Effect of psychosocial stimulation on mental development of malnourished children attending community nutrition centres of Bangladesh Integrated Nutrition Program.

This thesis concerns a randomised-controlled trial of the effects of adding psychosocial stimulation to the nutritional treatment of the malnourished children on their development and behaviour. The effect on their mothers' knowledge of parenting was also examined. Moderately and severely malnourished children attending 20 Community Nutrition Centres (CNC) of the Bangladesh Integrated Nutrition Programme (BINP) were enrolled in the study. Subsequently, the CNCs were randomly assigned to intervention and control groups and the malnourished children attending the intervention CNCs participated in an intervention for one year. Another group of adequately nourished children, matched for age (6 months), gender and village was compared with the malnourished children. Preceding the intervention, focus group discussions were held with rural mothers to determine their knowledge and attitudes about child development and the information was used in the design of the intervention. The intervened children were visited at home biweekly and then weekly and mothers attended weekly group meetings at the CNCs. The mothers were shown how to play with their child in such a way as to promote good development. They were also shown how to make toys from the waste materials. On enrolment all children had their mental (MDI) and psychomotor (PDI) development assessed using the Revised Version of Bayley Scales of Infant Development (BSID-II). Their behaviour during the test was rated using Wolke's behaviour rating scale and mothers' knowledge of parenting, health, and hygiene was assessed. All children and mothers were re-evaluated at the end. The children's growth was monitored every three months throughout the study. The intervention significantly benefited mental development of malnourished children and their behaviour compared with the control malnourished children. Their psychomotor development was not affected. The malnourished children came from poorer homes than the adequately nourished children When socioeconomic variables were controlled, the malnourished children initially had significantly poorer levels of psychomotor development than the adequately nourished children. There was no significant difference in their mental development or behaviour. By the end of the study the control malnourished children had significantly lower scores from the adequately nourished children in both their mental and motor development. They also had poorer behaviour. In contrast, the intervened malnourished children were not significantly different in mental development and behaviour from the adequately nourished children but remained behind them in motor development. The mothers of intervened children showed benefits from intervention in knowledge of child rearing. Neither malnourished group improved in nutritional status during the year and the intervention had no effect on their nutritional status It may be concluded that it is feasible to integrate child development activities into the nutrition services in Bangladesh and it is an effective means of improving the development of malnourished children