Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross-sectional study
Meta van den Heuvel1, Wieger Voskuijl2,3, Kate Chidzalo2
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children with severe acute malnutrition (SAM) experience profound developmental delays in motor, language, and social skills. Kwashiorkor cases showed worse language development than marasmus cases, highlighting the need for targeted interventions.
Area of Science:
- Pediatrics
- Developmental Psychology
- Global Health
Background:
- Early childhood development is crucial for human capital.
- Severe acute malnutrition (SAM) significantly impacts child development outcomes.
- Limited data exists on developmental and behavioral outcomes of SAM children, especially in Sub-Saharan Africa with high HIV prevalence.
Purpose of the Study:
- To assess the prevalence and severity of developmental and behavioral disorders in children with SAM.
- To compare developmental and behavioral profiles between kwashiorkor and marasmus phenotypes in SAM children.
Main Methods:
- Cross-sectional observational study of children hospitalized with complicated SAM in Malawi.
- Malawi Developmental Assessment Tool (MDAT) used for gross motor, fine motor, language, and social development assessment.
- Strengths and Difficulties Questionnaire (SDQ) used for emotional and behavioral problems in children aged ≥24 months.
Main Results:
- 150 SAM children recruited; 18% had neurodisabilities, 23% had HIV.
- All SAM children exhibited profound delays in gross motor, fine motor, language, and social domains.
- Kwashiorkor cases had significantly lower language scores than marasmus cases (p<0.05).
- Children with SAM displayed low prosocial behavior scores, indicating social interaction difficulties.
Conclusions:
- Children with SAM exhibit severe developmental delays post-hospitalization.
- Significant differences in developmental attainment may exist between kwashiorkor and marasmus.
- Further research on long-term outcomes and interventions for SAM children is essential.
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.
