Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar

Hasina Rakotomanana; Deana Hildebrand; Gail E Gates; David G Thomas; Fanjaniaina Fawbush; Barbara J Stoecker

doi:10.1186/s41043-023-00399-x

Home stimulation, development, and nutritional status of children under 2 years of age in the highlands of Madagascar

J Health Popul Nutr. 2023 Jun 29;42(1):59. doi: 10.1186/s41043-023-00399-x.

Authors

Hasina Rakotomanana¹, Deana Hildebrand², Gail E Gates², David G Thomas³, Fanjaniaina Fawbush⁴, Barbara J Stoecker²

Affiliations

¹ Department of Nutritional Sciences, Oklahoma State University, 301 Nancy Randolph Davis Building, Stillwater, OK, 74078, USA. hasina.rakotomanana@okstate.edu.
² Department of Nutritional Sciences, Oklahoma State University, 301 Nancy Randolph Davis Building, Stillwater, OK, 74078, USA.
³ Department of Psychology, Oklahoma State University, Stillwater, USA.
⁴ Department of Agricultural and Food Science and Technology, University of Antananarivo, Antananarivo, Madagascar.

Abstract

Background: The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11-13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region.

Methods: Cognitive (n = 36), language (n = 36), motor (n = 36), and socioemotional (n = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z-score < - 2) and underweight (weight-for-age z-score < - 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents.

Results: Almost all mothers reported that parent-child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children's toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 < r < 0.7, p < 0.05].

Conclusions: The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

Keywords: Child development; Home stimulation; Madagascar; Undernutrition.

MeSH terms

Child Development*
Child, Preschool
Growth Disorders* / epidemiology
Growth Disorders* / etiology
Home Environment
Humans
Infant
Infant Nutrition Disorders* / epidemiology
Infant, Newborn
Madagascar / epidemiology
Malnutrition / epidemiology
Mother-Child Relations*
Nutritional Status*
Parent-Child Relations
Parenting

Supplementary concepts

Madagascan people