Under nutrition in early childhood affects around 150 million children under five years old globally. It is associated with poverty and limited mental stimulation and can lead to poor mental development. However, with resources, children's mental development can be improved if psychological and social stimulation are included in their primary health care services.

Researchers with the University of the West Indies randomly recruited groups of children from clinics in Jamaica from the urban parishes of Kingston, St Andrew and St Catherine.  The children’s mental development was assessed at the beginning of the study and one year later.

The researchers used the Griffiths mental development scales which measure the rate of development of children from birth to 8 years based on play with a series of toys. The researchers also measured the children’s weight and height and assessed mothers’ knowledge and practices of childrearing, socioeconomic status and verbal IQ (intelligent quotient). A control group was also used to compare the progress of the children.

Over a one year period community health visitors regularly called on the homes of children in the groups.  During the visits they watched how the children played. This assessment followed the Griffiths scales by leaving different toys in the homes each week and exchanging them at each visit.   They also discussed parenting issues in addition to giving advice on health and nutrition.  At the end of the year 93 percent of the children originally enrolled were reassessed.

The study revealed significant benefits to the children’s development:

• At the end of one year the test group showed a greater level of mental development than the control group.
• The test group also scored considerably higher for hearing, speech and hand and eye coordination.
• The intervention had no significant effect on locomotor skills such as walking, running and jumping.
• There was no noteworthy effect on height or body mass index in the test group.
• The study produced a significant benefit to mothers’ knowledge and practice of child rearing.

Jamaican public health visitors ran the trial successfully based on the curriculum in addition to performing their usual duties.  Their activities significantly reduced a decline in mental development levels, which is common in children from low income households in Jamaica.

Policy lessons which arise from the study include:

• An earlier pilot study had shown that mothers were very reluctant to attend group meetings in clinics. As in this study, a successful intervention may require a programme of home visits. 
• Governments need to commit additional resources to enable child development activities to be integrated into primary health care services.
• Resources would be needed to cover the costs of: training for health visitors and clinic nurses to deliver and supervise the programme; the recruitment and salary costs of a full time programme coordinator; production of curriculum manuals; and purchase of tools and materials for making toys.
• The cost and workload of staff varies from country to country and the number of children served would depend on this.  In this study it was determined that each aide could visit three to five children in addition to their usual duties.

In resource-poor countries there is a limit to the number of children who can be visited, and so the programme would be most suitable for those who are most undernourished.  For the benefits to children to be sustained over the longer term, the reported improvements to mothers’ knowledge and practice of childrearing is important to ensure children receive the nutrition and mental stimulation they need in order to develop.

Source(s):
‘Feasibility of integrating early childhood stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial’, British Medical Journal 329(7457): 89, by C. Powell, H. Baker-Henningham et al, 2004 Full document.

Funded by: Thrasher Research Fund, USA; British High Commission, Uganda; UK Department for International Development, Jamaica; University of the West Indies Mona Campus research and publications fund.

id21 Research Highlight: 10 May 2005

Further Information:
Christine Powell
Epidemiology Research Unit
University of the West Indies
Mona, Kingston
Jamaica

Contact the contributor: christine.powell@uwimona.edu.jm

Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica

Other related links:
'Zinc supplementation during pregnancy: does it improve mental development in children?'

'Gloomy prospects – effects of postnatal depression on infants’ development'

'Lessons in nutrition: stunting and anaemia in Tanzanian schoolchildren'

'Underweight and stunting: wake-up call for nutritionists in South Asia'

World Health Organisation, Child and Adolescent Health: nutrition

Griffiths Mental Development Scales

See id21's collection of links relevant to maternal and child health.