Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

Abstract

Malnutrition impairs cognitive, communication, and motor development, but it is not known how nutrition and health are associated with development in children with moderate acute malnutrition (MAM). We aimed to describe motor and language development of children with MAM and explore its nutrition and health‐related correlates. This cross‐sectional study used baseline data from a nutritional trial in children with MAM aged 6–23 months in Burkina Faso. Motor and language skills were assessed using the Malawi Development Assessment Tool (MDAT). Linear mixed models were used to explore potential correlates of MDAT including socio‐economic status, anthropometry, body composition, whole‐blood polyunsaturated fatty acids (PUFA), haemoglobin (Hb), iron status, and morbidity. We also assessed child and caregiver participation during MDAT procedures and their associations with correlates and development. MDAT data were available for 1.608 children. Mean (95% CI) MDAT z‐scores were −0.39 (−0.45, −0.34) for gross motor, 0.54 (0.48, 0.59) for fine motor, and −0.91 (−0.96, −0.86) for language skills. Children with higher mid‐upper arm circumference, weight‐for‐height, height‐for‐age, fat‐free mass, n‐3 PUFAs, Hb, and iron status had better MDAT z‐scores, whereas children with more fat mass index, anaemia, illness, and inflammation had poorer z‐scores. In addition, children living in larger households or with an unmarried mother had poorer MDAT z‐scores. Associations between morbidity and z‐scores were largely explained by children's poorer participation during MDAT assessment. The identified factors associated with child development may inform interventions needed to stimulate development during or after management of MAM.

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“…The main strengths of our study are the randomised factorial design and the large study sample with low attrition and high degree of data completeness. Furthermore, we assessed motor and language development using a well-validated tool with high inter-and intra-rater reliability and sensitivity in our study setting [17] and predictive validity for later school performance shown from other settings [27]. It is also a strength that our study included analyses of effects by sex and whether effects were sustained post-supplementation, which are rarely reported from nutritional trials.…”

“…The high rates of malnutrition among children in the study setting were likely due to inadequate dietary intake and diversity [15] as well as a high prevalence of disease. As we have reported previously, morbidity was very common in the study population with 38% of children recently ill at the time of recruitment and 40% having a positive malaria test on the day of baseline assessment [17]. During the study, ALIMA was implementing a nutrition program in collaboration with local nongovernmental organisations (NGOs) and the Ministry of Health, in which they supported government health structures in the treatment of severe acute malnutrition (SAM).…”

“…Child development was assessed at baseline, at the end of intervention (12 weeks), and postintervention (24 weeks) using the Malawi Development Assessment Tool (MDAT) at the study sites [23]. Adaptation, validation, and pilot testing of the tool have been reported previously [17]. We assessed the gross motor, fine motor, and language domains of the MDAT.…”

“…Cognitive functions such as problem-solving, attention, and pre-academic knowledge of numbers and letters are mainly reflected in the tool's language and fine motor domain (e.g., asking the child to find an object under a piece of cloth reflects fine motor as well as problemsolving and memory skills). Due to the young age of participants, we assessed only the first 30 items of each domain [17]. Items were rated as passed (1 point) or failed (0 point).…”

“…We calculated MDAT z-scores from a Malawian reference population of healthy non-malnourished children [23]. As previously reported [17], we imputed 4 additional items per domain in our data as reference data contained 34 items in each domain. If children had already failed 6 consecutive items during assessment, the values of imputed items were "0."…”