Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial

Abessa, Teklu Gemechu; Worku, Berhanu Nigussie; Wondafrash, Mekitie; Girma, Tsinuel; Valy, Johan; Lemmens, Johan; Bruckers, Liesbeth; Kolsteren, Patrick; Granitzer, Marita

doi:10.1186/s12887-019-1696-z

Table 5 Regression coefficients [95% CI] from the GEE models ^a with a continuous time scale (days in the study) depicting average change in developmental, growth and nutritional status during follow-up of the intervention

From: Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial

Explanatory variables			Developmental outcomes
			FM	GM	LA	PS	SE
			β (95%CI)	β (95%CI)	β (95%CI)	β (95%CI)	β (95%CI)
Group ^b			0.099 ^h [− 0.18, 0.38] p = 484	0.37 ^h [0.09, 0.65] p = 0.010	− 0.17 ^g [− 0.55, 0.21] p = 0.377	0.11 ^g [− 0.39, 0.16] p = 0.419	− 0.22 ^g [− 3.55, 3,11] p = 0.898
Time ^c	Linear term		1.10 ^h [0.91, 1.21] p < 0.001	1.10 ^h [0.93, 1.24] p < 0.001	0.81 ^h [0.68, 00.95] p < 0.001	1.46 ^h [1.12, 1.80] p < 0.001	−4.30 ^g [− 10.11, 1.57] p = 0.151
	Quadratic term		−0.05 ^g [− 0.13, 0.02] p = 0.151	0.04 ^g [− 0.05, 0.12] p = 0.330	− 0.03 ^g [− 0.13, 0.06] p = 0.480	−0.06 ^g [− 0.10, − 0.01] p = 0.019	0.39 ^h [0.24, 0.54] p < 0.001
Baseline data	MUACZ		0.15 ^h [0.07, 0.24] p < 0.001	0.07 ^g [−0.02, 0.16] p = 0.127	–	0.13 ^h [0.06, 0.20] p < 0.001	−0.45 ^g [− 1.30, 0.41] p = 0.310
	WAZ		–	–	0.20 ^h [0.09, 0.31] p < 0.001	–	–
	Development		0.76 ^h [0.71, 0.81] p < 0.001	0.93 ^h [0.88, 0.98] p < 0.001	0.81 ^h [0.76,0.86] p < 0.001	0.87 ^h [0.83, 0.92] p < 0.001	0.86 ^h [0. 81, 0. 91] p < 0.001
	Age		0.06 ^h [0.04, 0.08] p < 0.001	0.03 ^h [0.01, 0.04] p < 0.001	0.08 ^h [0.05, 0.10] p < 0.001	0.04 ^h [0.02, 0.06] p < 0.001	0.13 ^h [0.04, 0.23] p = 0.008
Interactions of Time ^c with	Baseline development		−0.06 ^h [− 0.07, − 0.04] p < 0.001	− 0.06 ^h [− 0.07, − 0.04] p < 0.001	−0.06 ^h [− 0.08, − 0.05] p < 0.001	−0.07 ^h [− 0.08, − 0.06] p < 0.001	−0.08 ^h [− 0.09, − 0.06] p < 0.001
	Baseline Age		0.01 ^h [0.001, 0.012] p = 0.018	0.02 ^h [0.01, 0.022] p < 0.001	0.03 ^h [0.02, 0.04] p < 0.001	0.014 ^h [0.001, 0.02] p = 0.001	0.04 [0.01, 0.06] p = 0.010
Interactions of Group with	Time ^c (Linear)		0.15 ^g [0.07, 0.22] p < 0.001	0.41 ^g [− 0.44, 1.27] p = 0.344	0.02 ^g [− 0.92, 0. 96] p = 0.971	− 0.06 ^g [− 0.72, 0.59] p = 0.850	1.63 ^g [−6.73, 9,98] p = 0.703
	Interaction of Sex ^f with Time (Linear)	Control female	− 0.02 ^g [− 0.13, 0.08] p = 0.657	−0.07 ^g [− 0.20, − 0.06] p = 0.302	−0.08 ^g [− 0.21, 0.05] p = 0.240	−0.004 ^g [− 0.1, 0.09] p = 0.940	0.29 ^g [− 0.92, 0.50] p = 0.638
		Intervention Female	0.01 ^g [− 0.09, 0.11] p = 0.827	− 0.02 ^g [− 0.14, − 1.00] p = 0.742	0.04 ^g [− 0.08, 0.17] p = 0.525	−0.08 ^g [− 0.17, 0.01] p = 0.086	−0.47 ^g [− 1.60, 0.67] p = 0.421
	Interaction of Baseline development with Time (Linear)		0.02 ^g [−0.01, 0.04] p = 0.206	− 0.02 ^g [− 0.05, 0.003] p = 0.086	0.004 ^g [− 0.02, 0.03] p = 0.765	−0.02 ^g [− 0.04, 0.004] p = 0.102	−0.02 ^g [− 0.04, 0.01] p = 0.236
	Interaction of Baseline Age with Time (Linear)		−0.005^g [− 0.01, 0.004] p = 0.253	0.01 ^g [− 0.004, 0.01] p = 0.278	0.001 ^g [− 0.01, 0.01] p = 0.889	0.01 ^g [− 0.001, 0.02] p = 0.072	−0.01 ^g [− 0.07, 0.06] p = 0.861
			Linear growth ^d and nutritional ^e outcomes
Explanatory variables			HAZ	MUACZ	WAZ		WHZ/BAZ
Group ^b			−0.26 ^g [− 0.57, 0.06] p = 0.101 p = 0.113	0.07 ^g [− 0.12, 0.26] p = 0.461	−0.215 ^g [− 0.05, 0.47] p = 0.119		0.22 ^g [− 0.13, 0.58] p = 0.214
