A quantitative cross-sectional survey of psychosocial stimulation and counselling interventions at nutritional rehabilitation units in Southern Malawi

Abstract

<jats:p>BackgroundInpatient treatment at nutritional rehabilitation units (NRUs) is needed for children who have severe acute malnutrition (SAM) and acute illness, loss of appetite, or severe oedema. World Health Organization guidelines state that nutritional counselling should be done with primary caregivers at NRUs. These recommendations also include psychosocial stimulation interventions to improve developmental outcomes in children with SAM. However, there is limited information about the delivery of these types of interventions for caregivers and children in NRU settings. The primary objective of this research was therefore to obtain data about NRU resources, activities, and protocols relevant to psychosocial stimulation and counselling interventions during inpatient treatment of children with SAM. MethodsA cross-sectional survey was administered by interview at all 16 NRUs in seven districts in Southern Malawi. Participants were health workers, nurses, and nutritionists employed at the respective NRUs. ResultsThe response rate was 100% across NRUs. Half of participants said that psychosocial stimulation interventions are conducted at their respective NRUs, yet none of the NRUs have protocols for delivery of these interventions. Furthermore, 7/16 (44%) NRUs have no resources for psychosocial stimulation including play materials. Thirteen of 16 (81%) participants said that they feel this type of intervention is very important and 3/16 (19%) participants said that this somewhat important for children with SAM. All NRUs provide counselling to caregivers about breastfeeding and nutrition; 15/16 (94%) also give counselling about water, sanitation and hygiene. ConclusionsUltimately, results from this survey highlighted that there is a need to invest in comprehensive interventions to improve developmental and nutritional outcomes in these vulnerable children requiring admission to NRUs. </jats:p>

Effects of Integrated Intervention of Psychosocial Stimulation, Nutritional Support, and Water Sanitation Hygiene on Malnourished Children in Kanam, Plateau State, Nigeria

“…The results show that the developmental status as measured using the malnourished children's body mass indices were found to be significant compared to their baseline body mass index obtained. The finding, therefore, corroborates that of Allison et al (2019) and the World Health Organization guidelines which recommended psychosocial stimulation intervention as well as other supporting activities such as nutrition to improve developmental outcomes in children with malnutrition. Similarly, the study of Abesa et al (2019), where the researchers established that play-based psychomotor/psychosocial stimulation on the severe acute malnourished children shows a significant improvement on gross motor functions when combined with standard nutrient rich diet.…”

“…Several systematic review evidence indicated that integrating psychosocial intervention to nutritional interventions have resulted in positive cognitive and social-emotional benefits over nutritional intervention alone. A study conducted in Malawi in 2019 shows a comprehensive intervention was used to improve developmental and nutritional outcomes of the vulnerable children (Allison et al, 2019). Similarly, in a study conducted in University Specialized Hospital, Ethiopia, on the effects of play-based psychomotor/psychosocial stimulation on the severe acute malnourished children shows that the intervention group improved significantly on gross motor functions when combined with standard nutrient rich diet during hospital follow-up and on fine motor functions during the home follow-up.…”

Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019

“…The authors suggested post-training support for healthcare workers at NRUs, integration with emergency care in alignment with Emergency Triage Assessment and Treatment (ETAT), and pre-service training of healthcare workers which started in Malawi in 2016 (Kauchali et al, 2022). With fewer children admitted to NRUs meaning that many are not at capacity (Daniel et al, 2019; Kouam, 2016) – and many sitting empty – there is strong potential for this to be done without greatly increasing resource requirements.…”

Comparative Study on Integrated Psychosocial Stimulation, Nutritional Support, Water Sanitation Hygiene Interventions among Malnourished Children in Kanam, North Central Nigeria

“…The impact of inappropriate water facilities, hand washing, and hygiene practices results in poor nutrition and health outcomes in children (Joshi & Amadi, 2013). A recently published systematic review clearly outlines the benefits of the provision of psychosocial stimulation for improve developmental and nutritional outcomes in children hospitalized with SAM in Jamaica and Bangladesh who received this type of intervention (Daniel et al, 2019;Daniel et al, 2017;Kerac et al, 2010;Grantham-McGregor et al, 1994). Several research reports show that the promotion and support of responsive caregiving can promote better nutritional status and development in children (Aboud et al, 2018;WHO, 2018;Engle et al, 2007;Daelmans et al, 2015).…”