Behaviour of severely malnourished children in a Jamaican hospital

The behaviour of 18 children with severe malnutrition bertween the ages of six and 24 months was observed. They were compared with 21 age-matched adequately nourished children in hospital with other diseases, and were given regular developmental assessments with the Giffiths test. On admission to hospital the malnourished children were less active and more apathetic than the controls when alone in their cots, while the controls were more distressed. When given toys, initially the malnourished children explored them less, using fewer play actions and touching fewer toys. These differences were not present on recovery. Initial behaviour did not predict later developmental levels. (AU)

Selenium status during recovery from malnutrition: effects of selenium supplementation - abstract

It was previously shown that malnourished Jamaican children often had evidence of selenium deficiency, viz. low erythrocyte glutathione peroxidase (RBC GSH Px) activity that correlated inversely with cardiothoracic ratio, and was particularly low in children who died. In this study, RBC GSH Px activity, plasma GSH Px activity and plasma selenium concentration were measured in 41 malnourished children on admission to hospital, and after recovery in weight-for-height. Plasma GSH Px activity and selenium concentrations were also measured longitudinally throughout recovery in a group of 24 initially selenium-deficient children, 17 of whom were given oral selenium supplements for the first 3 weeks. RBC GSH Px activity was low in all malnourished children, whether oedematous or not (Table). It did not change with recovery. Plasma GSH Px activity and plasma selenium concentration were low only in oedematous malnourished children. PEM GROUPS: control, marasmus, oedematous; ERYTHROCYTE GSH Px (U/gHb)- *36ñ2, 24ñ4, 21ñ3 respectively; PLASMA GSH Px act. (U/L) - 140ñ9, 142ñ15, 98ñ8 respectively, PLASMA SE CONCN. (æg/e) - 86ñ4, 76ñ12, 53ñ5. *meanñSEM. Selenium was associated with a rapid rise in both plasma GSH Px activity and plasma selenium concentration. The increase in plasma selenium was more dramatic (44 up to 144 æg/e in 6 days): the variability in plasma GSH Px activity was much greater, and they remained within the control range. The changes were sustained after supplementation ceased. We conclude that (1) selenium deficiency in malnourished Jamaican children is not reversed during 'recovery' on the conventional 'high energy' diet, (2) plasma selenium concentration responds rapidly to changes in selenium intake, and is a useful measure of selenium status, and (3) oral selenium supplements improve selenium status in children recovering from malnutrition (AU)

Longitudinal study of growth and development of young Jamaican children recovering from severe protein-energy malnutrition

The developmental level and nutritional status of a group of 17 children aged between six and 24 months who were admitted to hospital with severe protein-energy malnutrition were studied from admission to hospital until 36 months after returning home. They were compared with a group of 14 adequately nourished children of similar age who had been admitted to hospital for other reasons. Initially the malnourished group were markedly behind the controls in developmental level, and they fail to reduce their deficit in hospital. Over the following 36 months they showed a gradual improvement relative to the controls in developmental level, height and head circumference, but were still significantly behind at the end of the study. In contrast, they caught up in weight for height by one momth after returning home. When length of stay in hospital, age at admission, birthweight, mother's IQ and home background measures were taken into account, the direction of the differences between the two groups and significance levels were unchanged. (AU)

Effect of long term psychosocial stimulation on mental development of severely malnourished children

The effect of adding psychosocial stimulation to the treatment of severly malnourished children was studied by comparing the developmental levels (DQs) of the children with those of two other groups of children - an adequately nourished group with diseases other than malnutrition and a second malnourished group who received standard hospital care only. The intervention children underwent structural play sessions daily in hospital and weekly for 6 months after discharge; mothers were also shown how to play with them. The non-intervention malnourished group showed a marked deficit in DQ compared with the adequately nourished group throughout the study period. The intervention group made significant improvements in DQ in hospital and continued to do so after discharge. By 6 months they were significantly behind the adequately nourished group. (AU)

