1
|
Jensen CL, Sanga E, Kitt H, PrayGod G, Kunzi H, Setebe T, Filteau S, Webster J, Gladstone M, Olsen MF. Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania. PLoS One 2024; 19:e0285240. [PMID: 38722956 PMCID: PMC11081340 DOI: 10.1371/journal.pone.0285240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/15/2024] [Indexed: 05/13/2024] Open
Abstract
More than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a psychosocial stimulation programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on psychosocial stimulation would be helpful, e.g., how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant psychosocial stimulation programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.
Collapse
Affiliation(s)
- Cecilie L. Jensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erica Sanga
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Heather Kitt
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - George PrayGod
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Happiness Kunzi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Theresia Setebe
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Mwita FC, PrayGod G, Sanga E, Setebe T, Joseph G, Kunzi H, Webster J, Gladstone M, Searle R, Ahmed M, Hokororo A, Filteau S, Friis H, Briend A, Olsen MF. Developmental and Nutritional Changes in Children with Severe Acute Malnutrition Provided with n-3 Fatty Acids Improved Ready-to-Use Therapeutic Food and Psychosocial Support: A Pilot Study in Tanzania. Nutrients 2024; 16:692. [PMID: 38474820 PMCID: PMC10934689 DOI: 10.3390/nu16050692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/08/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modified ready-to-use therapeutic food and context-specific psychosocial intervention in Mwanza, Tanzania. We recruited 82 children with SAM (6-36 months) and 88 sex- and age-matched non-malnourished children. We measured child development, using the Malawi Development Assessment Tool (MDAT), measures of family and maternal care for children, and whole-blood PUFA levels. At baseline, the mean total MDAT z-score of children with SAM was lower than non-malnourished children; -2.37 (95% confidence interval: -2.92; -1.82), as were their total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. After 8 weeks of intervention, MDAT z-scores improved in all domains, especially fine motor, among children with SAM. Total n-3 and EPA levels increased, total n-6 fatty acids decreased, and DHA remained unchanged. Family and maternal care also improved. The suggested benefits of the combined interventions on the developmental and nutritional status of children with SAM will be tested in a future trial.
Collapse
Affiliation(s)
- Fredrick Cyprian Mwita
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Erica Sanga
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Theresia Setebe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Gaudensia Joseph
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Happyness Kunzi
- Mwanza Research Centre, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania; (F.C.M.); (E.S.); (T.S.); (G.J.); (H.K.)
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Melissa Gladstone
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Rebecca Searle
- Department of Women and Children’s Health, University of Liverpool, Alder Hey Children’s Hospital, Liverpool L12 2AP, UK; (M.G.); (R.S.)
| | - Maimuna Ahmed
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Adolfine Hokororo
- Department of Paediatrics, Bugando Medical Centre, Mwanza P.O. Box 1370, Tanzania; (M.A.); (A.H.)
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere University, Arvo Ylpön Katu 34, 33100 Tampere, Finland
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 2200 Copenhagen, Denmark; (H.F.); (A.B.); (M.F.O.)
