Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial

Abstract

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.

Development and Evaluation of the Korean Health Literacy Instrument

“…Visits were conducted by village women in one study and female health workers in another. In addition to the home visits, in both studies mothers attended centers where there were individual play sessions (Nahar et al, 2012) or group sessions on topics concerning child development and the importance of play (Hamadani, Huda, Khatun, & Grantham-McGregor, 2006). …”

“…A few had small effect sizes, but typically effects were medium to large. Home-visiting programs benefited development in children recovering from severe malnutrition (Grantham-McGregor, Schofield, & Powell, 1987; Nahar et al, 2012); undernourished children (Grantham-McGregor, Powell, Walker, & Himes, 1991; Hamadani et al, 2006; Powell, 2004), children with iron deficiency anemia (Lozoff et al, 2010); low birth weight infants (Walker, Chang, Powell, & Grantham-McGregor, 2004), and disadvantaged children in poor communities (Powell & Grantham-McGregor, 1989; Eickmann et al, 2003; Powell, 2004; Vazir et al, 2013). The evaluations of home-visit interventions provide strong evidence that they can be successfully implemented by women who have completed only primary education or partially completed secondary education.…”

Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?

“…Preliminary results show eff ects of all three intervention packages on developmental scores com pared with control, with larger eff ect sizes among the two stimulation groups. In Bangladesh, 118 psycho social stimulation with or without food supplements among severely underweight children aged 6-24 months on discharge from hospital had an eff ect on mental development and a small eff ect on WAZ, but no additive or synergistic eff ects were noted between the two interventions. One intervention that closely ties feeding practices with child stimulation is responsive feeding.…”

“…Other trials-in India, Pakistan, and Bangladesh [116][117][118] although successful at improving child development or nutrition outcomes, or both, failed to show additive or synergistic eff ects between nutrition and stimulation interventions. In India, 116 benefi ciaries of the Integrated Child Development Services (ICDS) programme were allocated to groups receiving breastfeeding and complementary feeding counselling, or this package plus responsive feeding and psychosocial stimulation skills.…”

La medición de la calidad de los servicios de visitas domiciliarias: Una revisión de la literatura

“…Also in Bangladesh, Nahar et al (2012) studied malnourished children receiving either nutrition or play-based stimulation delivered through home visits. The authors examined a sample of 507 hospitalized, severely-underweight children between 6 months and 2 years of age.…”