Primary care

Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial

BMJ 2004; 329 doi: 10.1136/bmj.38132.503472.7C (Published 8 July 2004)
Cite this as: BMJ 2004;329:89
  1. Christine Powell, senior lecturer (christine.powell{at}uwimona.edu.jm)1,
  2. Helen Baker-Henningham, lecturer2,
  3. Susan Walker, professor1,
  4. Jacqueline Gernay, health systems and services development advisor3,
  5. Sally Grantham-McGregor, professor4
  1. 1 Epidemiology Research Unit, University of the West Indies, Mona, Kingston, Jamaica
  2. 2 Department of Educational Studies, University of the West Indies
  3. 3 Pan American Health Organization/World Health Organization, Kingston, Jamaica
  4. 4 Centre for International Child Health, Institute of Child Health, London WC1N 1EH
  1. Correspondence to: C Powell
  • Accepted 1 April 2004

Abstract

Objectives To assess the feasibility of integrating early psychosocial stimulation into primary care for undernourished children and to determine the effect on children's development and mothers' knowledge and practices of childrearing.

Design Cluster randomised controlled trial.

Setting 18 clinics in three Jamaican parishes.

Participants 139 undernourished children aged 9 to 30 months and their mothers enrolled in intervention or control clinics.

Interventions Weekly home visits by community health aides for one year in addition to usual duties. Parenting issues were discussed with the mothers and play activities were demonstrated with the children using homemade materials.

Main outcome measures Children's scores on the Griffiths mental development scales and mothers' knowledge and practices of childrearing measured by questionnaires.

Results Children from the intervention group showed significant improvements in development: developmental quotient, 7.8 points (95% confidence interval 4.5 to 11.1); hearing and speech, 10.7 (5.9 to 15.4 points); hand and eye coordination, 6.8 (3.4 to 10.1 points); and performance subscale, 11.0 (5.6 to 16.4 points). No improvements were shown on the locomotor subscale. The mothers from the intervention group showed improved knowledge and practices of childrearing. Change in children's body mass index and height independently affected change in development.

Conclusion Integrating parenting skills and early psychosocial stimulation for undernourished children into primary care was feasible and effective in improving the children's development and mothers' knowledge and practices of childrearing.

Footnotes

  • We thank research assistants Pauline Alcott, Ava Mundell, Joan Thomas, and Michael Ennis, and the public health nurses, the community health aides, the clinic staff, and the parents and children who participated in the study.

  • Contributors CP, SGM, SW, JG were responsible for the conceptualisation and design of the study. CP and HBH supervised the intervention. HBH, SGM, and CP analysed the data and HBH drafted the paper. All authors contributed to the critical review of the paper and approved the final draft for publication. CP will act as guarantor for the paper.

  • Funding This study was supported by the Thrasher Research Fund, USA, with subsidiary grants from the British High Commission's Department for International Development, Jamaica, and the University of the West Indies Mona Campus research and publication fund. The Ministry of Health Jamaica supported the community health aides. This work was undertaken in collaboration with Great Ormond Street Hospital for Children NHS Trust, which receives a proportion of its funding from the NHS Executive.

  • Competing interests None declared.

  • Ethical approval University of the West Indies ethics committee and the Ministry of Health, Jamaica.

  • Accepted 1 April 2004

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