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DeLacey E, Tann C, Groce N, Kett M, Quiring M, Bergman E, Garcia C, Kerac M. The nutritional status of children living within institutionalized care: a systematic review. PeerJ 2020; 8:e8484. [PMID: 32071812 PMCID: PMC7007983 DOI: 10.7717/peerj.8484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/29/2019] [Indexed: 12/19/2022] Open
Abstract
Background There are an estimated 2.7 million children living within institutionalized care worldwide. This review aimed to evaluate currently available data on the nutrition status of children living within institutionalized care. Methods We searched four databases (Pubmed/Medline, CINHAL Plus, Embase and Global Health Database) for relevant articles published from January 1990 to January 2019. Studies that included information on anthropometry or micronutrient status of children living within institutionalized care were eligible for inclusion. The review is registered on PROSPERO: CRD42019117103. Results From 3,602 titles screened, we reviewed 98 full texts, of which 25 papers were eligible. Two (8%) studies reported data from multiple countries, nine (36%) were from Asia, four (16%) from Africa, three (12%) from Eastern Europe, four (16%) from the European Union and one (4%) from each of the remaining regions (Middle East, South America and the Caribbean). Twenty-two (88%) were cross sectional. Ten (40%) of the studies focused on children >5 years, seven (28%) on children <5 years, seven (28%) covered a wide age range and one did not include ages. Low birth weight prevalence ranged from 25–39%. Only five (20%) included information on children with disabilities and reported prevalence from 8–75%. Prevalence of undernutrition varied between ages, sites and countries: stunting ranged from 9–72%; wasting from 0–27%; underweight from 7–79%; low BMI from 5–27%. Overweight/obesity ranged from 10–32% and small head circumference from 17–41%. The prevalence of HIV was from 2–23% and anemia from 3–90%. Skin conditions or infections ranged from 10–31% and parasites from 6–76%. Half the studies with dietary information found inadequate intake or diet diversity. Younger children were typically more malnourished than older children, with a few exceptions. Children living within institutions were more malnourished than community peers, although children living in communities were also often below growth standards. High risk of bias was found. Conclusions This study highlights the limited amount of evidence-based data available on the nutritional status of children in institutions. Of the studies reviewed, children living within institutionalized care were commonly malnourished, with undernutrition affecting young children particularly. Micronutrient deficiencies and obesity were also prevalent. Data quality was often poor: as well as suboptimal reporting of anthropometry, few looked for or described disabilities, despite disability being common in this population and having a large potential impact on nutrition status. Taken together, these findings suggest a need for greater focus on improving nutrition for younger children in institutions, especially those with disabilities. More information is needed about the nutritional status of the millions of children living within institutionalized care to fully address their right and need for healthy development.
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Affiliation(s)
- Emily DeLacey
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.,Holt International, Eugene, OR, United States of America.,Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
| | - Cally Tann
- Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.,MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene & Tropical Medicine, University of London, Entebbe, Uganda.,Neonatal Medicine, University College London Hospitals NHS Trust, London, United Kingdom
| | - Nora Groce
- UCL International Disability Research Centre, Department of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Maria Kett
- UCL International Disability Research Centre, Department of Epidemiology and Health Care, University College London, London, United Kingdom
| | | | - Ethan Bergman
- Department of Health Sciences, College of Education and Professional Studies, Central Washington University, Ellensburg, WA, United States of America
| | - Caryl Garcia
- Holt International, Eugene, OR, United States of America
| | - Marko Kerac
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.,Centre for Maternal, Adolescent, Reproductive, & Child Health (MARCH), London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom
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Baptista J, Silva JR, Marques S, Martins C, Soares I. EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS. Infant Ment Health J 2018; 39:718-729. [PMID: 30339735 DOI: 10.1002/imhj.21741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.
