title: Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden. baitun.nahar@kbh.uu.se
authors.forename: Baitun
authors.initials: B
authors.lastname: Nahar
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.forename: Jena D
authors.initials: JD
authors.lastname: Hamadani
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Sally
authors.initials: S
authors.lastname: Grantham-McGregor
authors.forename: Lars-Ake
authors.initials: LA
authors.lastname: Persson
mesh_terms: D001459:Bangladesh; D015362:Child Nutrition Disorders / Q000517:prevention & control*; D002675:Child, Preschool; D019058:Community Networks; D019587:Dietary Supplements; D006801:Humans; D007223:Infant; D016487:Parenting; D010290:Parents / Q000193:education* / Q000523:psychology*; D011795:Surveys and Questionnaires