Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh

BMC Public Health

Lars-Ake Persson³  Sally Grantham-McGregor¹  Tahmeed Ahmed²  Jena D Hamadani²  Md Iqbal Hossain²  Baitun Nahar² 

[1] Centre for International Health and Development (CIHD), Institute of Child Health, University College London, London, UK;International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh;International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden

关键词: Bangladesh;    Community-based intervention;    Food supplementation;    Psychosocial stimulation;    Child-rearing practices;    HOME;   

Others  :  1163344
DOI  :  10.1186/1471-2458-12-622

 received in 2012-03-20, accepted in 2012-07-23,  发布年份 2012

【 摘 要 】

Background

Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers’ child-rearing practices in a community-based trial with severely malnourished Bangladeshi children.

Method

Severely underweight children (n = 507), 6–24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150–300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome.

Results

322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p < 0.001 for all). The PS group benefitted 2.4 points compared with CH (p = 0.035), 3.3 points compared with CC (p = 0.004), and 2.9 points compared with FS (p = 0.006). Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p < 0.001 for all).

Conclusions

Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.

【 授权许可】

   
2012 Nahar et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Engle PL, Huffman SL: Growing children's bodies and minds: maximising child nutrition and development. Food Nutr Bull 2010, 31:S186-S197.
• [2]Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, Carter JA: Child development: risk factors for adverse outcomes in developing countries. Lancet 2007, 369(9556):145-157.
• [3]WHO: The importance of caregiver-child interactions for the survival and healthy development of young children: a review, Geneva. Geneva: World Health Organization; 2004.
• [4]Aber JL, Bennett NG, Conley DC, Li J: The effects of poverty on child health and development. Annu Rev Public Health 1997, 18:463-483.
• [5]Chilton M, Chyatte M, Breaux J: The negative effects of poverty & food insecurity on child development. Indian J Med Res 2007, 126(4):262-272.
• [6]Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B: Developmental potential in the first 5 years for children in developing countries. Lancet 2007, 369(9555):60-70.
• [7]Engle PL, Riccuiti HN: Psychosocial Aspects of Care and Nutrition. Food and Nutrition Bulletin Supplement 1995, 16(4):365-377.
• [8]Petterson SM, Albers AB: Effects of poverty and maternal depression on early child development. Child Dev 2001, 72(6):1794-1813.
• [9]Eshel N, Daelmans B, de Mello MC, Martines J: Responsive parenting: interventions and outcomes. Bull World Health Organ 2006, 84(12):991-998.
• [10]Baker-Henningham H, López Bóo F: Early Childhood Stimulation Interventions in Developing Countries: A comprehensive literature review. IDB Publications 9394, Inter-American Development Bank; 2010.
• [11]Engle PL, Fernald LC, Alderman H, Behrman J, O'Gara C, Yousafzai A, de Mello MC, Hidrobo M, Ulkuer N, Ertem I, et al.: Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet 2011, 378(9799):1339-1353.
• [12]Powell C, Baker-Henningham H, Walker S, Gernay J, Grantham-McGregor S: Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial. Bmj 2004, 329(7457):89.
• [13]Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, Stein A, McPherson K, Murray L: Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial. Bmj 2009, 338:b974.
• [14]Walker SP, Chang SM, Powell CA, Grantham-McGregor SM: Psychosocial intervention improves the development of term low-birth-weight infants. J Nutr 2004, 134(6):1417-1423.
• [15]Waber DP, Vuori-Christiansen L, Ortiz N, Clement JR, Christiansen NE, Mora JO, Reed RB, Herrera MG: Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. Am J Clin Nutr 1981, 34(4):807-813.
• [16]Aboud FE: Evaluation of an early childhood parenting programme in rural Bangladesh. J Health Popul Nutr 2007, 25(1):3-13.
• [17]Hamadani JD, Huda SN, Khatun F, Grantham-McGregor SM: Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J Nutr 2006, 136(10):2645-2652.
• [18]UNICEF: Child and Maternal Nutrition in Bangladesh. Bangladesh: United Nations Children's Fund; 2009.
