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Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study

BACKGROUND: Early childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe ac...

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Autores principales: van den Heuvel, Meta, Voskuijl, Wieger, Chidzalo, Kate, Kerac, Marko, Reijneveld, Sijmen A, Bandsma, Robert, Gladstone, Melissa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Edinburgh University Global Health Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735778/
https://www.ncbi.nlm.nih.gov/pubmed/29302321
http://dx.doi.org/10.7189/jogh.07.020416
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author van den Heuvel, Meta
Voskuijl, Wieger
Chidzalo, Kate
Kerac, Marko
Reijneveld, Sijmen A
Bandsma, Robert
Gladstone, Melissa
author_facet van den Heuvel, Meta
Voskuijl, Wieger
Chidzalo, Kate
Kerac, Marko
Reijneveld, Sijmen A
Bandsma, Robert
Gladstone, Melissa
author_sort van den Heuvel, Meta
collection PubMed
description BACKGROUND: Early childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe acute malnutrition (SAM). Particularly an important research gap exists in Sub–Saharan Africa where there is a high prevalence of SAM and a high rate of co–occurring HIV (human immune deficiency virus) infection. Our first objective was to assess the prevalence and severity of developmental and behavioural disorders on a cohort of children admitted to an inpatient nutritional rehabilitation centre in Malawi. Our second objective was to compare the developmental and behavioural profiles of children with the two main phenotypes of SAM: kwashiorkor and marasmus. METHODS: This was a cross–sectional observational study including all children hospitalized with complicated SAM in Blantyre, Malawi over an 8–month period from February to October 2015. At discharge, children were assessed with the well-validated Malawi Developmental Assessment Tool (MDAT) for gross motor, fine motor, language and social development. In children ≥24 months, emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). RESULTS: 150 children (55% boys) with SAM were recruited; mean age of 27.2 months (standard deviation 17.9), 27 children (18%) had pre–existing neurodisabilities (ND) and 34 (23%) had a co–occurring human immune deficiency virus (HIV) infection. All children with SAM experienced profound delays in the gross and fine motor, language and social domains. Linear regression analysis demonstrated that children with kwashiorkor scored 0.75 standard deviations lower (95% confidence interval –1.43 to –0.07) on language MDAT domain than children with marasmus when adjusted for covariates. The prosocial behaviour score of the SDQ was low in children with SAM, indicating a lack of sensitive behaviour in social interactions. CONCLUSIONS: Children with SAM have severe developmental delays after a hospital admission. Our results indicate that there might be a significant difference in developmental attainment between children with kwashiorkor and with marasmus. Future studies exploring longer–term outcomes and testing possible intervention strategies are urgently needed.
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spelling pubmed-57357782018-01-04 Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study van den Heuvel, Meta Voskuijl, Wieger Chidzalo, Kate Kerac, Marko Reijneveld, Sijmen A Bandsma, Robert Gladstone, Melissa J Glob Health Articles BACKGROUND: Early childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe acute malnutrition (SAM). Particularly an important research gap exists in Sub–Saharan Africa where there is a high prevalence of SAM and a high rate of co–occurring HIV (human immune deficiency virus) infection. Our first objective was to assess the prevalence and severity of developmental and behavioural disorders on a cohort of children admitted to an inpatient nutritional rehabilitation centre in Malawi. Our second objective was to compare the developmental and behavioural profiles of children with the two main phenotypes of SAM: kwashiorkor and marasmus. METHODS: This was a cross–sectional observational study including all children hospitalized with complicated SAM in Blantyre, Malawi over an 8–month period from February to October 2015. At discharge, children were assessed with the well-validated Malawi Developmental Assessment Tool (MDAT) for gross motor, fine motor, language and social development. In children ≥24 months, emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). RESULTS: 150 children (55% boys) with SAM were recruited; mean age of 27.2 months (standard deviation 17.9), 27 children (18%) had pre–existing neurodisabilities (ND) and 34 (23%) had a co–occurring human immune deficiency virus (HIV) infection. All children with SAM experienced profound delays in the gross and fine motor, language and social domains. Linear regression analysis demonstrated that children with kwashiorkor scored 0.75 standard deviations lower (95% confidence interval –1.43 to –0.07) on language MDAT domain than children with marasmus when adjusted for covariates. The prosocial behaviour score of the SDQ was low in children with SAM, indicating a lack of sensitive behaviour in social interactions. CONCLUSIONS: Children with SAM have severe developmental delays after a hospital admission. Our results indicate that there might be a significant difference in developmental attainment between children with kwashiorkor and with marasmus. Future studies exploring longer–term outcomes and testing possible intervention strategies are urgently needed. Edinburgh University Global Health Society 2017-12 2017-11-30 /pmc/articles/PMC5735778/ /pubmed/29302321 http://dx.doi.org/10.7189/jogh.07.020416 Text en Copyright © 2017 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License.
spellingShingle Articles
van den Heuvel, Meta
Voskuijl, Wieger
Chidzalo, Kate
Kerac, Marko
Reijneveld, Sijmen A
Bandsma, Robert
Gladstone, Melissa
Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title_full Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title_fullStr Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title_full_unstemmed Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title_short Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study
title_sort developmental and behavioural problems in children with severe acute malnutrition in malawi: a cross–sectional study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735778/
https://www.ncbi.nlm.nih.gov/pubmed/29302321
http://dx.doi.org/10.7189/jogh.07.020416
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