The effects of a cognitively-oriented intervention programme on the development of severely malnourished children
18 severely malnourished Jamaican children (the Non-Intervention group), admitted to hospital between 6 and 24 months of age, were compared with a group of 21 well-nourished (Comparison) children of similar ages and social backgrounds, admitted during the same period. The malnourished children received the standard medical care and nutritional rehabilitation. Both groups were assessed at intervals on the Griffiths test and it was found that although they showed a similar pattern of change in developmental quotients (DQ) during the period of the study, the malnourished children obtained significantly lower scores than the well-nourished children at each test. The malnourished children developed at similar rates to the well-nourished children and therefore showed little sign of catching up in DQ. In behaviour observation sessions on admission to hospital, the malnourished children were more likely to be apathetic than the well-nourished children and the well-nourished children were more likely to cry and show acute distress when they were unattended in their cots. When given a set of toys, the groups were significantly different in the quality of their play, with the well-nourished children using more of a wider range of actions on more of the toys. Most of these differences had disappeared by discharge. A second group of 21 malnourished children (the Intervention group) participated in a structured programme of play activities in hospital, followed by weekly visits after discharge involving the mothers. 6 months after discharge, the Intervention group were significantly different from the Non-Intervention and the Comparison groups in general DQ on the Griffiths test. The Intervention children had caught up with the Comparison children on the Hearing and Speech and Hand-Eye Co-ordination subscales of the test, and were significantly ahead of the Non-Intervention children on the Performance subscale, but showed no significant advantage in Locomotor development. The interpretation and implications of these findings are discussed.