Assessing the effectiveness of a nutrition and psychosocial intervention for treatment of children with uncomplicated sam aged 6-24 months admitted in CMAM program in Saptari Nepal.

Research Report.

SUMMARY: Background: Worldwide, children affected by severe acute malnutrition (SAM) are treated with standard nutritional treatment. In recent years, increase attention has been given to combined nutrition-related interventions that integrate psychosocial care to the treatment of undernourished infants and children (IASC, 2007; WHO, 2006; MAMI Project, 2009, Lancet, 2013) because they seem to enhance benefits for both nutrition and development outcomes (Ruel, 2013). Nevertheless, the studies on the effectiveness of nutrition treatment programmes with a psychosocial or child stimulation component are scarce, in particular in the context of humanitarian aid (Engle et al, 2011; Daniel et al, 2017). The overall objective of this research is to assess the effectiveness of a brief psychosocial intervention on child nutrition, health and development by comparing the effect of a combined nutrition and psychosocial intervention to a stand-alone nutritional treatment of children with uncomplicated Severe Acute Malnutrition (SAM) aged 6 to 24 months admitted in Community Management of Acute Malnutrition (CMAM) programme in Nepal. Methods: Between December 2014 and January 2017, a Cluster Randomized Control Trial with 2 arms was conducted with 427 SAM children and their mothers in 12 Outpatient Treatment Programmes within the district of Saptari. The two research groups were randomly assigned to the 12 OTPs. Among the two groups, the experimental group NUTPSY (i.e. combined nutrition and psychosocial intervention with 5 thematic sessions aiming at improving child care practices) included 211 children and the control group NUT was composed of 216 children (i.e. 2-month of standard nutritional treatment only). An additional comparison group of 213 non-malnourished children called 'non-SAM' was selected randomly in the community in order to have reference values of the child development and other outcomes. Assessments with psychometric tests and anthropometric measures were conducted during home visits at baseline (within one week of admission), post-test (after 10 weeks) and at 5-months and 11-months follow-up after admission in the CMAM programme. The results from the different groups was compared. Results: Priminary analyses show no statistical differences between the NUTPSY and the NUT groups regarding nutritional outcomes. The recovery rate remains low in both groups (38,6% in NUT group vs 35,7% in NUTPSY group). For child development scores, the most notable differences are observed at posttest and 5-month. Family Care Indicators shows a statistically significant difference between the groups at all time points. In both case, the mean score's evolution between the tests period remains statistically nonsignificant. Regarding the attendance to psychosocial sessions, about half of the mothers (51,66%) came to four and five sessions. Maternal mental health status is negatively influenced by the presence of the father. EPDS scores decrease between pre- and post-test for all mothers excepted for mothers attending one session only (t test=7, 121). SRQ-20 scores decreases between pre- and post-test for all mothers and increase till the end of the follow up. For maternal self-esteem, scores increase between pre and post-test for all mothers attending at least three sessions (t test = 9,381). Finally, The frequency of interactions is higher from the mother side than the child side. Regarding child interactions scores, the mean scores for the intervention group are lower than the comparison group at all point of test except at 11-month. Conclusion: Adding a psychosocial component to a standard nutritional treatment for SAM mitigates the deterioration of some aspects of the child development. More studies are needed to explore other pathways and ensure a more efficient and sustainable impact of psychosocial interventions on maternal mental health and child's health and development.