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Affiliation(s)
- Joana Baptista
- University of Minho, School of Psychology, CIPsi, Braga, Portugal.,Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - Joana R Silva
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Sofia Marques
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Carla Martins
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
| | - Isabel Soares
- University of Minho, School of Psychology, CIPsi, Braga, Portugal
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Gough EK, Moodie EE, Prendergast AJ, Ntozini R, Moulton LH, Humphrey JH, Manges AR. Linear growth trajectories in Zimbabwean infants. Am J Clin Nutr 2016; 104:1616-1627. [PMID: 27806980 PMCID: PMC5118730 DOI: 10.3945/ajcn.116.133538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Undernutrition in early life underlies 45% of child deaths globally. Stunting malnutrition (suboptimal linear growth) also has long-term negative effects on childhood development. Linear growth deficits accrue in the first 1000 d of life. Understanding the patterns and timing of linear growth faltering or recovery during this period is critical to inform interventions to improve infant nutritional status. OBJECTIVE We aimed to identify the pattern and determinants of linear growth trajectories from birth through 24 mo of age in a cohort of Zimbabwean infants. DESIGN We performed a secondary analysis of longitudinal data from a subset of 3338 HIV-unexposed infants in the Zimbabwe Vitamin A for Mothers and Babies trial. We used k-means clustering for longitudinal data to identify linear growth trajectories and multinomial logistic regression to identify covariates that were associated with each trajectory group. RESULTS For the entire population, the mean length-for-age z score declined from -0.6 to -1.4 between birth and 24 mo of age. Within the population, 4 growth patterns were identified that were each characterized by worsening linear growth restriction but varied in the timing and severity of growth declines. In our multivariable model, 1-U increments in maternal height and education and infant birth weight and length were associated with greater relative odds of membership in the least-growth restricted groups (A and B) and reduced odds of membership in the more-growth restricted groups (C and D). Male infant sex was associated with reduced odds of membership in groups A and B but with increased odds of membership in groups C and D. CONCLUSION In this population, all children were experiencing growth restriction but differences in magnitude were influenced by maternal height and education and infant sex, birth weight, and birth length, which suggest that key determinants of linear growth may already be established by the time of birth. This trial was registered at clinicaltrials.gov as NCT00198718.
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Affiliation(s)
- Ethan K Gough
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Erica Em Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Robert Ntozini
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Jean H Humphrey
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Baptista J, Belsky J, Marques S, Silva JR, Oliveira P, Mesquita A, Martins C, Soares I. The interactive effect of maltreatment in the family and unstable institutional caregiving in predicting behavior problems in toddlers. CHILD ABUSE & NEGLECT 2014; 38:2072-2079. [PMID: 25459985 DOI: 10.1016/j.chiabu.2014.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023]
Abstract
The current study extends research on the effects of institutionalization, most notably by examining whether-and how-both pre-institutional maltreatment in the family and the stability and consistency of institutional care interact to shape emotional and behavioral development. Fifty Portuguese children, placed in residential institutions when 8 days to 26 months of age, were evaluated using the Child Behavior Checklist when aged 18-31 months. Caregiver-rated internalizing and externalizing behavior problems proved to be unrelated to both early family and institutional experiences, as main effects, but the interaction of these factors significantly predicted externalizing problems: a history of maltreatment in the family coupled with unstable institutional caregiving arrangements predicted especially elevated levels of externalizing problems. Results are discussed in terms of the importance of more distal and proximate developmental experiences.
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Affiliation(s)
| | - Jay Belsky
- University of California, Davis, CA, USA
| | | | | | | | - Ana Mesquita
- School of Psychology, University of Minho, Portugal
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Soares I, Belsky J, Oliveira P, Silva J, Marques S, Baptista J, Martins C. Does early family risk and current quality of care predict indiscriminate social behavior in institutionalized Portuguese children? Attach Hum Dev 2014; 16:137-48. [PMID: 24405461 DOI: 10.1080/14616734.2013.869237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study extends research on the effects of institutionalization, most notably by evaluating the influence of proximal relationship processes over and above prenatal and pre-institutional family experiences. By focusing on current quality of institutional care and the child's early family background, it examines the influence of variations in the institutionalization experience on displays of indiscriminate social behavior, after taking into account potentially confounding pre-admission experiences. Seventy-four Portuguese children (11-30 months) placed in 17 residential institutions and their primary caregivers participated in the study. Children's displays of indiscriminate social behavior were assessed based on an observational measure and a semi-structured interview administered to the child's caregiver. Data on children's physical and mental development were also collected. Three contextual-risk composites of early family behavior - prenatal, family relational, and emotional-neglect--were created. The quality of institutional care was examined in terms of structural, relational characteristics, and, additionally, of the quality of child-caregiver relationship. Current quality of care experienced in the institution, operationalized in terms of the absence (vs. presence) of a preferred caregiver, predicted indiscriminate social behavior over and above prenatal and family risk conditions that preceded the child's institutionalization.
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Affiliation(s)
- Isabel Soares
- a School of Psychology , University of Minho , Braga , Portugal
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