Epidemiology

Research CritiqueIntroduction , Objectives and HypothesisThe search reading entitled Effectiveness of an educational encumbrance delivered through with(predicate) the wellness services to improve feed in young kidskinren : a cluster-randomised envisionled trial was deviseed and assessed by Mary Penny , Hilary Creed-Kanashiro , Rebecca Robert , M Narro , Laura Caulfield , and Robert Black . The was authored by cognise professionals from the Johns Hopkins School of Public Health and published by The shaft , an international peer-reviewed journal specializing in wellness check issues and practicesThe primary physical object of the is to restrict the potential benefit of wellness-service educational interpolation in improving the wellness and avoiding malnutrition and stunted harvesting among young small fryren . The piece of work too aims to situate the impressiveness of much(prenominal)(prenominal) intervention in eliminating or reducing morbidity ca utilize by malnutrition . Other objectives argon to raise the quality of health facilities and child-oriented programs and counseling not nevertheless in the said knowledge do primary(prenominal) exactly also to early(a) similar locationsThe prove was conducted based on the surmisal that gain in nutrition education through the improvement of health facilities and services stop reduce the prevalence of stunted gain in childhood and can lead to improved victuals practices of the cargongivers which can help prevent malnutrition among young children . Relatively , there may be available resources and sufficient nourishment in particular argonas but c argivers and p argonnts lack knowledge or has heathenish beliefs that hinder them in providing comme il faut nutrition to their children , thus usurp advice and educational interventions argon essential . Such hypotheses are pen with earlier studies such(prenominal) as the ones conducted by Allen and Gillespie in 2001 , by Caulfield et al in 1999 and by Gulden et al in 2000Method and Research DesignThe ask was conducted in an urban area specific each(prenominal)y in shanty areas of Trujillo , a city in Peru . The nation in the target location is characterized by low incomes , despicable ho exploitation and lack access to essential services such as sewage disposal , electricity supply and pee system However , the area has access to nutritionary and adequate solid food as well as to health facilities resultd by its government . The area was chosen due to anemia and ripening faltering problems in the said area that resulted to stunted harvest-time among childrenThe intervention was conducted by becoming a part of the brisk children-oriented programs of the regional health authority . It was approved by particular health authorities of the country which also take partd and assisted in conducting the canvassSamples involved in the study are of both types : the participate health facilities and the combat-ready children aged 0- 18 months . Children specimens were gathered by calling pregnant women through house to house census . in that respect were 791 pregnant women identified in the area and when their babies were born they were invited to participate in the study but only 377 wanton it to the memorandum due to the sample surface requirement . Babies with congenital malformations and those with unsoundness which can put in the issue of the corrupt were also excluded from the sample . This 377 were divided into two multitudes : the intervention aggroup or those who be facilities with nutritional counseling intervention and the control group or those who attended facilities which continued providing routine health services . The caregivers of the samples were interviewed and visited at regular intervals until the children reached 18 months . They were also provided nutritional counseling such as food preparation demonstrations , messages almost what nutritional foods that should be given to their children at particular ages , and recommended the dietary stirring by suggesting the type of foods that should be include in the children s dietBasically , the intervention valued to enhance the existing programs and practices of the health facilities in the target area , thus those facilities with the identical characteristics were chosen . Such facilities include health centers with available checkup staff eternally on responsibility community hospitals which offer maternal and perinatal service , and health posts with more limited services . All in all there were twelve facilities involved in the study 6 for the intervention group and six-spot for the control group . These six facilities include : one community hospital , triad health posts , and two health centers . Health facilities were paired to the community depending on services offered . The intervention did not include training of the medical staff and health facilitator because according to the author , it would be separate to integrate the intervention to the existing programs of the facilities which can be endlessly implement rather than educating the staff that might leave the facilities in the near futureThe search study involved 377 samples : 187 infants for the intervention group and 190 from control areas . From this , it can be viewed that the program of the study is randomized and comparative . That is , information obtained from the intervention group are compared and contrasted from the selective information from the control group or for those who utilise health facilities which were not given educational interventions . The design of the study has been effective in determining the effects of educational interventions by depicting the differences among the two group samples . Through comparisons , the advantages of having educational interventions in health facilities were easily identified . Systematic bias was also minify by standardizing data collection while interviews were structured in such a way of life that interviewees did not get to always interview the same samples . The sample size seems to be seemly for the research study although the study alone is not nice to generally conclude that educational interventions generates positive effect in all cities or countries similar with similar characteristics with that of Trujillio or Peru . This is because health facilities and the services offered they offered as well as the programs and practices world implemented differ from one location to anotherMeasurementsThe study aims to help eliminate growth stunt among young children thus the primary progeny of the study was growth which was thrifty by burden unit , aloofness and Z scores for weight-for-age and length-for-age at age 18 months (Penny et al , 2005. 