Predictors of Psychomotor Developmental Delay Among Under-Five Children With Severe Acute Malnutrition in a Food Insecure Setting in DRC: Exploratory Analysis of Children From EfRAMAS Trial.

This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.