Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial
Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial
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DOI：
10.1186/s12887-019-1696-z
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发表时间：
2019-09-14
期刊：
影响因子：
2.4
通讯作者：
Granitzer, Marita
中科院分区：
文献类型：
--
作者：
Abessa, Teklu Gemechu;Worku, Berhanu Nigussie;Granitzer, Marita
背景世界卫生组织(WHO)建议将心理社会刺激纳入严重急性营养不良(SAM)的管理。然而，几乎没有证据表明这些干预措施对SAM儿童的有效性，特别是在严重食物短缺和缺乏平衡饮食的情况下。这项研究的目的是检验在低收入环境下基于家庭的精神运动/心理社会刺激是否改善了SAM儿童的发育、线性增长和营养结果。方法将339例在埃塞俄比亚吉马大学专科医院就诊的SAM患儿随机分为对照组(n=170)和干预组(n=169)。两组都在医院接受了常规医疗和营养治疗。干预组在住院期间接受基于游戏的精神运动/心理社会刺激，出院后在家接受6个月的治疗。儿童精细运动(FM)和粗大运动(GM)功能、语言(LA)和个人-社会(PS)技能的评定采用适应丹佛II，社会-情绪(SE)行为采用适应年龄和阶段问卷：社会-情绪，并通过人体测量确定线性生长和营养状况。所有结果在干预前、出院时和出院后6个月(作为终止线)进行评估。使用广义估计方程比较两组测量的这些结果的超时变化。结果干预组住院期间GM评分提高0.88分(p<；0.001，效应值=0.26SD)，家庭随访期FM功能评分提高1.09分(p=0.001，效应值=0.22SD)。年龄较小的儿童和年龄较大的儿童都从治疗中受益相似。干预措施对线性增长和营养结果没有显著贡献。结论SAM患儿的心理运动/社会心理刺激与营养丰富的标准膳食相结合，可促进粗大运动功能的改善，但即使在缺乏标准膳食护理的情况下，也能提高精细运动功能。
Background The World Health Organization (WHO) recommends incorporating psychosocial stimulation into the management of severe acute malnutrition (SAM). However, there is little evidence about the effectiveness of these interventions for SAM children, particularly when serious food shortages and lack of a balanced diet prevail. The objective of this study was to examine whether family-based psychomotor/psychosocial stimulation in a low-income setting improves the development, linear growth, and nutritional outcomes in children with SAM. Method Children with SAM (N = 339) admitted for treatment to the Jimma University Specialized Hospital, Ethiopia, were randomized to a control (n = 170) or intervention (n = 169) group. Both groups received routine medical care and nutritional treatment at the hospital. The intervention group additionally received play-based psychomotor/psychosocial stimulation during their hospital stay, and at home for 6 months after being discharged from hospital. The fine motor (FM) and gross motor (GM) functions, language (LA) and personal-social (PS) skills of the children were assessed using adapted Denver II, the social-emotional (SE) behavior was assessed using adapted Ages and Stages Questionnaires: Social-Emotional, and the linear growth and nutritional status were determined through anthropometric assessments. All outcomes were assessed before the intervention, upon discharge from hospital, and 6 months after discharge (as end-line). The overtime changes of these outcomes measured in both groups were compared using Generalized Estimating Equations. Results The intervention group improved significantly on GM during hospital follow-up by 0.88 points (p < 0.001, effect size = 0.26 SD), and on FM functions during the home follow-up by 1.09 points (p = 0.001, effect size = 0.22 SD). Both young and older children benefited similarly from the treatment. The intervention did not contribute significantly to linear growth and nutritional outcomes. Conclusion Psychomotor/psychosocial stimulation of SAM children enhances improvement in gross motor functions when combined with standard nutrient-rich diets, but it can enhance the fine motor functions even when such standard dietary care is not available.