Palmer, RAC; (2016) Emotional stimulation as an addition to therapeutic food intervention for treatment of young children with severe acute malnutrition in a low-income country. Doctoral thesis , UCL (University College London).

Abstract

This thesis presents the results of a series of studies evaluating the potential of a short, low-cost intervention aiming to enhance the sensitivity of mothers of severely malnourished children in Ethiopia. The emotional stimulation (ES) intervention was integrated with the existing nutrition programme and delivered by local health workers and lay workers. There are five empirical chapters. 1) A pilot trial of the ES intervention, which demonstrated that it was feasible to implement the intervention in Ethiopia and provided preliminary evidence of the intervention’s potential. 2) A cluster randomised controlled trial (RCT) comparing the ES intervention to an attention placebo control. This study demonstrated that the ES intervention led to improvements in the rate of children’s BMI gain and to improvements in their socio-emotional functioning. The intervention had little impact on maternal psychosocial functioning, with the exception of on social symptoms. 3) A cross-sectional study with a subsample from the cluster RCT demonstrated that the ES intervention was associated with improved cognitive performance and behaviour of children. 4) Another cross-sectional study with a subsample from the cluster RCT found that the ES intervention was associated with higher quality parent–child interaction, but did not impact on children’s interactive behaviour. The improvements in maternal sensitivity did not mediate the effects of the intervention on BMI gain, but there was inadequate power to detect an effect. 5) A 1-year follow-up of the cluster RCT demonstrated that the group difference in children’s BMI was not maintained but that there were continued improvements in maternal social functioning in the ES group, and evidence for some benefits to depressive symptoms. The ES intervention may therefore be of benefit to children during the acute stages of malnutrition, but is unlikely to have an enduring impact. The improvements in maternal psychosocial functioning require further investigation.

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