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Predictors of Psychomotor Developmental Delay Among Under-Five Children With Severe Acute Malnutrition in a Food
Julien Ntaongo Alendi1, Karine Le Roch2, Alemayehu Argaw3
1Department of Basic Sciences, Faculty of Medicin, University of Kinshasa, Kinshasa, DRC.
Insights
Children with severe acute malnutrition (SAM) face significant risks of delayed psychomotor development, particularly in motor skills and problem-solving. Early intervention and integrated psychosocial stimulation are crucial for improving developmental outcomes.
Area of Science:
- Child Development
- Nutritional Science
- Public Health
Background:
- Severe acute malnutrition (SAM) significantly impacts child development, with potential long-term consequences.
- Understanding the trajectory of psychomotor development (PMD) in SAM children is critical for effective interventions.
- Previous research highlights developmental challenges in undernourished populations, necessitating further investigation in specific contexts.
Purpose of the Study:
- To assess the risk and predictors of delayed psychomotor development in children treated for SAM in the Democratic Republic of Congo.
- To evaluate the changes in PMD risk from admission through 6 months post-discharge.
- To identify key factors influencing PMD delay in this vulnerable population.
Main Methods:
- A sub-study of the EfRAMAS clinical trial involving children aged 6-59 months with SAM.
- Repeated cross-sectional assessments of PMD using the Ages and Stages Questionnaires (ASQ3) at admission, discharge, and 6 months post-discharge.
- Mixed-effects linear regression analysis to identify predictors of psychomotor delay.
Main Results:
- At admission, high risks of PMD were observed in fine motor skills (21.3%), gross motor skills (23.7%), and problem-solving (21.5%).
- PMD risk significantly reduced at discharge, with communication skills showing 0% delay, though motor and problem-solving domains remained affected around 2%.
- At 6 months post-discharge, over 10% of children still exhibited delays in gross motor skills and problem-solving. Predictors included age, sex, malnutrition severity, breastfeeding, illness episodes, vaccination status, maternal education, and household headship.
Conclusions:
- Delayed psychomotor development is a significant concern for children with SAM, persisting even after treatment.
- Integrating psychosocial stimulation and parental skills training into malnutrition management is recommended.
- Targeted interventions addressing identified predictors are essential to mitigate long-term developmental deficits in SAM children.
Abstract:
This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.