Children with severe acute malnutrition (SAM) are at serious risks that compromise their growth and development. Studies have shown the benefits of psychosocial intervention in mitigating the negative consequences of SAM. However, such intervention studies have targeted the critical period in child development and thus focused on children under three years of age. Dietary rehabilitation is usually included as part of the intervention package. Moreover, these young children in such studies customarily obtain more care than older ones and have access to breast milk, more frequent interaction with mother and other caregivers in the family. Therefore, effects of psychosocial interventions targeting such age groups may be different for older children. Much is not known if children older than three years of benefit from similar interventions, and if family-based psychomotor/psychosocial intervention can benefit SAM children in low income contexts such as Ethiopia where access to balanced diet remains hardly possible. In Ethiopia, one of the poorest countries in the world, many children are admitted to hospital for treatment due to SAM. The nutritional rehabilitation unit at hospitals provide dietary treatment to the SAM children who are also treated for related illnesses and complications. Once discharged from hospital, however, the SAM children return to the same poor home environments with inadequate care and unbalanced diets. The main objective of this study was to evaluate the effect of play-based family-centered psychomotor/psychosocial stimulation on linear growth, nutritional status and developmental outcomes of under-six SAM children in the Jimma Zone, south west Ethiopia. This was done by randomly assigning the SAM children admitted to Jimma University's Specialized Referral Teaching Hospital into control and intervention groups. Both groups were receiving the routine medical and dietary treatment services. The intervention group additionally received play-based psychomotor/psychosocial stimulation. Caregivers, supported by periodic visits made to their homes, continued the simulation. Measurements were taken after six months of home follow-up. It was hypothesized that the intervention would significantly improve some of the developmental skills of these children, and that the effect may be age-dependent.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
339
Children in the intervention group received routine medical treatment and nutritional rehabilitation services in hospital; their primary caregivers were given basic orientations on child care, feeding and nutrition. Children attended play-based stimulation sessions in which trained nurses demonstrated caregivers on how to stimulate the SAM child using play materials and facilities at playroom and playground of the hospital. After discharge from hospital, they were followed up at home and visited three times over a period of six months. During the visits, new play materials were provided and caregivers were shown how to use them to stimulate the SAM child.
On the other hand, the control SAM group did not receive the guided psychomotor/psychosocial stimulation services although they had access to the playground facilities. Both the intervention and the control groups received all the routine medical care and dietary rehabilitation services at the hospital.
Language outcome
Denver II-Jimma was used to test language outcome \& the total number of items successfully performed was counted.
Time frame: baseline
Language outcome
Denver II-Jimma was used to test language outcome \& the total number of items successfully performed was counted.
Time frame: at discharge from the hospital (on average at 2 weeks)
Language outcome
Denver II-Jimma was used to test language outcome \& the total number of items successfully performed was counted.
Time frame: 6 months after discharge from hospital
Personal-Social outcome
Denver II-Jimma was used to test Personal-social outcome \& the total number of items successfully performed was counted.
Time frame: baseline
Personal-Social outcome
Denver II-Jimma was used to test Personal-social outcome \& the total number of items successfully performed was counted.
Time frame: at discharge from the hospital (on average at 2 weeks)
Personal-Social outcome
Denver II-Jimma was used to test Personal-social outcome \& the total number of items successfully performed was counted.
Time frame: 6 months after discharge
Fine motor outcome
Denver II-Jimma was used to test Fine motor outcome \& the total number of items successfully performed was counted.
Time frame: baseline
Fine motor outcome
Denver II-Jimma was used to test Fine motor outcome \& the total number of items successfully performed was counted.
Time frame: at discharge from the hospital (on average at 2 weeks)
Fine motor outcome
Denver II-Jimma was used to test Fine motor outcome \& the total number of items successfully performed was counted.
Time frame: 6 months after discharge
Gross motor outcome
Denver II-Jimma was used to test Gross motor outcome \& the total number of items successfully performed was counted.
Time frame: baseline
Gross motor outcome
Denver II-Jimma was used to test Gross motor outcome \& the total number of items successfully performed was counted.
Time frame: at discharge from the hospital (on average at 2 weeks)
Gross motor outcome
Denver II-Jimma was used to test Gross motor outcome \& the total number of items successfully performed was counted.
Time frame: 6 months after discharge
Social-emotional outcome
The Ages and Stages questionnaire: Social emotional (ASQ:SE) was used to test Social emotional outcome \& a child's total behavior score was obtained by adding up scores on each of the items
Time frame: baseline
Social-emotional outcome
The Ages and Stages questionnaire: Social emotional (ASQ:SE) was used to test Social emotional outcome \& a child's total behavior score was obtained by adding up scores on each of the items
Time frame: at discharge from the hospital (on average at 2 weeks)
Social-emotional outcome
The Ages and Stages questionnaire: Social emotional (ASQ:SE) was used to test Social emotional outcome \& a child's total behavior score was obtained by adding up scores on each of the items
Time frame: 6 months after discharge
Linear growth
Height/length-for-age z score was used to determine linear growth. For children under two years of age, a length measuring board on a flat table was used. The height of a child above two years of age was measured by using a portable stadiometer.
Time frame: baseline
Linear growth
Height/length-for-age z score was used to determine linear growth. For children under two years of age, a length measuring board on a flat table was used. The height of a child above two years of age was measured by using a portable stadiometer.
Time frame: at discharge from the hospital (on average at 2 weeks)
Linear growth
Height/length-for-age z score was used to determine linear growth. For children under two years of age, a length measuring board on a flat table was used. The height of a child above two years of age was measured by using a portable stadiometer.
Time frame: 6 months after discharge from hospital
Nutritional status (Weight -for-age)
Weight-for-age z score was used to determine nutritional status. A child's weight was measured by using a calibrated electronic weighing scale.
Time frame: baseline
Nutritional status (Weight -for-age)
Weight-for-age z score was used to determine nutritional status. A child's weight was measured by using a calibrated electronic weighing scale.
Time frame: at discharge from the hospital (on average at 2 weeks)
Nutritional status (Weight -for-age)
Weight-for-age z score was used to determine nutritional status. A child's weight was measured by using a calibrated electronic weighing scale.
Time frame: 6 months after discharge from hospital
Nutritional status (Weight for height/length)
Weight-for-height/length z score (for under five children) and body-max-index-for age z score (for children above five years) were used to determine nutritional status.
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Time frame: baseline
Nutritional status (Weight for height/length)
Weight-for-height/length z score (for under five children) and body-max-index-for age z score (for children above five years) were used to determine nutritional status.
Time frame: at discharge from the hospital (on average at 2 weeks)
Nutritional status (Weight for height/length)
Weight-for-height/length z score (for under five children) and body-max-index-for age z score (for children above five years) were used to determine nutritional status.
Time frame: 6 months after discharge from hospital
Nutritional status (Mid-upper-arm circumference)
Mid-upper-arm circumference z score was used to determine nutritional status. Mid Upper Arm Circumference (MUAC) was measured with MUAC tape.
Time frame: baseline
Nutritional status (Mid-upper-arm circumference)
Mid-upper-arm circumference z score was used to determine nutritional status. Mid Upper Arm Circumference (MUAC) was measured with MUAC tape.
Time frame: at discharge from the hospital (on average at 2 weeks)
Nutritional status (Mid-upper-arm circumference)
Mid-upper-arm circumference z score was used to determine nutritional status. Mid Upper Arm Circumference (MUAC) was measured with MUAC tape.
Time frame: 6 months after discharge from hospital