EFFECT OF LONG-TERM PSYCHOSOCIAL STIMULATION ON MENTAL DEVELOPMENT OF SEVERELY MALNOURISHED CHILDREN

doi:10.1016/S0140-6736(80)90395-5

The Lancet

Volume 316, Issue 8198, 11 October 1980, Pages 785-789

https://doi.org/10.1016/S0140-6736(80)90395-5 Get rights and content

Abstract

The effect of adding psychosocial stimulation to the treatment of severely malnourished children was studied by comparing the developmental levels (DQs) of the children with those of two other groups of children—an adequately nourished group with diseases other than malnutrition and a second malnourished group who received standard hospital care only. The intervention children underwent structured play sessions daily in hospital and weekly for 6 months after discharge; mothers were also shown how to play with them. The non-intervention malnourished group showed a marked deficit in DQ compared with the adequately nourished group throughout the study period. The intervention group made significant improvements in DQ in hospital and continued to do so after discharge. By 6 months they were significantly ahead of the non-intervention malnourished group, and were no longer significantly behind the adequately nourished group.

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Cited by (28)

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Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment.
This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM.
Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6–59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome.
Ten studies fulfilled the inclusion criteria, recruiting 39–1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality.
Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).
A year-long caregiver training program improves cognition in preschool ugandan children with human immunodeficiency virus
2013, Journal of Pediatrics
To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls.
Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist.
Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year.
MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home.
Protein energy malnutrition and the nervous system
1992, Journal of the Neurological Sciences
Protein-energy malnutrition (PEM), a natural ramification of poverty, continues to be a perennial source of concern to a large segment of the world population. The developing nervous system of a child is specially vulnerable to deprivations in nurture. Peripheral nerve and muscle derangements are clinically evident by weakness, hypotonia and hyporeflexia in accordance with severity and duration of PEM. Motor and sensory nerve conduction studies exhibit significant abnormalities and often furnish useful and ominous correlation with grades of PEM. The human sural nerve histology in cases of severe PEM is characterized by persistence of small myelinated fibres, striking failure of internodal elongation and significant segmental demyelination. Young rhesus monkeys are ideal experimental PEM models and they show myopathic EMG changes amenable to rehabilitation. Muscle pathology comprises obliteration of cross-striations, streaming of Z bands, increased interfibrillary spaces, mitochondriomegaly and small-for-age fibres. Radioisotope assays reveal anomalous incorporation into various nerve and muscle constituents. Central nervous system, specially the neurophysiological functions are affected in a lasting manner. Learning deficits, behavioural problems and manual indexterity are most obtrusive features.
An overview of somatic treatment of psychosis during pregnancy and postpartum
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Treatment and management of the psychotic pregnant patient is insufficiently covered by most standard texts and the current literature. To date, there are no controlled studies on the efficacy of different therapeutic modalities during pregnancy. Medications that have proved effective in the treatment of the various psychoses are not without added risk for the pregnant patient. However, there is no effective medical treatment without attendant risk. Although the psychotic pregnant patient presents a therapeutic dilemma, these patients can be effectively treated by a program that allows for flexibility and innovation within the framework of sound conservative medical practice. Professional territorial difficulties can be avoided by a unified effort.
Studies in behaviour and malnutrition in jamaica
1988, Transactions of the Royal Society of Tropical Medicine and Hygiene
Vitamins and neural and cognitive developmental outcomes in children
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¹: Present address: Department of Psychology, Bedford College, University of London, Regents Park, London.

²: Present address: Post Experience Courses Unit, Open University, Milton Keynes, England.

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Child DevelopmentEFFECT OF LONG-TERM PSYCHOSOCIAL STIMULATION ON MENTAL DEVELOPMENT OF SEVERELY MALNOURISHED CHILDREN

Abstract

Lancet

15-year developmental study on effects of severe undernutrition during infancy on subsequent physical growth and intellectual functioning

Arch Dis Childh

Intellectual levels of school children severely malnourished during the first two years of life

Pediatrics

The effects of protein energy malnutrition in early childhood on intellectual and motor abilities in later childhood and adolescence

Devl Med Child Neurol

Early childhood intervention programs in Latin America: a selective review

The relation of severe malnutrition in infancy to the intelligence of school children with differing life histories

Pediat Res

Clinical studies on the effects of malnutrition during infancy on subsequent physical and intellectual development

Nutrition, behavioral development and mother-child interaction in young rural children

Fed Proc

The behavioural development of infants recovering from severe malnutrition

J Ment Defic Res

Not by bread alone: effect of early malnutrition and stimuli deprivation on mental development

The subsequent mental and physical development of rehabilitated marasmic infants

J Ment Defic Res

Role of stimulation in recovery from marasmus

Is early intervention effective?

Malnutrition and environmental enrichment by early adoption

Science

A new look at the assessment of mental development in young children recovering from severe protein-energy malnutrition

Devl Med Child Neurol

Mental development of young children recovering from severe protein energy malnutrition

The experiences of young children in a Kingston hospital, Jamaica

W I Med J

Child Development
EFFECT OF LONG-TERM PSYCHOSOCIAL STIMULATION ON MENTAL DEVELOPMENT OF SEVERELY MALNOURISHED CHILDREN