- Department of Infectious Diseases, Rigshospitalet, 2100 Copenhagen, Denmark
| |
Collapse
|
3
|
Jatnika R, Agustiani H, Abidin FA, Lubis FY, Kustimah K, Febriani LV, Syahlaa S. Child Development Card (KKA) as a discriminant tool for the growth and development of stunted and normal children in Indonesia. J Public Health Res 2024; 13:22799036241231790. [PMID: 38356734 PMCID: PMC10865944 DOI: 10.1177/22799036241231790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Background Stunting is a significant concern in Indonesia, but its detection currently relies on anthropometric measurements, lacking the integration of comprehensive evaluations of child development. Therefore, the Child Development Card (KKA) serves as a valuable instrument employed to assess the growth and developmental aspects of children. Aim This research aimed to investigate the potential of KKA as a discriminative tool for distinguishing between stunted and normal children. Methods The participants consisted of 159 and 88 normal and stunted children aged 13-24 and 25-60 months. The aspects of children's development examined included passive communication, social behavior, gross motor skills, active communication, fine motor skills, intelligence, and self-help skills. Discriminant analysis was conducted to identify the developmental aspects differentiating stunted children from normal children. Results The analysis using SPSS 25 showed that the discriminating aspects of children's development between stunted and normal children were gross motor skills, fine motor skills, passive communication, and intelligence. For the age group of 13-24 months, the discriminant function is represented as D = - 0.276 + 0.197 K - 0.511 GK + 0.361 KP. Meanwhile, for the age group of 25-60 months, the discriminant function is expressed as D = - 2.586 + 0.151 GK - 0.081 GH. Conclusion Stunted and normal children could be differentiated based on four key aspects of development: gross and fine motor skills, passive communication, and intelligence. These findings aid in the early detection of stunted children and emphasize the crucial role of parental stimulation across these four aspects.
Collapse
Affiliation(s)
- Ratna Jatnika
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
- Center for Psychometrics Study, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| | - Hendriati Agustiani
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| | - Fitri Ariyanti Abidin
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| | | | - Kustimah Kustimah
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| | - Lucia Voni Febriani
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| | - Syauqiyyah Syahlaa
- Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Sumedang, Bandung, Indonesia
| |
Collapse
|
4
|
Cavagnari BM, Guerrero-Vaca DJ, Carpio-Arias TV, Duran-Aguero S, Vinueza-Veloz AF, Robalino-Valdivieso MP, Morejón-Terán YA, Vinueza-Veloz MF. The double burden of malnutrition and gross motor development in infants: A cross-sectional study. Clin Nutr 2023; 42:1181-1188. [PMID: 37225559 DOI: 10.1016/j.clnu.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of the present work was to study the relationship between the double burden of malnutrition and gross motor development in infants. METHOD ology: Sample included 5900 infants under 24 months of age, participants of the ENSANUT-ECU study. To evaluate nutritional status, we calculated z-scores for body mass index/age (BAZ) and height/age (HAZ). Six gross motor milestones were considered: sitting without-support, crawling, standing and walking with-support, standing and walking without-support. Data was analysed using logistic regression models in R. RESULTS Independently form age, sex and other socio-economic factors, the probability of achieving three gross motor milestones was significantly lower among chronically undernourished infants compared to their peers: sitting without-support, crawling, and walking without-support. Compared to no malnourished infants the probability of sitting without-support at six months was 10% lower for chronically undernourished infants (0.70, 95%CI [0.64-0.75]; 0.60, 95%CI [0.52-0.67]; respectively). The probability of crawling at eight months and walking without-support at 12 months were also significantly lower among chronically undernourished infants (0.62, 95%CI [0.58-0.67]); 0.25, 95%CI [0.20-0.30]; respectively) in comparison to no malnourished infants (0.67, 95%CI [0.63-0.72]); 0.29, 95%CI [0.25-0.34]; respectively). Obesity/overweight was not associated with the achievement of gross motor milestones, except for sitting without-support. Chronically undernourished infants with low or high BMI/age were generally delayed in the achievement of gross motor milestones than their peers. CONCLUSIONS Chronic undernutrition is related to delayed gross motor development. Public health measures are needed to be implemented to prevent the double burden of malnutrition and its detrimental effects on infant development.
