Limited psychosocial stimulation and nutritional problems as associates of developmental performances of children in extreme poverty in Jimma, Ethiopia

Abstract

Background: Children living in extreme poverty lack adequate care and face increased developmental and health risks. However, few evidence on the combined influences of undernutrition and psychosocial factors on children’s developmental outcomes is available. The main objectives of this study were, therefore, to identify how nutritional indices relate to the developmental outcomes, and to investigate whether the developmental scores and psychosocial factors were associated while correcting for the effect of the nutritional indices. Methods: A cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than five years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Development in personal-social, language, fine and gross motor skills was assessed with the Denver II-Jimma and social-emotional skills with the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with developmental scores of children in extreme poverty. Results: Children in extreme poverty performed worse than the reference children in all the developmental domains. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) underweight and 27 (3.3%) wasted. The lowest performance was observed in younger children who suffered from the combination of stunting, wasting and underweight. The results also disclosed that stunting and underweight were negatively associated with all the developmental skills. After taking into account the effects of stunting and underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. Conclusion: Children living in extremely poor households were not only more likely to be undernourished but they were also highly exposed to less favorable psychosocial factors. Both conditions negatively affected their developmental outcomes independently. Intervention, for these children, should integrate home-based developmental stimulation and nutritional rehabilitation.