Innovation summary

Undernutrition and poor psychosocial stimulation are two known crucial factors for the deterioration of child growth and development1. In the context of severe acute malnutrition (SAM), a sustainable recovery depends not only on health care for the child, but also for the mother. The objective of the present project is to assess the effectiveness of a combined nutrition and psychosocial intervention on child health, growth, and development, as well as maternal mental health. The protocol involves five bi-monthly psychosocial counselling sessions in which the mothers/caregivers and SAM children take part.

Impact summary

  • 630 psychosocial sessions were conducted by 6 psychosocial workers for 211 children and their mothers.
  • 52% of mothers and their children attended at least 4 or 5 sessions.
  • Mothers and caregivers became aware of the importance of child care.
  • Percentage of children recovered from SAM and percentage of mothers showing a decrease in depression are being evaluated.


"What I learned from the counselling is beneficial for life."


- Kamlabati Mandal (FUSAM beneficiary) 

Innovation details

In the brief combined nutrition psychosocial (NUTPSY) treatment, the mothers/caregivers and their severe acute malnourished (SAM) children take part in five bi-monthly 30-minute counselling sessions (in parallel to the nutritional treatment) in which their concerns and doubts around SAM illness and child care practices are heard. Appropriate strategies for child stimulation and emotional responsiveness are worked out with the support of a psychosocial counsellor. The intervention considers the mother as a patient of psychosocial support, but also as the key partner in the treatment of the undernourished child.

The content of the sessions is as follows:

  1. Family welcome
  2. Communication & play
  3. Breastfeeding & feeding
  4. Massage & bathing, sleep & relaxation
  5. Family sharing

These topics have been chosen for easy integration into the daily life activities of families, but the major transversal psychosocial drivers of the intervention are counselling and play. Through counselling, mothers listen and are encouraged to express their thoughts and feelings regarding their child’s illness, parenting challenges, and the current family situation. Through play, mothers are supported to enhance children’s stimulation and learning, practice good communication patterns, and strengthen mother-child interaction and bonding. All the referred factors are determinants for the success of childcare and general well-being of both the child and the mother.

Key drivers

  • Level of acceptance of health workers in health centres
  • Referral system in place to refer people for psychosocial counselling
  • Extension of psychosocial services to all health centres in the district upon the request of District Public Health Office
  • Access to psychosocial services to all women regardless of the problems faced


  • Delay in inclusion of participants due to lower SAM rate than previous years: implementation of continuous community screening during 5 months
  • Environmental challenges: 25th of April earthquake, adverse political events during a six month period (August 2015-February 2016), widespread area with difficulties reaching households (eg. during monsoon)
  • Reduced supervision from Kathmandu due to non-renewal of visas for expatriates, resulting in inability to conduct field visits
  • Lack of knowledge from families about child care practices as well as counselling, and low health seeking behavior
  • Slow integration of psychosocial services into the health care system due to lack of recognition by health staff: Psychosocial services are new and require continuous sensitization of staff in health centers
  • Low treatment compliance (i.e. due to other beliefs, low management of Outpatient Therapeutic Programmes [OTPs])


The innovation will be implemented in other Action contre la Faim programmes worldwide with socio-cultural adaptation of the protocol taking into consideration the maternal mental health status of the mothers.


  • District Public Health Office in Saptari district
  • Child Health Division from Ministry of Health in Kathmandu


Evaluation methods

Beneficiaries’ data were collected across four assessments periods (pre-test, post-test, 5-month, and 11-month follow-up after admission) using both quantitative and qualitative techniques in order to produce a more comprehensive understanding of the results. Eight testers, blind to the research groups and hypothesis, administered the tests to the mothers and their children during home visits. The tests included:

  1. Child’s growth and nutritional/health status (MUAC and Weight-For-Height Z-score, weight-gain, recovery and relapse rates, morbidity and mortality);
  2. Child motor, cognitive, emotional, and social development (Extended Ages and Stages Questionnaire, Squires et al, 1999);
  3. Childcare practices and stimulation (ACF Child Care Knowledge & Practices Questionnaire);
  4. Mother-child interaction (ACF Observation Mother-Child Interaction Grid); and
  5. Maternal mental health (Edinburgh Post-natal Depression Scale (Cox et al, 1987), Multidimensional Scale of Perceived Social Support (Zimet et al, 1988), Rosenberg Self-esteem Scale (Rosenberg, 1965) and WHO SRQ-20 (Beusenberg and Orley, 1994).

Cost of implementation

The cost for the implementation of the psychosocial intervention in 6 OTP centers is estimated to be 300,000 euros over 24 months.

Impact details

  • Among 427 children treated for SAM, there were 39 relapse cases
  • 630 psychosocial sessions were conducted by 6 psychosocial workers for 211 children and their mothers
  • 52% of mothers and their children attended at least 4 or 5 sessions
  • The mean span of attendance of the psychosocial intervention was 49 days
  • Mothers and caregivers became aware of the importance of child care
  • The level of overall satisfaction (including satisfaction related to the relationship with the staff and the methodology used) tended to increase throughout the sessions
  • The level of satisfaction related to the topics addresses increased between the first and the second sessions and then remained at the same level


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