Collapse
Affiliation(s)
- Brian M Cavagnari
- School of Nutrition, Faculty of Medical Sciences, Pontificia Universidad Católica, Buenos Aires, Argentina
| | - Darío Javier Guerrero-Vaca
- School of Medicine, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Tannia Valeria Carpio-Arias
- School of Nutrition and Dietetics, Faculty of Public Health, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
| | - Samuel Duran-Aguero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago, Chile
| | | | | | - Yadira Alejandra Morejón-Terán
- Research Program Social Change, Asthma and Allergy in Latin America - SCAALA, Universidade Federal de Bahía, Salvador, Brazil; Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC). Facultad de Ciencias de la Salud Eugenio Espejo (FCSEE). Universidad UTE, Quito, Ecuador
| | - María Fernanda Vinueza-Veloz
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| |
Collapse
|
5
|
Brett BE, Doumbia HOY, Koko BK, Koffi FK, Assa SE, Zahé KYAS, Kort R, Sybesma W, Reid G, de Weerth C. Normative cognition and the effects of a probiotic food intervention in first grade children in Côte d'Ivoire. Sci Rep 2022; 12:19491. [PMID: 36376341 PMCID: PMC9663712 DOI: 10.1038/s41598-022-23797-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
The cognitive skills critical for success have largely been studied in Western populations, despite the fact that children in low- and middle-income countries are at risk to not reach their full developmental potential. Moreover, scientists should leverage recent discovery to explore means of boosting cognition in at-risk populations. This semi-randomized controlled trial examined normative cognitive development and whether it could be enhanced by consumption of a probiotic food in a sample of 251 4- to 7-year-old children in urban schools in Côte d'Ivoire. Participants completed executive functioning measures at baseline (T1) and 5 months later (T2). After T1, children in one school received a probiotic (N = 74) or placebo (N = 79) fermented dairy food every day they were in school for one semester; children in the other school (N = 98) continued their diet as usual. Children improved on all tests across time (Cohen's d = 0.08-0.30). The effects of probiotic ingestion were inconclusive and are interpreted with caution due to socio-political factors affecting daily administration. Given the general feasibility of the study, we hope that it will serve as an inspiration for future research into child development and sustainable (health-promoting) interventions for school children in developing nations.
Collapse
Affiliation(s)
- Bonnie E. Brett
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Bruno K. Koko
- UFR Biosciences, Université Félix Houghouët-Boigny, Abidjan, Côte d’Ivoire
| | | | - Savorgnan E. Assa
- UFR Biosciences, Université Félix Houghouët-Boigny, Abidjan, Côte d’Ivoire
| | | | - Remco Kort
- Yoba For Life Foundation, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Molecular Cell Biology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Gregor Reid
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute and Western University, London, Canada
| | - Carolina de Weerth
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Kirolos A, Goyheneix M, Kalmus Eliasz M, Chisala M, Lissauer S, Gladstone M, Kerac M. Neurodevelopmental, cognitive, behavioural and mental health impairments following childhood malnutrition: a systematic review. BMJ Glob Health 2022; 7:e009330. [PMID: 35793839 PMCID: PMC9260807 DOI: 10.1136/bmjgh-2022-009330] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe childhood malnutrition impairs growth and development short-term, but current understanding of long-term outcomes is limited. We aimed to identify studies assessing neurodevelopmental, cognitive, behavioural and mental health outcomes following childhood malnutrition. METHODS We systematically searched MEDLINE, EMBASE, Global Health and PsycINFO for studies assessing these outcomes in those exposed to childhood malnutrition in low-income and middle-income settings. We included studies assessing undernutrition measured by low mid-upper arm circumference, weight-for-height, weight-for-age or nutritional oedema. We used guidelines for synthesis of results without meta-analysis to analyse three outcome areas: neurodevelopment, cognition/academic achievement, behaviour/mental health. RESULTS We identified 30 studies, including some long-term cohorts reporting outcomes through to adulthood. There is strong evidence that malnutrition in childhood negatively impacts neurodevelopment based on high-quality studies using validated neurodevelopmental assessment tools. There is also strong evidence that malnutrition impairs academic achievement with agreement across seven studies investigating this outcome. Eight of 11 studies showed an association between childhood malnutrition and impaired cognition. This moderate evidence is limited by some studies failing to measure important confounders such as socioeconomic status. Five of 7 studies found a difference in behavioural assessment scores in those exposed to childhood malnutrition compared with controls but this moderate evidence is similarly limited by unmeasured confounders. Mental health impacts were difficult to ascertain due to few studies with mixed results. CONCLUSIONS Childhood malnutrition is associated with impaired neurodevelopment, academic achievement, cognition and behavioural problems but evidence regarding possible mental health impacts is inconclusive. Future research should explore the interplay of childhood and later-life adversities on these outcomes. While evidence on improving nutritional and clinical therapies to reduce long-term risks is also needed, preventing and eliminating child malnutrition is likely to be the best way of preventing long-term neurocognitive harms. PROSPERO REGISTRATION NUMBER CRD42021260498.
