Supportive Caregiving & Children s Nutritional Status. Michelle Fong, Ounprason Inthachith, Jeff Measelle, & Dare Baldwin

Transcription

1 Supportive Caregiving & Children s Nutritional Status Michelle Fong, Ounprason Inthachith, Jeff Measelle, & Dare Baldwin 1

2 45% Deaths in children under 5, prompted by nutritional deficiencies Malnutrition deaths are a failure of recognition. Children slip towards death s door without most noticing. Then, it is too late. If someone does notice, the chance of thriving is likely lost Peter Horton 2

3 Nutrition Interventions Adolescence to Pregnancy Birth 0-5 Months 6-23 Months (UNICEF, 2013) 3

4 Nutritional intervention alone does not promote healthy development, or protect against nutritional deficits. UNICEF

5 What helps promote optimal child development? Water, Sanitation, Hygiene Play Nutrition Supportive Caregiving Communication

6 Supportive Caregiving Interventions Birth-1 week 1 Week-6 Months 6-9 Months 9-12 Months 12 Months-2 Years 2 Years + 6

7 Typical Design to Study Effects of Nutrition & Supportive Caregiving on Development in Stunted Children Combined Interventions Supportive Caregiving Intervention Nutrition Supplementation

8 Effects of Nutrition & Supportive Caregiving on Development in Stunted Children (Jamaica) 110 Non-stunted Development Quotient Control (Stunted) 85 Baseline (Grantham-McGregor et al., 1991) Age (months) 8

9 Effects of Nutrition & Supportive Caregiving on Cognitive Development (Pakistan) 90 Control Language Score (Yousafzai et al., 2013) 12 months 24 months 9

10 Effects of Nutrition & Supportive Caregiving on Adult Involvement in Activities with Children (Pakistan) 70% Control 64.2% Adult Involvement in 4+ Activities 60% 50% 40% 30% 20% 10% 15.3% 26.8% 58.2% 26.8% 11.0% 40.4% 42.4% 0% Mother Father (Yousafzai et al., 2013) 10

11 Effects of Nutrition & Supportive Caregiving on Growth and Weight at Age 7 (Columbia) 7% % increase of mean compared to control group 6% 5% 4% 3% 2% 1% 1.9% 1.9% 3.8% 2.5% 3.3% 6.0% 0% Height Weight (Herrera & Super, 1983) 11

12 Effect sizes of nutrition on cognitive development (Aboud & Yousafzai, 2015) Small effects of d =

13 Effect sizes of supportive caregiving on cognitive development (Aboud & Yousafzai, 2015) Medium effects of d =

14 Effect sizes of supportive caregiving on language development (Aboud & Yousafzai, 2015) Medium effects of d =

15 Combined nutrition + supportive caregiving interventions published since 2000: Aboud, F. E., & Akhter, S. (2011). A cluster-randomized evaluation of a responsive stimulation and feeding intervention in Bangladesh. Pediatrics,127, e1191-e1197. Nahar, B., Hossain, M. I., Hamadani, J. D., Ahmed, T., Huda, S. N., Grantham-McGregor, S. M., & Persson, L. A. (2012). Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: A randomised trial. European Journal of Clinical Nutrition, 66, Vazir, S., Engle, P., Balakrishna, N., Griffiths, P. L., Johnson, S. L., Creed-Kanashiro, H.,... & Bentley, M. E. (2013). Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Maternal & Child Nutrition, 9, Yousafzai, A. K., Rasheed, M. A., Rizvi, A., Armstrong, R., & Bhutta, Z. A. (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a clusterrandomised factorial effectiveness trial. The Lancet, 384,

16 Effect sizes of combined interventions on cognitive and language development Study Weight Aboud, F. E., & Akhter, S. (2011) 17.7 Nahar, B., et al. (2012) 25.7 Vazir, S. et al. (2013) 22.7 Yousafzai, A. K. et al., (2014) 33.9 Overall effect size 100 Large effects of d = 0.88

17 Social interaction is essential for learning Infants are very receptive to information presented in the context of social interaction. Embedding information -- such as language or action or presentation of objects -- in a social format radically enhances infants' learning. Socially enriched interaction serves to "open a gate" to learning for infants. Social Gating (Kuhl, 2007; Kuhl, Tsao, & Liu, 2003) 17

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19 Caregiver responsiveness has a positive effect on brian development % infants 60 knowing at least 50 words High responsive mothers Low responsive mothers Age (months) (Tamis-Le Monda et al., 2001) 19

20 Serve and Return: Social interaction builds brains Child serves by gesturing, babbling, or crying Caregivers return the serve with eye contact, words, laughing, or a hug (Center on the Developing Child, 2016) 20

21 Social interactions are compromised in the context of malnutrition Effects of malnutrition: Increased fatigue Reduced activity levels In children: Less positive affect More negative emotionality Greater fearfulness Less sociability Less attentiveness (Huffman, Zehner, Harvey, & Martin, 2001; Baker-Henningham, Hamadani, Huda, & Grantham-McGregor, 2009; Walker et al., 2007)) 21

22 Social interactions are compromised in the context of malnutrition Malnutrition causes child to be more lethargic and withdrawn Child less able to serve and get caregiver s attention Caregivers have less opportunity to return and may be less likely to feed, play, and communicate Delays in brain development Delays in overall development 22

23 Malnutrition compromises serve and return and disrupts the development of the child s brain Addressing the nutritional needs of the family AND supporting serve and return is essential for children s healthy development 23

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26 Thank you ຂອບ ໃຈ Cảm ơn bạn អរគ ណ&'ឆ)ន