Journal Article

Child play and caregiver support to promote convalescence following severe acute malnutrition in Zimbabwe: The Tamba‐SAM pilot study

Kabongo, Jacqueline, Dzikiti, Anesu, Dzapasi, Lloyd, Cordani, Isabella, Mudawarima, Louisa, Tome, Joice, Chasekwa, Bernard, Langhaug, Lisa F., Majo, Florence D., Mutasa, Batsirai, Prendergast, Andrew J., Bwakura‐Dangarembizi, Mutsa, Ntozini, Robert, Munetsi, Epiphania

2025

Overview

Children hospitalised for severe acute malnutrition (SAM) have a high risk of mortality, relapse and rehospitalisation following hospital discharge. Current approaches fail to promote convalescence, or to address the underlying social determinants of SAM, meaning that restoration of long‐term health, growth and neurodevelopment is not achieved. Although guidelines recommend play and stimulation to promote recovery, most caregivers are not supported to do this at home. We set out to evaluate the feasibility and acceptability of a codesigned intervention package aimed at providing child stimulation through play, and strengthening caregiver capabilities through problem‐solving skills, peer support and income‐generating activities. We evaluated the intervention in two phases, enroling 30 caregiver–child pairs from paediatric wards in Harare, Zimbabwe, once children who had been hospitalised with SAM were ready for discharge. Children were median 17.8 months old, and 28.6% had human immunodeficiency virus. Trained intervention facilitators (IFs)—lay workers whose own children had previously had SAM—delivered the intervention over 12 weeks with nurse supervision. Qualitative interviews with caregivers and IFs showed that the intervention was feasible and acceptable. Participants reported benefiting from the psychosocial support and counselling, and several started income‐generating projects. Caregivers appreciated the concept of play and caregiver–child interaction, and all reported practising what they had learned. By Week 12, caregiver mental health and caregiver–child interaction improved significantly. Overall, the intervention was feasible, acceptable and showed promise in modifying caregiver knowledge, attitudes and practice. An efficacy trial is now needed to evaluate whether the intervention can improve child convalescence following complicated SAM. We codesigned an intervention package for children recovering from complicated severe acute malnutrition (SAM) in Zimbabwe, providing child stimulation through play, and strengthening caregiver capabilities through problem‐solving skills, peer support and income‐generating activities. The package was delivered by trained lay workers and was feasible and acceptable to caregivers, providing a potential new strategy to holistically enhance the home psychosocial environment during SAM convalescence. Key messages A psychosocial intervention which enhances child play and promotes caregiver support may improve convalescence following severe acute malnutrition. We co‐designed a complex intervention, designed to provide child stimulation through play, and to strengthen caregiver and household capabilities through problem‐solving skills, peer support and income‐generating activities. The 12‐week intervention, delivered by trained lay workers whose own children had previously had SAM, was feasible and acceptable, and caregivers showed improvements in mental health and caregiver‐child interaction. This psychosocial support package should now be tested in a randomised trial to evaluate its efficacy in promoting convalescence.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Acceptability / Adult / Attitudes / Caregivers / Caregivers - psychology / Child, Preschool / Children / Children & youth / Convalescence / Discharge / Efficacy / Feasibility / Feasibility Studies / Female / High risk / HIV / Human immunodeficiency virus / Humans / Income / Infant / Intervention / Male / Malnutrition / Mental health / Mortality risk / Original / Pediatrics / Pilot Projects / Play and Playthings / Problem solving / Psychosocial factors / Psychosocial support / Relapse / Severe Acute Malnutrition - therapy / Social factors / Social meaning / Social Support / Stimulation / Stimuli / Zimbabwe