Evaluation of the psychosocial impacts of baby friendly spaces for Rohingya refugee mothers and their malnourished infants living in Cox's Bazar, Bangladesh

BACKGROUND AND AIMS
Despite the well-recognised risk poor maternal mental health poses to child growth, it is still rarely addressed in global health programming. There is also a relative lack of evidence for low-intensity psychosocial programmes aiming at improving or promoting maternal mental health in humanitarian contexts within low- and middle-income countries (LMICs). In Bangladesh, we sought to evaluate the effectiveness of a psychosocial support programme for Rohingya refugee mothers and their malnourished infants under two years old.

METHODS
Using matched pair randomisation, ten Baby-Friendly Spaces (BFS) programme sites were allocated to either service delivery “as usual” or to an “enhanced BFS programme” after re-training and providing continuous supervision of the Mental Health and Psychosocial Support (MHPSS) staff. 600 mothers and their infants were enrolled in the study, with data collected at baseline and 8-week follow-up. Primary outcomes included maternal distress and well-being; functioning; and coping. We also collected data on child gross motor milestones and child psychosocial stimulation.

RESULTS
Relative to “as usual” sites, mothers in “enhanced BFS programme” sites reported greater reductions in distress (B=-0.30) and improvement in well-being (B=0.58). These differences were small, but marginally significant (p=0.058; p=0.038 respectively) with standard estimation. Among children who, at baseline, were at both a similar age and similar stage of development, the average stage of development score at follow-up for children in the intervention group was 0.14 points lower than for children in the control group, but this difference was not significant (p=0.488).

CONCLUSIONS
Integrating psychosocial support activities with nutrition services has the potential to reduce distress and improve subjective well-being of conflict-affected mothers of malnourished children. Results were weaker for improving functioning and positive coping. Small but feasible adjustments to implementation can both improve programme delivery to maximise impact and support the effectiveness of research.