Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial

Teklu Gemechu Abessa, Berhanu Nigussie Worku, Mekitie Wondafrash, Tsinuel Girma, Johan Valy, Johan Lemmens, Liesbeth Bruckers, Patrick Kolsteren, Marita Granitzer, Teklu Gemechu Abessa, Berhanu Nigussie Worku, Mekitie Wondafrash, Tsinuel Girma, Johan Valy, Johan Lemmens, Liesbeth Bruckers, Patrick Kolsteren, Marita Granitzer

Abstract

Background: The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM.

Method: Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital. The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations.

Results: The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes.

Conclusion: Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available.

Trial registration: The trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) # NCT03036176 .

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of sample enrolled and finally analyzed
Fig. 2
Fig. 2
Developmental, linear growth and nutritional outcomes among the control and intervention SAM children during follow-up measurements (Figures were based on the basic GEE model comprising treatment, time (as indicator variable) and interaction between time and treatment)

References

    1. WHO. World Health Statistics 2016: monitoring health for the SDGs, sustainable development goals. World Health Organization; 2016. .
    1. Central Statistical Agency [Ethiopia] 2016 . ETHIOPIA Demographic and Health Survey 2016. Addis Ababa and Rockville: CSA and ICF; 2016.
    1. Martorell R. Early child development: investing in our children’s future. 1997. Undernutrition during pregnancy and early childhood and its consequences for cognitive and behavioral development; pp. 39–83.
    1. Heaver R. Strengthening country commitment to human development: lessons from nutrition. Washington DC: The World Bank; 2005.
    1. Martorell R, Nguyen P. Nestlé Nutrition workshop series Pediatric program. Vevey; Philadelphia: Nestec; Lippincott Williams & Wilkins, c1999; 2010. Interrelationship between growth and development in low and middle income countries; pp. 99–121.
    1. Roseboom TJ, Painter RC, AFMv A, Veenendaal MVE, SRd R. Hungry in the womb: what are the consequences? Lessons from the Dutch famine. Maturitas. 2011;70(2):141–145. doi: 10.1016/j.maturitas.2011.06.017.
    1. Prado EL, Dewey KG. Nutrition and brain development in early life. Nutr Rev. 2014;72(4):267–284. doi: 10.1111/nure.12102.
    1. Santos DN, Assis AMO, Bastos ACS, Santos LM, Santos CAS, Strina A, Prado MS, Almeida-Filho NM, Rodrigues LC, Barreto ML. Determinants of cognitive function in childhood: a cohort study in a middle income context. BMC Public Health. 2008;8:202. doi: 10.1186/1471-2458-8-202.
    1. Black RE, Victora CG, Walker SP, Bhutta PZA, Christian PP, Md O, Ezzati M, Grantham-McGregor S, Katz PJ, Martorell PR, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–451. doi: 10.1016/S0140-6736(13)60937-X.
    1. Grantham-McGregor SM, Fernald LCH, Kagawa RMC, Walker S. Effects of integrated child development and nutrition interventions on child development and nutritional status. Ann N Y Acad Sci. 2014;1308:11–32. doi: 10.1111/nyas.12284.
    1. Aboud FE, Yousafzai AK. Global health and development in early childhood. Annu Rev Psychol. 2015;66(1):433–457. doi: 10.1146/annurev-psych-010814-015128.
    1. Daniel AI, Bandsma RH, Lytvyn L, Voskuijl WP, Potani I, Mvd H. Psychosocial stimulation interventions for children with severe acute malnutrition: a systematic review. J Glob Health. 2017;7(1):010405. 10.7189/jogh.07.0104051.
    1. WHO: Mental health and psychosocial well–being among children in severe food shortage situations. In., vol. WHO/MSD/MER/06.1: Department of Mental Health and Substance Abuse (MSD) mental health: Evidence and Research (MER); 2006.
    1. WHO . Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: World Health Organization; 1999.
    1. Guideline: updates on the management of severe acute malnutrition in infants and children []. Accessed 21 June 2017.
    1. Ashworth A, Khanum S, Jackson A, Schofield C. Guidelines for the inpatient treatment of severely malnourished children. Geneva: World Health Organization; 2003.
    1. Nahar B, Hamadani J D, Ahmed T, Tofail F, Rahman A, Huda S N, Grantham-McGregor S M. Effects of psychosocial stimulation on growth and development of severely malnourished children in a nutrition unit in Bangladesh. European Journal of Clinical Nutrition. 2008;63(6):725–731. doi: 10.1038/ejcn.2008.44.
    1. Nahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson L-A. Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur J Clin Nutr. 2012;66:701–709. doi: 10.1038/ejcn.2012.13.
    1. Nahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson L-A. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh. BMC Public Health. 2012;12:622. 10.1186/1471-2458-12-622.
