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Emotional Stimulation in the Context of Emergency Food Intervention in the Treatment of Malnourished Children: a Randomised Controlled Trial

  • Research Project Team

    Research project team members

    • Professor Peter Fonagy
    • Dr Alessandro Conticini
    • Rose Palmer


    • Lynn Murray
    • Chris McManus
    • Rodney Rivers


  • Background

    Malnutrition has a devastating impact on children’s life chances; it is implicated in 50% of all deaths of under-fives worldwide and also affects children’s intellectual ability, capacity to learn and ability to make friends.

    The introduction of emergency food supplements has led to huge increases in the rates of child survival in East Africa. Despite these improvements, 44% of children in Ethiopia are stunted (low height for age) and 10% are wasted (low weight for height).

    Increasingly, research suggests that food interventions work better when they are combined with approaches that focus on strengthening the bond between mother and child. Our trial investigates the effectiveness of a simple play therapy (emotional stimulation) compared to a control intervention (nutrition education) on the recovery of 400 severely malnourished young children in Ethiopia.

  • Aims

    To test whether compared to the control intervention emotional stimulation leads to

    • Faster recovery of children with severe acute malnutrition
    • Greater improvements in social and emotional outcomes of the children
    • Greater improvements in the mothers’ wellbeing and sense of mastery

    We also aim to establish protocols to ensure that this intervention can be scaled up beyond the experimental sites.

  • Methodology

    This study is a cluster-randomised controlled trial comparing two interventions for the treatment of severely malnourished children aged between 6 months and 5 years. It is being carried out in the Southern Nations, Nationalities and People’s Region (SNNP) of Ethiopia.

    The 400 children taking part had all presented with malnourishment to the community health services in their local areas. The services had been randomly allocated to offer either emotional stimulation (12 health posts) or nutritional education (12 health posts) in addition to emergency food supplements.

    Both interventions were delivered by local health extension workers (health care assistants) and paid young volunteers recruited from neighbouring villages. They each involved 12 weekly one hour coaching sessions, either in the home or at the health post. The emotional stimulation intervention focuses on improving the parent child relationship, whereas the nutritional education focuses on dietary and hygiene issues.

    To assess the extent and rate of weight gain in the children, the health extension workers took height and weight measurements at enrolment and at 1, 7, 12 and 24 weeks following treatment. They also collected data on the children’s social and emotional development and the mothers’ wellbeing using tools that had been translated into the local language.