The relationship between hospitalisation social background, severe protein energy malnutrition and mental development in young Jamaican children

The development levels, length of hospital stay, social and biological backgrounds of 18 young Jamaican children who had recently been hospitalised for severe PEM, and 21 adequately nourished children who had been hospitalised for other reasons were studied. Birth-weights, age severity of illness, length of hospital stay, standard of housing mothers' verbal IQ, and the quality of the micro-environment were all examined. Multiple regression analysis was carried out on the data of both groups combined. Eighty-three percent of the variance in the Developmental Quotient (DQ) was accounted for by all the background variables together. The occurrence of PEM had a greater effect on DQ than any of the other variables, and it also made the largest independent contribution to the DQ variance. Age, length of hospital stay and the quality of the micro-environment made smaller significant effects on DQ.(AU)

A longitudinal study of the mental development of severly malnourished Jamaican children - abstract

A longitudinal study of the mental development of seventeen children admitted to hospital with severe protein energy malnutrition (PEM) was commenced in 1975. They were compared with fourteen adequately nourished children hospitalized for other reasons. Throughout the three years after leaving hospital all children had regular developmental assessments on the Griffiths Mental Development Scales, and anthropomentric measurements. When they left hospital the developmental level (DQ) of the malnourished group was markedly behind that of the comparisons. During the following three years the deficit was reduced, but the malnourished group remained significantly behind. (Malnourished mean = 86.1, SD = 11.8: comparison mean = 99.7, SD = 8.2, p<01). The malnourished group was significantly behind the comparisons in each subscale of the Griffiths test. Since leaving hospital the malnourished children had reduced their deficit in "performance" and "hand and eye' subscales but not in "locomotor" or "hearing and speech" subscales. All children were given the School Achievement Test (SAT) and Peabody Picture Vocabulary Test (PPVT) between one and six months after their 36-month test. These tests have been modified for Jamaica and are used to assess children's progress in Basic School. In both tests the malnourished children were behind the well nourished. (PPVT mean: comparison = 27.5, SD = 10.9, malnourished = 19.7, SD = 9.4; p<0.5 SAT mean: comparison = 34.3, SD = 19.0, malnourished = 26.8, SD = 10.6, p<.05). The malnourished children caught up to the comparison in percentage expected weight for age, but remained significantly more stunted, with smaller head circumferences and lighter. It was concluded that Jamaican children who suffer from severe PEM in early childhood have a persistent lag in mental development and retarded physical growth for several years. It is apparent that more comprehensive care is required to ensure full rehabilitation (AU)

The experiences of young children in a Kingston Hospital, Jamaica

As a part of a study on malnourished children in hospital, observations were made of staff-child interaction in the two medical paediatric wards of the UHWI involving children below the age of 2 years and all categories of staff. The children were found to be approached infrequently and were attended to by a relatively large number of adults. When the quality of interactions was assessed, the staff were silent and neutral in affect, often not responding to the childern. Good physical care was provided, but there was little attention paid to their social, emotional and intellectual development. There was no systematic differences between wards or in the behaviour of different categories of staff, suggesting that the behaviour of different categories of staff, suggesting that the behaviour reflected the organization of the institution rather than personal characteristics of the staff. The need for programmes to provide support for all areas of the child's development during his/her stay in hospital is stressed. Such a programme is being developed at UHWI (AU)

A new look at the asssessment of mental development in young children recovering from severe malnutrition

Previous studies of malnourished children is hospital have shown that their developmental quotients (DQs) improve as their nutritional status improves, but they have not taken into account the possible effects of being in hospital and of test practice. The present study assessed development of malnourished and adequately nourished children in hospital and found that mean DQs of each group rose to a similar extent during recovery from illness. It is concluded that DQs on admission to hospital were lowered by the children's discomfort and unhappiness at being in hospital, and/or by illness, and that rises in DQ shown by children recovering from malnutrition are not necessarily attributable to improving nutritional status. (AU)