    1. Chamois S, Golden M, Grellety Y. Ethiopia protocol for the management of severe acute malnutrition. Addis Ababa: Ethiopian Federal Ministry of Health; 2007.
    1. Hamill PVV, Drizd TA, Johnson CL, Reed RB, Roche AF. NCHS growth curves for children birth-18 years. USA: National Center for Health Statistics; 1977.
    1. Frankenburg WK, Dodds JB, Archer P, Shapiro H, Bresnick B. Denver II training manual. Denver: Denver Developmental Materials, Inc; 1992.
    1. Frankenburg Wk,Dodds JB, Archer P, Shapiro H, Bresnick B. Denver II Technical Manual. Denver, Co, USA.: Denver Developmental Materials, Inc; 1992.
    1. Klein Pnina S. Promoting flexibility in young children’s mind within the family — A cross cultural view. International Journal of Early Childhood. 1987;19(2):51–60. doi: 10.1007/BF03174541.
    1. Klein Pnina S. Improving the quality of parental interaction with very low birth weight children: A longitudinal study using a Mediated Learning Experience model. Infant Mental Health Journal. 1991;12(4):321–337. doi: 10.1002/1097-0355(199124)12:4<321::AID-IMHJ2280120406>;2-Z.
    1. Klein Pnina S. Early Intervention. 2014.
    1. Feuerstein R, Klein PS, Tannenbaum AJ. Mediated learning experience (MLE) : theoretical, psychosocial and learning implications. Tel Aviv: Freund Publishing House LTD; 1999.
    1. Abessa TG, Worku BN, Kibebew MW, Valy J, Lemmens J, Thijs H, Yimer WK, Kolsteren P, Granitzer M. Adaptation and standardization of a Western tool for assessing child development in non-Western low-income context. BMC Public Health. 2016;16:652. doi: 10.1186/s12889-016-3288-2.
    1. WHO Expert Committee . Physical status : the use of and interpretation of anthropometry, report of a WHO expert committee. Geneva: World Health Organization; 1995.
    1. WHO . WHO Anthro software (version 3.2.2, January 2011) and macros. Geneva: WHO Anthro; 2011.
    1. StataCorp. Stata Statistical Software: Release 12. College Station: StataCorp LP; 2011.
    1. Eklund M, Girma T. Effectiveness of integrated outpatient care of severe acute malnutrition in Ethiopia. In: Field exchange: ENN; 2008. p. 7.
    1. Yebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigray, northern Ethiopia: a retrospective cohort study. PLoS One. 2013;8(6):e65840. doi: 10.1371/journal.pone.0065840.
    1. Powell C, Grantham-McGregor S. Home visiting of varying frequency and child development. Pediatrics. 1989;84(1):157–164.
    1. Wallander JL, Biasini FJ, Thorsten V, Dhaded SM, DMd J, Chomba E, Pasha O, Goudar S, Wallace D, Chakraborty H, et al. Dose of early intervention treatment during children’s first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries. BMC Pediatr. 2014;14:281. doi: 10.1186/1471-2431-14-281.
    1. Gardner J, Walker S, Powell C, Grantham-McGregor S. A randomized controlled trial of home-visiting intervention on cognition and behavior in term low birth weight infants. J Pediatr. 2003;143:634–639. doi: 10.1067/S0022-3476(03)00455-4.
    1. Grantham-McGregor S. A review of studies of the effect of severe malnutrition on mental development. J Nutr. 1995;125(Supplement):2233S–2238S. doi: 10.1093/jn/125.suppl_8.2233S.
    1. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. Br J Med. 2006;333(7566):472. doi: 10.1136/bmj.38897.555208.2F.
    1. Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. Lancet. 2005;366(9499):1804–1807. doi: 10.1016/S0140-6736(05)67574-5.
    1. Chang SM, Walker SP, Grantham-McGregor S, Powell CA. Early childhood stunting and later behaviour and school achievement. J Child Psychol Psychiatry. 2002;4(36):775–783. doi: 10.1111/1469-7610.00088.
    1. Grantham-McGregor SM, Walker SP, Chang SM, Powell CA. Effects of early childhood supplementation with and without stimulation on later development in stunted Jamaican children. Am J Clin Nutr. 1997;66(2):247–253. doi: 10.1093/ajcn/66.2.247.
    1. Grantham-McGregor S, Schofield W, Powell C. Development of severely malnourished children who received psychosocial stimulation: six-year follow-up. J Pediatr. 1987;79(2):247–254.
    1. Grantham-McGregor S, Powell C, Walker S, Chang S, Fletcher P. The long-term follow-up of severely malnourished children who participated in an intervention program. Child Dev. 1994;65:428–439. doi: 10.2307/1131394.
    1. Grantham-McGregor S, Schofield W, Harris L. Effect of psychosocial stimulation on mental development of severely malnourished children: an interim report. Pediatrics. 1983;72(2):239–243.
    1. Abessa TG, Bruckers L, Kosteren P, Granitzer M. Developmental performance of hospitalized severely acutely malnourished under-six children in low- income setting. BMC Pediatr. 2017;17:197. doi: 10.1186/s12887-017-0950-5.

Source: PubMed

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