The Long-Term Follow-up of Severely Malnourished Children Who Participated in an Intervention Program

Abstract

18 severely malnourished children (IM) who participated in a 3‐year home‐visiting program were compared with 2 other comparison groups comprising 17 severely malnourished (NIM) and 19 adequately nourished children (controls). On enrollment, all the groups were in the same hospital, and both malnourished groups had lower developmental levels than the controls. The IM group received intervention for 3 years after hospitalization, consisting of weekly or 2 weekly home visits with toy demonstrations. At 7, 8, 9, and 14 years after leaving the hospital, the 3 groups were compared on tests of school achievement and IQ. The NIM group showed no sign of reducing their deficits, and at the 14‐year follow‐up they had markedly lower scores on the WISC verbal and performance scales, the Wide Range Achievement Test (WRAT), and the Peabody Picture Vocabulary Test (PPVT), than the controls. Throughout the follow‐up the IM group's scores were intermediate between the NIM and the controls in every test. At the 14‐year follow‐up, their scores were significantly higher than those of the NIM group in the WISC verbal scale, and the difference approached significance in the WRAT. We conclude that psychosocial intervention should be an integral part of treatment for severely malnourished children.

Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial

“…The decline in developmental levels shown by children from control clinics is common in children from poor backgrounds,15 and intervention reduced this decline. In previous Jamaican studies, gains of this size have led to long term benefits, which should have functional significance 3 4. The benefits were greater than the average gain found in developed countries of 0.5 standard deviations for centre based programmes and less for programmes based on home visits 8 16.…”

“…These scales were developed in the United Kingdom but have been used in Jamaica 3. They have good test-retest reliability and predict long term development 3. We used four subscales—locomotor skills, hearing and speech, hand and eye coordination, and performance.…”

“…In small controlled trials, psychosocial stimulation produced sustainable benefits in the development of undernourished children 3 4. Yet little attempt has been made to integrate psychosocial stimulation into routine care of undernourished children.…”

The effect of early stimulation on maternal depression: a cluster randomised controlled trial

“…17 18 These scales have previously been modified for Jamaica where they have been shown to have good test-retest reliability and to predict long term development. 19 Four subscales were used-locomotor, hearing and speech, hand and eye coordination, and performance; these were averaged to give a global developmental quotient (DQ). The children were assessed by one of two persons who tested equal numbers from each group and were unaware of the children's group.…”

Research Review

“…So it is of great importance to identify those limits. As far as cognitive development is concerned, the duration of deprivation must not be too long, and the deprivation must be replaced by an optimally healthy physical and psychosocial environment ( Grantham‐McGregor et al . 1994 ).…”