Background/Objective: Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children. Subjects/Methods: Severely underweight hospitalised children aged 6-24 months (n ¼ 507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS þ FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure. Results: Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group * session interaction P ¼ 0.037, effect size ¼ 0.37 s.d.) and weight-for-age Z-score (group * session interaction P ¼ 0.02, effect size ¼ 0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth. Conclusion: Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status.

Abstractssuffered from diarrhea and fever than others. Children who attended at least five of the total six scheduled follow-up visits gained more in weight, length than those who attended fewer. Conclusions Community-based service delivery, especially including supplementary food with or without psychosocial stimulation, permits better rehabilitation of greater numbers of children with MAM compared to current hospital outpatients-based care.

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