1865 . Fieldworkers who were trained and standardized according to the WHO guidelines measured the weight of the children at each visit employ clock balances accurate to ascorbic acid grams while length was measured using stadiometers accurate to 0 .1 cm (p . 1865 Length -for-age and weight-for-age outcomes helped determine if children suffer from malnutrition by analyze the measured data to the standard height and weight of Peruvian children at specific ages . Such measurement also mulish the differences amongst the length-for-age and weight-for age of children in the intervention and control groups to identify which among the children wealthy person taken enough food for thoughts that will help them light upon the length and weight assume for their ageTo be able to identify the differences between the two study groups , the supplementary research manner acting used to gather data was interview . During the interview , questions asked were more on the ply practices to determine the awareness of the proper nutrition practices that should be practiced . Questions include (1 ) what foods or liquids does a baby need for the beginning months (2 ) how can a mother gravel more breast milk (3 what do you do if the child has collie or gases (4 ) name three foods that you think are the shell for infant 7 to 8 months old (5 ) when you give the main meal to a child , what is the food you give first and (6 what would you do if the child does not want to eat (p . 1867 . The same questions were asked at different intervals to two the intervention and control groups . selective information needed here are the number of correct answers to determine how the caregivers consume learned from the educational intervention . As expect , there were more correct answers from the intervention group than the control group by the end of the study periodThrough the interview , primal information such as the family composition and the socioeconomic given of the family and other information that have significance on the provide practices . A standardized , structured-observation technique was also used to compensate assess home hygiene of the family visited that may affect food preparation of the caregivers . Trained nutritionists were also part of the interview function . They estimated dietary intakes of the participants using quantitative 24-h draw off . A 24-h recall is a method of bar the dietary intake of an person through an interview requiring the participant to recall and report the food taken during the past 24 hours (Trabulsi Schoeller , 2001.E892 . The 24-h recall is commonly utilized in large population studies and can provide lucubrate information approximately foods consumed . Such details include the weight sizes , portion and ingredients of the meal served to children which have significance on the amount of money of nutrients taken by the children and can also be used to analyze the feeding practices of the caregivers . These data were used and compared to the recommended daily intake for children ate specific agesGenerally , the procedures used by the study are appropriate and reliable . First , interviews can be the surpass method on gathering data to be measured and analyzed as dictated by the research design of the study . Direct contact and communication on the samples is the easiest way to gather data and to evaluate the conditions of the sample Secondly , measuring the weight and the length of the children is the only way to obtain undeniable data most-valuable in evaluating and comparing the growth of the participants at specific intervals . Lastly , the 24-h recall is appropriate for large population studies bid this study and it was easy to use even if the respondents are not very educated However , 24-h recall can be subjected to bias reporting . That is , the respondents may not provide very accurate information but a full estimate of the trained nutritionists can already addressed such biasResults and FindingsUsing the above mentioned measurements , results obtained led to the determination of the following information (1 ) growth changes of children in both the intervention and control groups (which group has the lesser number of children with stunted growth and (2 ) knowledge obtained by participating caregivers from the intervention (did the caregivers showed desirable feeding practices resulting to adequate energy and nutrient intakeAll the data needed to provide reliable and convincing closing were presented in the study using graphs , figures and bows . Individual data about each participant such as length , weight and feeding practices do not need to be included in the report . Only the summary and evaluated data are included . For example , the answers of caregivers to the questions during the interview were summarized in tabulate 2 while the length-for-age and weight-for-age data can be easily prepare and analyzed using figure 3For the primary outcomes which should be the child growth during the 18 month period were calculated for 95 CI and bodily measures were converted to z scores using reference values to obtain the correspond weight soused height , mean z scores weight , mean z score length and other data for both the intervention and control . Results for the two groups were compared by calculating their differences both adjusted and adjusted as shown in table 4 . It was ground out that there are lesser children who go through stunting growth at 18 months in the intervention group than in the control group . Data were also analyzed using the SPSS version 10 Socioeconomic data obtained from visiting the participants were analyzed using the principal-component analysis , resulting to identification of three clusters of associated variables : housing , possessions , and educational level of parents (Penny et al , 2005 ,. 1865Data in table 4 are also discussed and can be back up by data about the energy and nutrient intakes from completing foods shown in figure 2 which were obtained using the 24-h recall method . Food intakes obtained from the 24-h recall were converted to nutrient using the Peruvian food-composition tables . Figure 2 shows that dietary energy and dietary surface intake from complementary foods and animal source were significantly higher(prenominal) for the intervention group compared to that of the control group .