Collapse
Affiliation(s)
- Amir Kirolos
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
| | - Magdalena Goyheneix
- Fundación ACNUR Argentina (Agencia de la ONU para los Refugiados, UNHCR), Buenos Aires, Argentina
| | - Mike Kalmus Eliasz
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Mphatso Chisala
- Malawi Epidemiology and Intervention Research Unit, Lilongwe/Karonga, Malawi
| | - Samantha Lissauer
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Blantyre, Malawi
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Melissa Gladstone
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Marko Kerac
- Centre for Maternal, Child, Adolescent & Reproductive Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
7
|
Mustakim MRD, Irwanto, Irawan R, Irmawati M, Setyoboedi B. Impact of Stunting on Development of Children between 1-3 Years of Age. Ethiop J Health Sci 2022; 32:569-578. [PMID: 35813667 PMCID: PMC9214736 DOI: 10.4314/ejhs.v32i3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Stunting occurs due to chronic malnutrition and is a major problem for children in developing countries. It is important to evaluate the impact of stunting on the development of children. This study aimed to investigate the impact of stunting on the development of children between 1-3 years of age. Methods This cross-sectional study was conducted from July 2020 to March 2021 in Surabaya, Indonesia. A questionnaire and growth assessment were done, following the development measurement to stunted and non-stunted children who met the inclusion and exclusion criteria. Development was measured by the Denver Developmental Screening Test II (DDST-II), and Cognitive Adaptive Test/Clinical Linguistic & Auditory Milestone (CAT/CLAMS) scales. Results Three hundred children are included in this study, consisting of 150 stunted and 150 non-stunted children. Stunted children had a higher risk to be suspected of delayed development compared to non-stunted children. The Crude Odd Ratio was 2.98, 4.24, 4.75 with the p-value 0.006, 0.001. and 0.001 respectively. The Adjusted Odd Ratio was 0.34, 0.24, 0.21 with p-value of 0.008, 0.001, and 0.001 respectively. Conclusion Stunting is associated with suspected development delay among children 1-3 years of age. Initiatives related to prevention need to be established and nutrition advice needs to be provided.
Collapse
Affiliation(s)
- Muhammad R D Mustakim
- Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Irwanto
- Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Roedi Irawan
- Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Mira Irmawati
- Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Bagus Setyoboedi
- Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
8
|
Olsen MF, Iuel-Brockdorff AS, Yaméogo CW, Cichon B, Fabiansen C, Filteau S, Phelan K, Ouédraogo A, Wells JC, Briend A, Michaelsen KF, Lauritzen L, Ritz C, Ashorn P, Christensen VB, Gladstone M, Friis H. Early development in children with moderate acute malnutrition: A cross-sectional study in Burkina Faso. MATERNAL AND CHILD NUTRITION 2019; 16:e12928. [PMID: 31823490 PMCID: PMC7083399 DOI: 10.1111/mcn.12928] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022]
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.
