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Interventions and public health nutrition

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=507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS+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=0.037, effect size=0.37 s.d.) and weight-for-age Z-score (group*session interaction P=0.02, effect size=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.

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Acknowledgements

The study was funded by Sida/SAREC, Sweden and supported by ICDDR,B and its donors, which provide unrestricted support to the Centre for its operations and research. Current donors providing unrestricted support include: the Australian Agency for International Development (AusAID), Government of the People's Republic of Bangladesh, Canadian International Development Agency (CIDA), Embassy of the Kingdom of the Netherlands (EKN), Swedish International Development Cooperation Agency (Sida), Swiss Agency for Development and Cooperation (SDC) and Department for International Development (DFID), UK. We sincerely appreciate these donors for their support and commitment to the Centre's research efforts. The study was also supported by the International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Sweden. We sincerely appreciate the secretarial assistance of IMCH staffs. We gratefully acknowledge the study participants, their parents and family members and all the staff of research team.

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Correspondence to B Nahar.

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Nahar, B., Hossain, M., Hamadani, J. et al. Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur J Clin Nutr 66, 701–709 (2012). https://doi.org/10.1038/ejcn.2012.13

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Keywords

  • malnutrition
  • community-based intervention
  • psychosocial stimulation
  • food supplementation
  • Bangladesh
  • children

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