- 作者：Michael J. Boivin ; Paul Bangirana ; Noeline Nakasujja ; Connie F. Page ; Cilly Shohet ; Deborah Givon ; Judith K. Bass ; Robert O. Opoka ; Pnina S. Klein
- 关键词：CAI ; Childhealth Advocacy International ; CBCL ; Child Behavior Checklist ; COAT ; Color-Object Association Test ; HAART ; Highly active anti-retroviral therapy ; HOME ; Home observation for measurement of the environment ; HSCL-25 ; Hopkins Symptoms Checklist 25-item ; MELS ; Mullen Early Learning Scales ; MISC ; Mediational intervention for sensitizing caregivers ; MSU ; Michigan State University ; OMI ; Observing mediational interactions ; RM-ANCOVA ; Repeated-measure ANCOVA ; UCOBAC ; Uganda Community Based Organ
- 刊名：The Journal of Pediatrics
- 出版年：November, 2013
- 年：2013
- 卷：163
- 期：5
- 页码：1409-1416.e5
- 全文大小：821 K
Objective
To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls.Study design
Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist.
Results
Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year.
Conclusions
MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home.