title: Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial.
abstract: OBJECTIVE
  Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children.
  
  
  METHODS
  Severely underweight hospitalised children aged 6-24 months (n = 507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS+FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure.
  
  
  RESULTS
  Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group*session interaction P = 0.037, effect size = 0.37 s.d.) and weight-for-age Z-score (group*session interaction P = 0.02, effect size=0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth.
  
  
  CONCLUSIONS
  Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status.
authors.affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. baitun.nahar@kbh.uu.se
authors.forename: B
authors.initials: B
authors.lastname: Nahar
authors.forename: M I
authors.initials: MI
authors.lastname: Hossain
authors.forename: J D
authors.initials: JD
authors.lastname: Hamadani
authors.forename: T
authors.initials: T
authors.lastname: Ahmed
authors.forename: S N
authors.initials: SN
authors.lastname: Huda
authors.forename: S M
authors.initials: SM
authors.lastname: Grantham-McGregor
authors.forename: L A
authors.initials: LA
authors.lastname: Persson
mesh_terms: D001459:Bangladesh; D001835:Body Weight; D002657:Child Development; D015362:Child Nutrition Disorders / Q000178:diet therapy / Q000523:psychology / Q000628:therapy*; D002675:Child, Preschool; D003153:Community Health Services; D003376:Counseling; D019587:Dietary Supplements; D002523:Edible Grain; D005260:Female; D006128:Growth; D006266:Health Education; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D018977:Micronutrients / Q000627:therapeutic use; D009752:Nutritional Status; D010290:Parents; D010988:Play and Playthings; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000523:psychology / Q000628:therapy*; D011610:Psychosocial Deprivation; D012720:Severity of Illness Index
chemical_list: D018977:Micronutrients