Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial

Eur J Clin Nutr. 2012 Jun;66(6):701-9. doi: 10.1038/ejcn.2012.13. Epub 2012 Feb 22.


Background/objective: Psychosocial stimulation (PS) and food supplementation (FS) improve development of malnourished children. This study evaluates the effects of a community-based approach of PS and FS on growth and development of severely malnourished children.

Subjects/methods: Severely underweight hospitalised children aged 6-24 months (n = 507) were randomly allocated on discharge to five groups: (i) PS, (ii) FS, (iii) PS+FS, (iv) clinic-control and (v) hospital-control. PS included play sessions and parental counselling on child development. This was done at each fortnightly follow-up visit, that is, every second week, for 6 months at community clinics. FS included distribution of cereal-based food packets (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplementation, health-education and growth monitoring. Children's development was assessed using revised version of Bayley Scales of Infant Development at baseline and after 3 and 6 months of intervention. Anthropometry was measured using standard procedure.

Results: Comparing groups with any stimulation with those with no stimulation there was a significant effect of stimulation on children's mental development index (group*session interaction P = 0.037, effect size = 0.37 s.d.) and weight-for-age Z-score (group*session interaction P = 0.02, effect size=0.26 s.d.). Poor levels of development and nutritional status were sustained, however, due to their initial very severe malnutrition. There was no effect on motor development and linear growth.

Conclusion: Children receiving any stimulation showed a significant benefit to mental development and growth in weight. More intensive intervention with longer duration is needed to correct their poor developmental levels and nutritional status.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bangladesh
  • Body Weight
  • Child Development*
  • Child Nutrition Disorders / diet therapy
  • Child Nutrition Disorders / psychology
  • Child Nutrition Disorders / therapy*
  • Child, Preschool
  • Community Health Services*
  • Counseling
  • Dietary Supplements*
  • Edible Grain
  • Female
  • Growth
  • Health Education
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Micronutrients / therapeutic use
  • Nutritional Status*
  • Parents
  • Play and Playthings
  • Protein-Energy Malnutrition / diet therapy
  • Protein-Energy Malnutrition / psychology
  • Protein-Energy Malnutrition / therapy*
  • Psychosocial Deprivation*
  • Severity of Illness Index


  • Micronutrients