结构化营养教育对母婴和幼儿喂养（IYCF）相关知识和儿童生长的影响：印度贝拉加维城市贫民窟的随机对照试验

摘要(中文译文)

儿童营养不良在印度仍是一场严峻的公共卫生危机，在城市贫民窟人群中尤为突出，该群体中不理想的婴幼儿喂养（IYCF）实践普遍存在。母亲的知识和行为是生命最初两年膳食摄入和体格生长的首要决定因素。本研究评估了在印度贝拉加维安甘瓦迪中心接受服务的6至24月龄儿童母亲中开展结构化营养教育干预的有效性。研究开展了一项随机对照试验，从城市贫民窟安甘瓦迪中心招募了62对母婴。参与者被随机分为干预组31名（50%）和对照组31名（50%）。干预组通过PowerPoint（美国华盛顿州雷德蒙德：微软公司）演示和涵盖母乳喂养、辅食添加及膳食多样性的宣传册（小册子）接受结构化营养教育，而对照组仅接受标准宣传册。在基线和三个月随访时评估母亲的知识、态度和实践（KAP）以及儿童人体测量指标（体重、身高、上臂中围{MUAC}）。基线时，两组在社会人口学和营养指标方面具有可比性。干预后，干预组的知识评分（16.29±3.34）显著高于对照组（14.16±2.40；p<0.01）。具体而言，干预组母亲对早开奶的知晓率从15名（48.4%）提高至28名（90.3%），对纯母乳喂养的知识从5名（16.1%）提高至24名（77.4%）。干预组的实践评分（19.13±1.63）显著高于对照组（17.68±1.33；p<0.01）。干预组报告的早开奶和纯母乳喂养实践从19名（62.5%）改善至31名（100%）。尽管母亲的知识和实践显著改善，但干预后两组间态度评分未见显著差异。虽然基于体重的指标未见显著差异，但干预组的身高别年龄Z评分（HAZ）仍显著优于对照组（p<0.01）。结构化的社区营养教育干预可显著提升母亲IYCF知识和实践。这些行为改善与干预组HAZ评分的稳定相关，提示有针对性的母亲教育是应对营养不良并支持贫困城市环境中生长稳定的一项可行且有效的策略。

Abstract

Child malnutrition remains a critical public health crisis in India, particularly within urban slum populations where suboptimal infant and young child feeding (IYCF) practices are prevalent. Maternal knowledge and behavior serve as the primary determinants of dietary intake and physical growth during the first two years of life. This study evaluated the effectiveness of a structured nutrition education intervention delivered to mothers of children aged six to 24 months attending Anganwadi centers in Belagavi, India. A randomized controlled trial was conducted involving 62 mother-child pairs recruited from urban slum Anganwadi centers. Participants were randomized into an intervention group of 31 (50%) participants and a control group of 31 (50%) participants. The intervention group received structured nutrition education via PowerPoint (Redmond, WA: Microsoft Corp.) presentations and handouts (pamphlets) covering breastfeeding, complementary feeding, and dietary diversity, while the control group received only standard pamphlets. Maternal knowledge, attitudes, and practices (KAP) and child anthropometric measurements (weight, height, mid-upper arm circumference {MUAC}) were assessed at baseline and at a three-month follow-up. At baseline, both groups were comparable across sociodemographic and nutritional indicators. Post-intervention, the intervention group demonstrated significantly higher knowledge scores (16.29±3.34) compared to the control group (14.16±2.40; p<0.01). Specifically, maternal awareness of early breastfeeding initiation in the intervention group increased from 15 (48.4%) to 28 (90.3%), and knowledge of exclusive breastfeeding rose from five (16.1%) to 24 (77.4%). Practice scores were significantly higher in the intervention group (19.13±1.63) than in the control group (17.68±1.33; p<0.01). Reported practices of early initiation and exclusive breastfeeding in the intervention group improved from 19 (62.5%) to 31 (100%). Although maternal knowledge and practices improved significantly, no significant post-intervention difference in attitude scores was observed between groups. While weight-based indicators showed no significant differences, height-for-age Z-score (HAZ) remained significantly better in the intervention group (p<0.01) compared to the control group. A structured, community-based nutrition education intervention significantly enhances maternal IYCF knowledge and practices. These behavioral improvements were associated with stabilized HAZ scores in the intervention group, suggesting that targeted maternal education is a feasible and effective strategy to address malnutrition and support growth stabilization in underprivileged urban settings.

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