The Impact on Child Wasting of a Capacity Building Project Implemented by Community and District Health Staff in Rural Lao PDR

寮國是一個低收入且糧食缺乏的國家，特別在高原地區營養不足情況嚴重。在沙灣拿吉省高地的12個村莊，實施一項為期三年的健康營養計畫，目的是減少此地區的兒童急性營養不良。各村莊的營養志工團隊監測兒童成長及推動健康哺餵。多部門地區委員會每月巡迴各村莊，評量兒童生長情形、處置急性營養不良與提供初級健康照護保健服務。在計畫執行前後分別進行一項橫斷型評估。基線評估是隨機抽取60%家戶；而終線評估目標是調查所有合格登記的參與者。6－59月的兒童進行體位測量；詢問有12個月以下兒童的母親，其哺餵嬰兒的方式、產前與產後之照護；記錄0－23月兒童的疫苗接種情況。基線取樣721個家戶；而終線評估在不同年齡組有82%－100%參與者被調查。急性營養不良由12.4%（95% CI：10.4－14.3）減少至6.1%（95% CI：4.9－7.3）。不健康的哺餵行為降低：在2008年，新生兒出生2小時內進行餵母乳的母親佔40.4%（34.7－45.3），而摒棄初乳的母親佔30.8%（25.7－35.8）；在2011年，二者比例分別為72%和8%。孕產婦保健和兒童疫苗接種的覆蓋率也提高。改善醫療衛生環境與幼兒哺餵方法，明顯降低兒童發育不良。不安全的哺餵方式雖然常見，但社區為基礎的營養團隊，能即時促以改善。

關鍵字

發育不良；急性營養不足；寮國；健康能力建構；哺餵行為

並列摘要

Laos is a low-income food-deficit country with pockets of high levels of wasting in the highland areas. We implemented a 3-year health/nutrition project in 12 villages in the highlands of Savannakhet province to reduce acute malnutrition in children. Volunteer nutrition teams in each village monitored child growth and promoted healthy feeding practices; a multisectoral district committee conducted monthly outreach to assess child growth, manage acute malnutrition and deliver primary health care services. We conducted a cross-sectional assessment before project activities began and at the end of the project. The baseline survey randomly sampled 60% of all households; the endline assessment aimed to survey all eligible registered participants. Anthropometric measures were taken from children aged 6-59 months; mothers with children aged ＜12 months were asked about infant feeding practices, antenatal and post-partum care; and child immunizations were recorded for children aged between 0-23 months. At baseline, 721 households were sampled, while the endline assessment surveyed between 82% and 100% of eligible participants in each age group. Acute malnutrition reduced from 12.4% (95% CI: 10.4-14.3) to 6.1% (4.9-7.3). Unhealthy feeding practices declined: in 2008, 40.0% (34.7-45.3) of mothers breastfed their newborn within 2 hours of birth and 30.8% (25.7-35.8) threw the colostrum away; in 2011, these figures were 72% and 8% respectively. Maternal care and child immunisation coverage also improved. Improving the health environment and child feeding practices appears to have markedly reduced the level of wasting. Unsafe feeding practices were common but readily changed by the community-based nutrition teams.

並列關鍵字

wasting ； acute malnutrition ； Laos ； capacity-building ； feeding behaviours

參考文獻

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國際替代計量

The Impact on Child Wasting of a Capacity Building Project Implemented by Community and District Health Staff in Rural Lao PDR

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