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Indian Pediatr 2016;53: 431-432 |
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Psychosocial Care and its Association with
Severe Acute Malnutrition
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Anurag Singh and *Sheesham Agarwal
Department of Pediatrics, Dr SN Medical College,
Jodhpur, Rajasthan, India.
Email:
[email protected]
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This cross-sectional study compared
120 children having severe acute malnutrition with 120 healthy children
for exposure to 40 behaviors, by measuring psychosocial care based on
Home Observation for Measurement of the Environment (HOME) inventory.
The mean (SD) psychosocial care score of cases and controls
significantly differed [18.2 (2.2) vs 23.5 (2.1); P<0.001].
A score of less than 14 was significantly associated with severe acute
malnutrition (OR 23.2; 95% CI 8.2, 50).
Keywords: Home environment, Undernutrition.
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India is home to more than one-third of the
world’s undernourished children, out of which 6.4% children
are severely malnourished [1]. Nutritional status is influenced by three
broad factors: food, health and care [2]. There is a significant gap in
knowledge on the relationship of psychosocial care and the nutritional
status of under-five children in India. Home Observation for Measurement
of the Environment (HOME) is a descriptive profile which yields a
systematic assessment of the caring environment in which the child is
reared [3]. We conducted
this cross-sectional study at a hospital in Jodhpur, India, from
December 2013 to November 2014, in which 120 children (age 6 mo-3 y)
with severe acute malnutrition (as per WHO criteria) were included.
Children with congenital heart disease, chronic metabolic and systemic
disease, and known chromosomal anomalies were excluded. Similar number
of control children were selected from amongst the healthy children
(children attending the under-five clinics and not meeting the criteria
‘for SAM).
The adequacy of psychosocial care in the family was
quantified using a questionnaire consisting of 40 questions (similar to
the one used in the infant and toddler HOME inventory for children aged
6 months to 3 years) in a 30 min interview (by one of the authors) with
the parents. The following behaviors were observed during the interview:
(a) responsiveness or sensitivity and maternal consistency in
dealing with the child’s needs; (b) acceptance of the child by
the mother; (c) attachment or involvement with the child; (d)
encouragement for autonomy and active stimulation of the child’s
development. Each positive answer was given a score of 1. The total
score was divided into 3 tertiles (0-13, 14-27, 28-40) indicating
inadequate, intermediate and adequate psychosocial care. All the data
were analyzed with the help of Statistical software STAR PACK version
3.0.
The mean (SD) inventory score for cases was 18.2
(2.2) and for controls it was 23.5 (2.1) (P<.001). SAM was
strongly associated (OR 23.2, 95% CI 8.2, 50) if the child had score
<14. We found statistically significant differences between cases and
controls in many behaviors in various subscales (Table I).
TABLE I Comparison of Psychosocial Care in Children with SAM and Controls
Questions |
Cases (n=120) |
Controls (n=120) |
OR (95% CI) |
P value |
Mother spontaneously vocalizes to child |
52 (43.3%)
|
90 (75%) |
0.25 (0.15, 0.44)
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<0.001 |
Mother labels objects for child |
36 (30%) |
102 (85%) |
0.08 (0.04, 0.14) |
<0.001 |
Mother has a positive response to praise of child |
67 (55.8%) |
115 (95.8%) |
0.05 (0.02, 0.14) |
<0.001 |
Restricts movements |
67 (54.8%) |
5 (4.8%) |
29.1 (11.1, 76.3) |
<0.001 |
Usually older sibling takes care of child rather than parents
|
82 (68.3%) |
17 (14.1%) |
13.0 (6.9, 24.8) |
<0.001 |
Regular check-up |
30 (25%) |
110 (91.6%) |
0.03 (0.01,0.07)
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<0.001 |
Role playing toy |
15 (12.5%) |
73 (60.8%) |
0.09 (0.05, 0.18)
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<0.001 |
Toys for literature and music |
10 (8.3%) |
73 (60.8%) |
0.06 (0.03, 0.12) |
0.008 |
Keeps child in visual range |
30 (25%) |
110 (91.6%) |
0.03 (0.01, 0.07)
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0.005 |
Invests in toys with value |
25 (20.8%) |
98 (81.6%) |
0.06 (0.03, 0.11) |
0.003 |
Father provides care-taking |
5 (4.2%) |
89 (74.1%) |
0.02 (.01, .04) |
<0.001 |
Eats one meal with mother/father |
28 (23.3%) |
103 (85.83%) |
0.05 (0.03, 0.1), |
0.004 |
Illiterate mothers and lower (0-13) inventory scores |
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11.2 (2.1, 60.9)
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0.005 |
We observed that poor psychosocial care had high
association with malnutrition, and that the interactions between SAM
children and their parents were less optimal than for the controls. The
restriction of movement leading to lesser interaction with the
surroundings, curtailed independence, volition activity, and the ability
to ask for or obtain food could lead to malnutrition
[4]. If mother is also illiterate, it further
increases the chances of developing severe acute malnutrition [5]. The
limitations of this study were small sample size and a hospital-based
setting that could not delineate the actual home environment.
We feel that it is imperative that the psychosocial
care environment of the child suffering with severe acute malnutrition
be thoroughly probed using a questionnaire such as the one suggested in
our study, and psychosocial care and rehabilitation should be brought
into focus and stressed during the management of the malnourished child.
Contributors: AS: writing, study design, data
interpretation; SA: writing, data collection, study design.
Funding: None; Competing interests: None
stated.
References
1. Operational Guidelines on Facility Based
Management of Children with Severe Acute Malnutrition, Ministry of
Health and Family Welfare,Government of India,2011. Available from:
http://www.nihf.org/ nchrc –publictions/operational guidelines.
Accessed February 25,2014.
2. Ruel MT, Arimond M. Measuring childcare practices:
approaches, indicators, and implications for programs. Intl Food Policy
Res Inst. 2003;6:1-81.
3. Bradley RH, Munfrom DJ, Whiteside L, Caldwell BM,
Casey PH, Kirby R, et al. A reexamination of the association
between HOME scores and income. Nurs Res. 1994;43:260-6.
4. Engle PL, Bentley M, Pelto G. The role of care in
nutrition programmes: current research and a research agenda. Proc Nutr
Soc. 2000;59:25-35.
5. Ruel MT, Levin CE, Armar KM, Maxwell D, Morris S.
Good care practices can mitigate the negative effects of poverty and low
maternal schooling on children’s nutritional status: evidence from
Accra. World Development.1999;27:1993-2009.
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