Time ^c	Linear term		− 0.09 ^h [− 0.11, − 0.07] p < 0.001	0.19 ^g [− 0.05, 0.44] p = 0.122	0.28 ^g [0.04, 0.53] p = 0.025		0.33 ^h [0.07, 0.59] p = 0.008
	Quadratic term		0.004 ^g [− 0.03, 0.02] p = 0.765	−0.02 ^g [− 0.05, 0.02] p = 0.360	−0.03 ^g [− 0.06, 0.001] p = 0.061		−0.04 ^h [− 0.08, − 0.001] p = 0.045
Baseline data	HAZ		0.85 ^h [0.81, 0.88] p < 0.001	0.004 ^g [− 0.02, 0.03] p = 0.727	0.07 ^h [0.01, 0.13] p = 0.024		0.02 ^g [− 0.10, 0.14] p = 0.733
	MUACZ		–	0.92 ^h [0.88, 0.96] p < 0.001	–		–
	WAZ		0.13 ^h [0.08, 0.17] p < 0.001	0.08 ^h [0.04, 0.13] p = 0.001	0.85 ^h [0.79, 0.90] p < 0.001		0.004 ^g [− 0.22, 0.21] p = 0.972
	WHZ or BAZ		–	–	–		0.82 ^g [0.75, 0.88] p < 0.001
	Age		−0.005 ^g [− 0.01, − 0.001] p = 0.011	−0.001 ^g [− 0.003, 0.003] p = 0.949	0.002 ^g [− 0.001, 0.004] p = 0.219		0.01 ^h [0.001, 0.010] p = 0.012
Interactions of Time ^c with	Baseline HAZ		−0.033 ^h [− 0.038, − 0.028] p < 0.001	0.01 ^g [− 0.01, 0.04] p = 0.202	0.01 ^g [− 0.01, 0.04] p = 0.265		0.005 ^g [− 0.03, 0.04] p = 0.782
	Baseline MUACZ		–	− 0.09 ^h [− 0.10, − 0.08] p < 0.001	–		–
	Baseline WAZ		0.01 ^g [− 0.04, 0.05] p = 0.800	− 0.01 ^g [− 0.04, 0.02] p = 0.556	− 0.042 ^h [− 0.05,-0.036] p < 0.001		0.02^g [− 0.04, − 0.07] p = 0.510
	Baseline WHZ or BAZ		–	–	–		− 0.09 ^h [− 0.11, − 0.07] p < 0.001
	Baseline Age		0.001 ^g [− 0.002, 0.004] p = 0.547	−0.001 ^g [− 0.004, 0.002] p = 0.589	−0.001 ^g [− 0.003, 0.001] p = 0.328		0.0002 ^g [− 0.003, 0.002] p = 0.824
Interactions of Group with,	Interaction between Time ^c and baseline HAZ		0.02 ^g [− 0.01, 0.05] p = 0.260	–	–		–
	Interaction between Time and baseline MUACZ		–	−0.01^g [− 0.005, 0.05] p = 0.879	–		–
	Interaction between Time and baseline WAZ		–	–	−0.001^g [− 0.05, 0.05] p = 0.970		–
	Interaction between Time and baseline WHZ or BAZ		–	–	–		0.02 ^h [0.01, 0.04] p = 0.012
	Interaction between Time and sex	Female control	−0,02 ^g [− 0.08, 0.05] p = 0.594	−0.04 ^g [− 0.12, 0.05] p = 0.408	−0.05 ^g [− 0.12, 0.02] p = 0.136		−0.03 ^g [− 0.12, 0.06] p = 0.514
		Female Intervention	−0.004 ^g [− 0.05, 0.04] p = 0.868	−0.06 ^g [− 0.12, 0.01] p = 0.102	−0.05 ^g [− 0.17, 0.06] p = 0.389		−0.01 ^g [− 0.08, 0.06] p = 0.819

Only significant terms (at p < 0.05) were kept in the models
BAZ body-mass-index-for-age z score, FM fine motor, GEE Generalized Estimating Equations, GM gross motor, HAZ height/length-for-age z score, LA language, MUACZ mid-upper-arm circumference -for-age z score, PS personal social, SE social-emotional, WAZ weight-for-age z score, WHZ weight-for-height/length z score
^a Intervention effect controlling for baseline score, baseline characteristics, and interactions with time. ^b Refers to the intervention group (treatment)
^c ‘Time’ refers to number of days in the study (duration of follow-up); ^d ‘growth’ refers to baseline linear growth expressed in HAZ score
^e‘nutritional’ refers to baseline nutritional status expressed in MUACZ score and WAZ score. ^f sex; the reference is female
^g Parameter estimates obtained from a full model by simultaneously including all potential explanatory variables
^h Parameter estimates obtained from a reduced model with statistically significant explanatory variables along with only essential non-significant model terms

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