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Effects of psychosocial stimulation on growth and development of severely malnourished children in a nutrition unit in Bangladesh

European Journal of Clinical Nutrition volume 63, pages 725–731 (2009)Cite this article

Abstract

Background/Objectives:

Young children with severe malnutrition usually have poor mental development. Psychosocial stimulation may reduce their cognitive deficit, but it is not usually provided. The aim of the study was to incorporate stimulation into the routine treatment of severely malnourished children in a nutrition unit and evaluate the impact on their growth and development.

Design:

Time-lagged controlled study.

Setting:

Nutritional Rehabilitation Unit (NRU) in ICDDR,B Dhaka Hospital.

Methods:

Severely malnourished children, aged 6–24 months, admitted to the NRU were enrolled. All received standard nutritional care. A control group of 43 children was studied initially, followed by an intervention group of 54 children. The intervened mothers and children participated in daily group meetings and individual play sessions for 2 weeks in hospital and were visited at home for 6 months. Children's growth was measured and development assessed using the Bayley Scales of Infant Development.

Results:

Twenty-seven children were lost to the study. In the remaining children, both groups had similar developmental scores and anthropometry initially. After 6 months, the intervention group had improved more than the controls did by a mean of 6.9 (P<0.001; 95% CI: 3.9, 10.0) mental and 3.1 (P=0.024; 95% CI: 0.4, 5.7) motor raw scores and a mean of 0.4 (P=0.029; 95% CI: 0.1, 0.8) weight-for-age z scores, controlling for background variables.

Conclusion:

Psychosocial stimulation integrated into treatment of severely malnourished children in hospital, followed by home visits for 6 months, was effective in improving children's growth and development and should be an integral part of their treatment.

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Acknowledgements

The study was supported by the Swedish International Development Cooperation Agency (Sida/SAREC). ICDDR,B acknowledges with gratitude the commitment of Sida/SAREC to the Centre's research efforts. We thank the children and parents who participated in the study; Ms Fahmida Khatun (psychologist), Ms Afroza Parveen (tester), Ms Jasmin Akhter (interviewer), Ms Parveen Sultana (stimulation supervisor), Ms Nurjahan Begum, Ms Hosne Ara Begum, Ms Kazi Sufia and Ms Selina Begum (play leaders), staff of NRU of ICDDR,B and Ms Shireen Ali for secretarial assistance.

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Authors and Affiliations

  1. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh

    B Nahar, J D Hamadani, T Ahmed, F Tofail & A Rahman

  2. International Maternal and Child Health, Uppsala University, Uppsala, Sweden

    B Nahar

  3. Institute of Nutrition and Food Science, Dhaka University, Dhaka, Bangladesh

    S N Huda

  4. Centre for International Health and Development, Institute of Child Health, University College London, London, UK

    S M Grantham-McGregor

Authors
  1. B Nahar
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  2. J D Hamadani
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  3. T Ahmed
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  4. F Tofail
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  5. A Rahman
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  6. S N Huda
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  7. S M Grantham-McGregor
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Corresponding author

Correspondence to J D Hamadani.

Additional information

Guarantors: T Ahmed and JD Hamadani.

Contributors: The hypothesis was developed by SGM. TA, JDH, BN and SGM contributed to the development of the protocol. The fieldwork was supervised by BN, FT, JDH, SNH and conducted by AR with the help of other supporting staff. BN, JDH, FT and SGM did the statistical analysis. BN wrote the first draft and coordinated completion of the paper with JDH and SGM. JDH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors critically commented on and edited earlier drafts and approved the final version of the paper.

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Nahar, B., Hamadani, J., Ahmed, T. et al. Effects of psychosocial stimulation on growth and development of severely malnourished children in a nutrition unit in Bangladesh. Eur J Clin Nutr 63, 725–731 (2009). https://doi.org/10.1038/ejcn.2008.44

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  • DOI: https://doi.org/10.1038/ejcn.2008.44

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