者(IFs)--自己的孩子曾经患过萨姆病的铺路工人--在护士的监督下进行了为期 12 周的干预。对护理人员和干预促进者的定性访谈表明,干预是可行的,也是可以接受的。参与者报告说,他们从心理支持和咨询中受益匪浅,一些人还开始了创收项目。照护者对游戏和照护者与儿童互动的概念表示赞赏,所有照护者都报告说他们正在实践所学到的东西。到第 12 周时,照顾者的心理健康和照顾者与儿童的互动有了显著改善。总体而言,该干预措施是可行的、可接受的,并有望改变照顾者的知识、态度和做法。现在需要进行一项疗效试验,以评估该干预措施是否能改善复杂性萨姆病后的儿童康复情况。
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来源期刊
Maternal and Child Nutrition
Maternal and Child Nutrition 医学-小儿科
CiteScore
7.70
自引率
8.80%
发文量
144
审稿时长
6-12 weeks
期刊介绍: Maternal & Child Nutrition addresses fundamental aspects of nutrition and its outcomes in women and their children, both in early and later life, and keeps its audience fully informed about new initiatives, the latest research findings and innovative ways of responding to changes in public attitudes and policy. Drawing from global sources, the Journal provides an invaluable source of up to date information for health professionals, academics and service users with interests in maternal and child nutrition. Its scope includes pre-conception, antenatal and postnatal maternal nutrition, women''s nutrition throughout their reproductive years, and fetal, neonatal, infant, child and adolescent nutrition and their effects throughout life.
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