Collapse
Affiliation(s)
- Mette F Olsen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | | | - Charles W Yaméogo
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark.,Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Bernardette Cichon
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Christian Fabiansen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Phelan
- The Alliance for International Medical Action (ALIMA), Paris, France
| | | | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - André Briend
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| | - Per Ashorn
- Centre for Child Health Research, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Vibeke B Christensen
- Department of Pediatrics and Adolescent Health, Rigshospitalet, Copenhagen, Denmark.,Medicins Sans Frontieres - Denmark, Copenhagen, Denmark
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, SCIENCE, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Tessema TT, Alamdo AG, Yirtaw TG, Deble FA, Mekonen EB, Abessa TG, Lema TB. The effects of psychosocial stimulation on the development, growth, and treatment outcome of children with severe acute malnutrition age 6-59 months in southern Ethiopia: a parallel group cluster randomized control trial (EPSoSAMC study). BMC Public Health 2019; 19:1610. [PMID: 31791303 PMCID: PMC6889618 DOI: 10.1186/s12889-019-7916-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 01/04/2023] Open
Abstract
Background Severe Acute Malnutrition (SAM) remains a major cause of child mortality. To improve the management and survival of children the World Health Organization (WHO) endorsed the protocol for the management of SAM. The protocol suggested the integration of psychosocial stimulation as part of the medico-nutritional care process to prevent the long-term adverse developmental impact of the SAM. However, there is little scientific evidence behind the recommended stimulation intervention. Method A parallel-group cluster-randomized controlled trial will be conducted among 144 children with SAM age 6–59 months in Southern Ethiopia. The study will have two groups where: children with SAM admitted in the intervention health facilities will receive psychosocial stimulation in addition to the routine inpatient care and for 6 months after discharge. Children with SAM admitted in the SC of the control health facilities will receive the routine inpatient care without psychosocial stimulation and home-based follow up for 6 months after discharge. All mothers/ caregivers will also receive uniform health education on child health-related issues. The primary outcome of the study will be child development while the secondary outcomes will include child growth and treatment outcome. All outcomes will be assessed four times: at enrollment, upon discharge from the SC, at 3 and 6 months of follow up. The data will be analyzed using STATA Version 15 Statistical Software. The anthropometric Z-scores and percentile of the median will be calculated child using WHO Anthro Version 3.2.2 Statistical Software. To assess the overall effect of the intervention by controlling other potential contributing factors, a generalized linear mixed model will be used. Discussion The present study will have an important contribution in generating supplementary evidence regarding the effect of psychosocial stimulation interventions on the development and growth outcomes of children with SAM. The study will further address the impact of the intervention on treatment outcome indicators that are still under-researched areas requiring new scientific evidence. Trial registration Pan African Clinical Trials Registry -PACTR201901730324304. Registered 25 November 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5739
Collapse
Affiliation(s)
- Tesfalem T Tessema
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Andamlak G Alamdo
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tewodrose G Yirtaw
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Fana A Deble
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eyoel B Mekonen
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teklu G Abessa
- College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia
| | - Tefera B Lema
- College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
10
|
Abstract
A new approach to comprehensive growth and nutrition assessment of infants, children, and adolescents that is etiology based and relatively simple to implement is now available. It encompasses five domains: anthropometry (growth measurements), assessment of change in growth (growth dynamism), duration of the growth abnormalities, etiology of the nutritional imbalance, and impact of the nutritional state on functional outcomes. Its increased use will help to standardize the screening, diagnosis, and documentation of malnutrition in both ambulatory and hospitalized patients. [Pediatr Ann. 2019;48(11):e425-e433.].
Collapse
|
11
|
Abessa TG, Worku BN, Wondafrash M, Girma T, Valy J, Lemmens J, Bruckers L, Kolsteren P, Granitzer M. Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial. BMC Pediatr 2019; 19:336. [PMID: 31521161 PMCID: PMC6744679 DOI: 10.1186/s12887-019-1696-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM. METHOD Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital. The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations. RESULTS The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes. CONCLUSION Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available. TRIAL REGISTRATION The trial was retrospectively registered on 30 January 2017 at the US National Institute of Health (ClinicalTrials.gov) # NCT03036176 .
Collapse
Affiliation(s)
- Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
| | - Berhanu Nigussie Worku
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
- Department of Psychology, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia
| | - Mekitie Wondafrash
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Johan Valy
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | - Johan Lemmens
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | | | - Patrick Kolsteren
- Department of Food Safety and Food Quality, University of Gent, Ghent, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
| |
Collapse
|