Introducing psychosocial stimulation to the treatment of children with acute malnutrition in Mali: a randomized clinical trial

Abstract

Background: Undernutrition affects 200 million children under five-years-old. The causes of malnutrition are multifactorial; in the mid and low-income countries, the causes include political, economic and environmental factors that provoke an unstable situation. Thus, producing food insecurity and insufficient health services. In these conditions, children suffer from a lack of emotional, social, motor and cognitive stimulation contributing to a worse children’s condition, as well as, affecting the relationship between the child and their caregiver. The actual treatment of malnutrition is based on an effective nutritional protocol without taking into consideration the lack of stimulation. Nonetheless, in the last years, the WHO includes psychosocial stimulation to the nutritional treatment in their recommendations to treat malnutrition. Anyhow, evidence to support including psychosocial stimulation in the treatment of undernourished children is scarce. Several projects have tried to fill the evidence gap by conducting trials that show isolated improvements in the development of the children that received the psychosocial intervention when compared to a control group. With this study, we wanted to contribute to fill the evidence gap and add information around the effects of psychosocial stimulation in malnourished children. Objective: The aim of this study is to examine whether anthropometric measures improve when psychosocial stimulation to food supplementation is added in children with malnutrition. Design and methods: A randomized controlled trial will take place at the “Hôpital Femmes et Enfants”, located in the city of Koutiala in Mali. 230 children between the ages of six months and fifty-nine months will be randomly assigned to the control (n=115) or the intervention group (n=115). The psychosocial intervention will consist of one session a week for a total of six weeks. Anthropometric measures such as weight for height and mid-upper arm circumference (MUAC) will be collected to do the statistical analysis adjusting them for all covariates