The role of developmental stimulation in nutritional rehabilitation.

OBJECTIVE To evaluate the role of developmental stimulation and nutritional supplementation in rehabilitation of malnourished children in the hospital and community settings. DESIGN Prospective follow up study. SETTINGS (i) Nutrition clinic of a teaching hospital; and (ii) Community Nutrition Project in coastal Kerala. SUBJECTS (i) Hospital study: 100 children aged 6-24 months with moderate and severe Protein Energy Malnutrition (PEM) constituted the study group. The control group consisted of well nourished children matched for age and sex, 50 from high (Control I) and 50 from low socioeconomic (SE) status (Control II). The study group was randomized into two subgroups to administer the interventions namely composite stimulation package (STIM) or nutritional management (NUT). (ii) COMMUNITY STUDY: A cohort of 332 children aged 6-24 months with varying grades of PEM were studied. As per the area of residence, they were divided into three subgroups; 2 study groups to administer the two interventions namely STIM or NUT and a control group. METHODS In both the hospital and community studies, environmental parameters, growth and development were assessed initially. After two years, the study groups were reassessed in comparison with the control groups. A final IQ assessment was done in each subgroup by a tester blinded to the grouping. RESULTS (i) Hospital study: Control children from high SE status (Control I) had the highest overall scores compared to those from low SE status (Control II) as well as the study groups with PEM even after administering either STIM or NUT. Both the interventions produced a significant positive impact on growth and development, but STIM was found superior to NUT. (ii) Community study: There was a high prevalence of PEM in the community, which reduced significantly after the interventions. STIM was found superior in its positive impact on growth and development. In both studies, direct correlation was observed between environmental parameters and anthropometric scores and between anthropometric scores and IQ. CONCLUSIONS The benefit of developmental stimulation in nutritional rehabilitation and the need for providing better environment for deprived children are brought out in this study.