1. The effect of play-based family-centered psychomotor/psychosocial stimulation on the recovery of severely malnourished children in Ethiopia
Teklu Gemechu Abessa1, 8*†, Berhanu Nigussie Worku 2,8, Mekitie Wondafrash 3, Tsinuel Girma 4, Jan Valy 4, Johan Lemmens 4, Liesbeth Bruckers 6, Patrick Kolsteren7 and Marita Granitzer 8†
1 Department of Special Needs and Inclusive Education, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia; 2 Department of Psychology, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia; 3 Department of Population and Family Health, Jimma University, Jimma, Ethiopia; 4 Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia; 5 Department of Healthcare, PXL University College, Hasselt, Belgium ; 6 I-Biostat, Hasselt University, Belgium; 7 Department of Food Safety and Food Quality, University of Gent, Gent, Belgium 8 REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
Background
The World Health Organization (WHO) recommends incorporating psychosocial intervention in the management of severe acute malnutrition (SAM). However, little is known about the effectiveness of the intervention in the context where access to balanced diet is not ensured. We examined whether or not family-based psychomotor/psychosocial stimulation in a low income context improves the developmental and nutritional outcomes of children with SAM.
Results
During the hospital follow-up, the performance score of the intervention group was significantly higher than that of the control on gross motor (mean difference =0.88, p<0.001, effect size=0.33 SD). During home follow-up, the intervention group performed significantly higher on fine motor (mean difference=1.09, p=0.001, effect size= 0.05 SD). Over the whole follow-up period, the intervention group performed significantly higher only in fine motor (mean difference=0.13, p=0.033, effect size= 0.22 SD). The intervention effect did not depend on age of child. On developmental outcomes that were not significant during the follow-up period, there was a trend of improvement. Duration of follow-up was a significant predictor of all the five developmental outcomes. This could indicate that the intervention would be effective in improving all developmental outcomes with a prolonged duration of follow-up. The intervention did not improve nutritional status of SAM children.
Materials and methods
SAM children under six years of age admitted to Jimma University’s Specialized Referral Teaching Hospital for medical treatment (n=339) had been randomly allocated to two groups (control=170, intervention=169). Both groups received routine medical care and nutritional rehabilitation at hospital. Only the intervention group received the psychomotor/psychosocial stimulation.
Intervention: Trained clinical nurses offered play-based stimulation using toys and attractive materials. Caregivers attended play sessions organized in a playroom, or a playroom and a playground. The caregivers practiced different stimulation techniques, and received orientation on basic child care and feeding practices. On discharge from hospital, children received simple play materials such as balls and cubes. They were visited at home three times over a period of six months follow-up. Fine motor, gross motor, language and personal social performances before start of the intervention, upon discharge from hospital and six months after discharge from hospital were measured using the Denver II adapted to the study context. Anthropometric measurements were also taken each time development was assessed. The evolution of the outcomes during the follow-up period was compared between the two groups using Generalized Estimating Equations.
Conclusions
Psychomotor/psychosocial stimulation seems to have a differential effect for gross motor and fine motor recovery, depending on whether or not it is combined with a standard dietary care. Lack of differential age effect seems to show that children beyond the “critical age period” can benefit from psychomotor/psychosocial intervention.
Copyright Colin Purrington (
Acknowledgments
Our gratitude goes to the staff at the pediatric ward of Jimma University Specialized Referral Teaching Hospital, Ethiopia; the intervention workers and nurses who walked long distances on foot during home follow-up visits to the children; all caregivers and family members who participated in the study. Our special gratitude is to Jimma University and VLIR/ Vlaamse Interuniversitaire Raad (Flemish Interuniversity Council) partnership program for funding the research project as part of a PhD scholarship.
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References
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 randomized trial. Eur J Clin Nutr; 66(6):[701-9 pp.].
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 randomized controlled trial. British Journal of Medicine. 2006;333(7566):472.
WHO. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children Geneva: WHO; 2013 [March 9, 2016]. Available from:
This is a part of a PhD research within a Child Health and Nutrition Project funded by VLIR-UOS in the context of Institutional University Cooperation between Jimma University and Association of Flemish Universities
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