Determinants of motor, language, cognitive, and global developmental delay in children with complicated severe acute malnutrition at the time of discharge: An observational study from Central India.

Navneet Khandelwal,Vandana Patil,Jagdish Mandliya,Ashish Pathak,Aditya Mathur,Kamna Nigam,Marzia Lazzerini

doi:10.1371/journal.pone.0233949

Abstract

BackgroundUndernutrition leads to impaired psychosocial and cognitive development. This study explored the developmental status of children with complicated severe acute malnutrition (SAM) and correlated it with various risk factors for SAM.Methods and findingsWe recruited 100 children with SAM and no other associated significant health issues during the recovery phase of treatment using the Bayley Scales of Infant and Toddler Development III prior to discharge from the nutritional rehabilitation unit in R D Gardi Medical College, Ujjain, Central India. We also assessed composite developmental scores, developmental age equivalents, and average differences in developmental age. Risk factors for developmental delay were identified in children with complicated SAM. The results revealed that 75%, 75%, and 63% of children with SAM exhibited delay in motor (mean score: 78.22), language (mean score: 83.97), and cognitive (mean score: 78.06) domains, respectively. A total of 63% children exhibited delay by an average of 4–7 months in the total developmental age. The proportion of children with delay in motor, language, and cognitive domains was determined. An increased risk of global developmental delay was observedin children with a low birth weight (adjusted odds ratio [aOR]: 18.06, 95%CI: 2.08–156.56; P = 0.009), having working mothers (aOR: 17.54, 95%CI: 3.02–102.59; P = 0.001), weight-for-age less than three standard deviations (aOR: 6.09, 95%CI: 1.08–34.10; P = 0.04), and presence of severe anemia (aOR: 16.34, 95%CI: 2.94–90.73; P = 0.001).ConclusionsThe results indicated that children with SAM exhibit developmental delay across all domains. Identifying multiple modifiable risk factors for developmental delay in children with SAM will be helpful in devising early interventional strategies in low-middle income countries; however, the exact timing of such interventions should be investigated.

Highlights

Undernutrition and severe acute malnutrition (SAM)are global pediatric public health problems [1, 2].Owing to acute undernutrition globally, 52 million under-5 children experience wasting and 17 million under-5 children experience SAM [1]
The results indicated that children with SAM exhibit developmental delay across all domains
Identifying multiple modifiable risk factors for developmental delay in children with SAM will be helpful in devising early interventional strategies in low-middle income countries; the exact timing of such interventions should be investigated

Summary

Introduction

Undernutrition and severe acute malnutrition (SAM)are global pediatric public health problems [1, 2].Owing to acute undernutrition globally, 52 million under-5 children experience wasting (approximately 7.7%) and 17 million under-5 children experience SAM [1]. In India, no study has used a quantitative developmental scale to assess developmental problems in children with SAM. Certain factors such as age, gender, parental literacy level, income, and occupation, family size, anemia, and birth weight are associated with SAM and child development [13]. The primary objective of this study was to assess motor, language, cognitive, and global developmental outcomes in children with SAM using Bayley Scales of Infant and Toddler Development III (BSID III). This study explored the developmental status of children with complicated severe acute malnutrition (SAM) and correlated it with various risk factors for SAM

Objectives

Methods

Results

Conclusion