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research letter

Indian Pediatr 2016;53: 431-432

Psychosocial Care and its Association with Severe Acute Malnutrition

 

Anurag Singh and *Sheesham Agarwal

Department of Pediatrics, Dr SN Medical College, Jodhpur, Rajasthan, India.
Email: [email protected]
 

  

 

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.



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) <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)  <0.001
Role playing toy 15 (12.5%) 73 (60.8%) 0.09 (0.05, 0.18) <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) 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 11.2 (2.1, 60.9) 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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