These results mean that , averagely , children in the intervention group receive more energy and nutrients than the children in the control groups . Relatively , nutrient intake is very definitive for children growth , which may explain why there are more children with stunted growth in the control group than in the intervention group . The study also found out that there were more caregivers who have been including energy heavy(a) food to their children s meal aside from breastfeeding and thick preparations due to the nutritional advice they received from health centers as early as afterward giving birth as shown in table 3 . This reflects that there were more caregivers who have been educated and consequently utilize what they learned from the interventionThe results and fingerings have proven that the authors hypothesis that educational intervention can lead to minimized stunting growth among children . The hypothesis that the intervention can also lead to better age-specific feeding practices and nutrient intake were also proven by the research study . The study used graphs and tables whenever appropriate . There were about nine graphs and tables in the report which were very helpful in interpretation and understanding of data . However there are data that would be very hard to be soundless by non-medical individuals therefore , the results and findings of the study can be crush interpreted and used in further studies by medical practitioners medical students , nurses and nutritionistsConclusions and ImplicationsThe conclusions and implications of the study were covered in the word of honor element of the report . The study successfully achieved its objectives which are to show that enduringness of educational intervention at health facilities and to identify the benefits of such interventions . The authors based their conclusions primarily on the findings and results of the research study itself and secondary on the two other similar studies conducted in china and India . According to the authors themselves , the strength of the study is mainly its randomized design that reduced intervention contamination and sufficient sample size powerful enough to test the hypothesis (p . 1870The authors also concede the weakness of their research study That is , the study might have just about bias that may be obtained from dietary-recall data using 24-h recall but have no significant effect on the weight and height measurements which are considered to the primary outcomes of the study . Limitation of the study was also acknowledged which were the socioeconomic differences between families in the intervention and control groups that could have affected the growth outcomes . However , the authors indicated that they developed and used a predefined analysis cast and have adjusted the differences in growth between the two groups in the multivariate analysis to address the identified limitation . The authors suggest that further studies should be conducted to be able to determine and evaluate the sustainability and the generalizability of the intervention strategy to Peru or to other evolution countriesSummary CritiqueThe word can be best analyzed by identifying its strengths and weaknesses . One of the strong points of the article is having completely described the hypotheses of the research as well as the methodology sample , statistical analysis , discussions , and limitations reflecting that the research is highly organized . The authors also have provided a straightforward of what they are trying to accomplish in their research . The title of the research alone strongly suggests right ahead what the research study was aboutAnother strong point of the article is its introduction . The introduction very well justified the importance of the study . The s of past studies like the studies mentioned are a very effective way of introducing the . Such introduction suggests that the study has relevance on past research thus important to be conducted However , the method , as well as the results is very technical in nature aside from being two wordy that only medical professionals will find it interesting and informational although the study is also important on non-medical professionals like pregnant women , lactating mother and caregiversThe research also uses think research studies as references from reputable medical and nutrition journals : articles from the universe of discourse Health Organization , Food feeding Bulletin , journal of Nutrition , the Lancet American Journal of Clinical Nutrition , JAMA , and others . The use of such reputable references makes the study reliable and super . It is also noticeable that although the authors are medical professionals themselves , any claims they make have strong theoretical basis and are indite to earlier studies . Additionally , the statistical method used is appropriate with a comparative study like this . The statistical data in the table shows important variables that are directly cogitate to the objective of the study . All data in the table are discussed and explained no irrelevant data is provided in the studyThe authors did not provide a separate part for their conclusion but as the discussion is read , it is noticeable that their conclusions are already included in the discussion of the findings , which only means that the conclusions are appropriate for the study . The discussion of the results is also backed up by references to make the explanation of the findings more reliable . The authors acknowledge the limitations and weaknesses of the study . However , the limitation statement is confusing because it declared its limitation but also added a statement that insinuating that the study s limitation was already solvedNevertheless , the study was carried out effectively , with some weaknesses that did not affect the effectiveness and importance of the research . The discussion is logically ed , making the study a just a reference for future studiesReferencesPenny , M , Kanashiro , H , Robert , R , Narro , M , Caulfield , L . and Black , Robert (2005Effectiveness of an educational intervention delivered through the health servicesto improve nutrition in young children : a cluster-randomised controlled trialThe Lancet Volume 365 , 1863-72Trabulsi , Jillian and Schoeller , Dale (2001 ) Evaluation of dietary assessment instrumentsagainst in two ways labeled water , a biomarker of habitual energy intakeAm J Physiol Endocrinol Metab 281 : E891-E899 ...If you want to get a full essay, order it on our website: Orderessay

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