• [19]Nahar B, Ahmed T, Brown KH, Hossain MI: Risk factors associated with severe underweight among young children reporting to a diarrhoea treatment facility in Bangladesh. J Health Popul Nutr 2010, 28(5):476-483.
• [20]UNICEF: Baseline survey of caregivers’ KAP on early childhood development in Bangladesh. New York, USA: Dhaka: Research Evaluation Associates for Development, United Nations Children's Fund; 2001:16.
• [21]Bayley N: The Bayley scales of infant development-II San Antonio. Tex USA: Psychological corporation; 1993.
• [22]Nahar B, Hossain MI, Hamadani JD, Ahmed T, Huda SN, Grantham-McGregor SM, Persson LA: 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 2012, 66(6):701-719.
• [23]Ahmed T, Begum B, Badiuzzaman , Ali M, Fuchs G: Management of severe malnutrition and diarrhea. Indian journal of pediatrics 2001, 68(1):45-51.
• [24]WHO: Physical status: the use and interpretation of anthropometry report of a WHO Expert Committee. Geneva: World Health Organisation; 1995.
• [25]BMHFW: EPI Programme Review Dhaka: Expanded Programme on Immunization. Bangladesh: Directorate General of Health Services,Bangladesh Ministry of Health and Family Welfare, Government of Bangladesh; 1998.
• [26]Karim R, Desplats G, Schaetzel T, Herforth A, Ahmed F, Salamatullah Q, Shahjahan M, Akhtaruzzaman M, Levinson J: Seeking optimal means to address micronutrient deficiencies in food supplements: A case study from the Bangladesh Integrated Nutrition Project. J Health Popul Nutr 2005, 23(4):369-376.
• [27]Caldwell BM, Bradley RH: Home observation for the measurement of the environment (Revised edition): Little Rock. Ark: University of Arkansas at Little Rock; 1984.
• [28]Caldwell BM, Bradley RH: Home Observation for Measurement of the Environment: Administration Manual. Tempe, AZ: Family & Human Dynamics Research Institute, Arizona State University; 2003.
• [29]Hamadani JD, Fuchs GJ, Osendarp SJ, Khatun F, Huda SN, Grantham-McGregor SM: Randomized controlled trial of the effect of zinc supplementation on the mental development of Bangladeshi infants. Am J Clin Nutr 2001, 74(3):381-386.
• [30]Hamadani JD, Fuchs GJ, Osendarp SJ, Huda SN, Grantham-McGregor SM: Zinc supplementation during pregnancy and effects on mental development and behaviour of infants: a follow-up study. Lancet 2002, 360(9329):290-294.
• [31]Black MM, Sazawal S, Black RE, Khosla S, Kumar J, Menon V: Cognitive and motor development among small-for-gestational-age infants: impact of zinc supplementation, birth weight, and caregiving practices. Pediatrics 2004, 113(5):1297-1305.
• [32]Tofail F, Kabir I, Hamadani JD, Chowdhury F, Yesmin S, Mehreen F, Huda SN: Supplementation of fish-oil and soy-oil during pregnancy and psychomotor development of infants. J Health Popul Nutr 2006, 24(1):48-56.
• [33]Nahar B, Hamadani JD, Ahmed T, Tofail F, Rahman A, Huda SN, Grantham-McGregor SM: Effects of psychosocial stimulation on growth and development of severely malnourished children in a nutrition unit in Bangladesh. Eur J Clin Nutr 2009, 63(6):725-731.
• [34]Radloff LS: The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied psychological measurement 1977, 3:385-401.
• [35]Black MM, Baqui AH, Zaman K, El Arifeen S, Black RE: Maternal depressive symptoms and infant growth in rural Bangladesh. Am J Clin Nutr 2009, 89(3):951S-957S.
• [36]Black MM, Baqui AH, Zaman K, McNary SW, Le K, Arifeen SE, Hamadani JD, Parveen M, Yunus M, Black RE: Depressive symptoms among rural Bangladeshi mothers: implications for infant development. J Child Psychol Psychiatry 2007, 48(8):764-772.
• [37]Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S: Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home. Eur J Clin Nutr 2003, 57(6):786-792.
• [38]Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S: The effect of early stimulation on maternal depression: a cluster randomised controlled trial. Arch Dis Child 2005, 90(12):1230-1234.
• [39]Hamadani JD, Tofail F, Hilaly A, Huda SN, Engle P, Grantham-McGregor SM: Use of family care indicators and their relationship with child development in Bangladesh. J Health Popul Nutr 2010, 28(1):23-33.
• [40]Bakermans-Kranenburg MJ, van IJzendoorn M.H. & Bradley, R.H: Those Who Have, Receive: The Mathew Effect in Early childhood Intervention in the home Environment. Review of Educational Research 2005, 75:1-6.
• [41]Walker SP, Chang SM, Younger N, Grantham-McGregor SM: The effect of psychosocial stimulation on cognition and behaviour at 6 years in a cohort of term, low-birthweight Jamaican children. Dev Med Child Neurol 2010, 52(7):148-154.