Developing a context-relevant psychosocial stimulation intervention to promote cognitive development of children with severe acute malnutrition in Mwanza, Tanzania

Abstract

AbstractMore than 250 million children will not meet their developmental potential due to poverty and malnutrition. Psychosocial stimulation (PS) has shown promising effects for improving development in children exposed to severe acute malnutrition (SAM) but programs are rarely implemented. In this study, we used qualitative methods to inform the development of a PS programme to be integrated with SAM treatment in Mwanza, Tanzania. We conducted in-depth interviews with seven caregivers of children recently treated for SAM and nine professionals in early child development. We used thematic content analysis and group feedback sessions and organised our results within the Nurturing Care Framework. Common barriers to stimulate child development included financial and food insecurity, competing time demands, low awareness about importance of responsive caregiving and stimulating environment, poor father involvement, and gender inequality. Caregivers and professionals suggested that community-based support after SAM treatment and counselling on PS would be helpful, e.g. how to create homemade toys and stimulate through involvement in everyday chores. Based on the findings of this study we developed a context-relevant PS programme. Some issues identified were structural highlighting the need for programmes to be linked with broader supportive initiatives.Key findingsFinancial insecurity, competing time constraints, lack of awareness and poor father involvement are all barriers highlighted by families with children who have severe acute malnutrition (SAM) as negatively impacting their ability to promote nurturing care and child development.Despite knowledge of the importance of good health and adequate nutrition as important contributors to child development, caregivers of children with SAM did not always have the resources to support this.Caregivers interviewed were less familiar with the importance of responsive caregiving and opportunities for early learning as ways to support children’s development.A context-relevant programme to support psychosocial development among young children treated for SAM should include clear linkages with community-based support after discharge, but also approaches to promote involvement of fathers in childcare, and counselling of caregivers on low-cost strategies to improve nutrition and development.Other supporting social welfare initiatives in the community are needed to address the broader structural issues identified in this study.