title: A prospective study of psychological distress among mothers of children admitted to a nutritional rehabilitation unit in Malawi.
abstract: OBJECTIVE
  Accompanying guardians (usually the mother) have a pivotal role in promoting recovery from childhood severe acute malnutrition on Nutritional Rehabilitation Units (NRUs). We describe the prevalence of maternal distress at an NRU in Malawi and identify factors associated with this. We tested the hypothesis that maternal distress during admission would be associated with reduced child weight gain over the 4-week post-discharge period.
  
  
  METHODS
  Maternal distress was measured using the Self Reporting Questionnaire (SRQ) administered to mothers of consecutive children during NRU admission. Repeat SRQ was administered to mothers attending a follow-up clinic 4 weeks post discharge. Maternal, child and psychosocial variables were also measured. Child weight change from discharge to follow-up was compared between children of mothers scoring SRQ ≥ 8 and those scoring SRQ < 8.
  
  
  RESULTS
  A total of 244 mothers and their children were recruited. In total, 71% of mothers scored SRQ ≥ 8 during admission. In all, 155 of 222 mothers eligible to complete repeat SRQ did so, and 33.5% scored SRQ ≥ 8. Maternal distress at recruitment was associated with older child age, no confiding relationship with spouse, having had a previous child die, and the child having diarrhoea. Maternal distress at follow-up was associated with older child age, the child having diarrhoea or fever since discharge, and the child being HIV sero-positive. Maternal distress during admission was not associated with child weight gain at 4-week post-discharge follow-up.
  
  
  CONCLUSIONS
  Levels of maternal distress are very high during child admission to an NRU. Persistent distress is associated with child health factors including HIV. Nutritional rehabilitation programmes should pay increased attention to carer psychological wellbeing using targeted evidence-based interventions.
authors.affiliation: Division of Community Health, College of Medicine, Blantyre, Malawi. robcstewart@mac.com
authors.forename: R C
authors.initials: RC
authors.lastname: Stewart
authors.forename: J
authors.initials: J
authors.lastname: Bunn
authors.forename: M
authors.initials: M
authors.lastname: Vokhiwa
authors.forename: E
authors.initials: E
authors.lastname: Umar
authors.forename: F
authors.initials: F
authors.lastname: Kauye
authors.forename: B
authors.initials: B
authors.lastname: Tomenson
authors.forename: A
authors.initials: A
authors.lastname: Rahman
authors.forename: F
authors.initials: F
authors.lastname: Creed
mesh_terms: D000223:Adaptation, Psychological; D002675:Child, Preschool; D003153:Community Health Services; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors