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Prehl U.1, Brus A.1, Botokro R.1, Boltz C.2
1Handicap International, Lyon, France, 2Handicap International, Bamako, Mali
Background: In the management of severe acute malnutrition (SAM), WHO guidelines and the national protocol for the management of acute malnutrition in Mali recommended adding physical and psychosocial stimulation to nutrition and curative medical treatment. As part of a development project Handicap International introduced the unprecedented association of early stimulation activities conducted by health workers and stimulative Physical Therapy provided by national Physical Therapists in to their clinical care of malnutrition.
Purpose: To analyse the short term effects of stimulative Physical Therapy during the nutritional recovery stage of SAM management on the physical, psychomotor and cognitive development of children in the age of 6 to 59 months, referred to specialised health facilities in Bamako, Mali.
Methods: Study design: A cohort study was conducted to compare the psychomotor and cognitive development of children with SAM, who had received comprehensive treatment (stimulation sessions and stimulative physical therapy sessions (case group) with children who had not received stimulative physical therapy (control group: stimulation sessions only).
Inclusion criteria: All children aged between six months and five years admitted to phase II of nutritional recovery on six study sites (3 intervention sites and 3 control sites) between 1 April 2014 and 15 July 2014, having received at least five stimulative physical therapy sessions.
Group 1) 120 children with stimulative physical therapy,
Group 2) 118 children without stimulative physical therapy.
Results: Nutritional status and anthropometric variables:
Between D1 and D35, percentages of severe wasting (weight for height under 3 z-scores) and severe stunting (height for age under 3 z-scores) decreased in case group
Psychomotor and cognitive development:
On D35 the average developmental delay is less important among children who received stimulative physical therapy 5,0 +/- 8,4 months in case group vs 6,3 +/- 6,7 months in control group, p 0,05)
On D35 the magnitude of developmental delay is less important among children who received stimulative physical therapy. 32,5% of case children are not delayed anymore after 35 days vs 4,2% of control children.
On D35 general development score and motricity score are significantly greater among children who received stimulative physical therapy,( respectivley 0,81 +/- 0,21 in case group vs 0,75 +/- 0,19 in control group; and 0,72 +/- 0,30 in case group vs 0,53 +/- 0,28 in control group, p 0,05)
Conclusion(s): Individual stimulative physical therapy sessions, in complement of WHO recommendations, positively contributed towards improving the physical, psychomotor and cognitive development of these children treated for severe acute malnutrition.
Implications: This study proves that individual physical therapy sessions have a positive impact on the developmental delay of children suffering from severe acute malnutrition. This study then led in to a regional project by Handicap International called ESSPOIR ("les enfants malnutris du Sahel sont stimulés, protégés, orientés et integré dans leur communautaire devenue plus resiliente" = the malnourished children of the Sahel are stimulated, protected, orientated and integrated in to their community), where individual physical therapy sessions are being provided alongside with cognitive and psychosocial support. This combines the psychomotor, cognitive and psychosocial aspect to one holistic approach of nutritional recovery.
Funding acknowledgements: UNICEF Agency Mali
Topic: Disability & rehabilitation
Ethics approval: Respect of ethical prinicipals and approval from the ethics commitee of Bamako, Faculté de Médecine, de Pharmacie et d´Odontostomatologie
All authors, affiliations and abstracts have been published as submitted.
