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Mbabazi J, Pesu H, Mutumba R, Bromley K, Ritz C, Filteau S, Briend A, Mupere E, Grenov B, Friis H, Olsen MF. Correlates of early child development among children with stunting: A cross-sectional study in Uganda. MATERNAL & CHILD NUTRITION 2024; 20:e13619. [PMID: 38291803 PMCID: PMC10981482 DOI: 10.1111/mcn.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 02/01/2024]
Abstract
Many children in low- and middle-income countries are not attaining their developmental potential. Stunting is associated with poor child development, but it is not known which correlates of stunting are impairing child development. We explored potential socioeconomic, nutritional, clinical, and household correlates of early child development among 12-59-month-old children with stunting in a cross-sectional study in Uganda. Development was assessed using the Malawi Development Assessment Tool (MDAT) across four domains of gross and fine motor, language, and social skills. Linear regression analysis was used to assess correlates of development in the four domains and total MDAT score. Of 750 children included, the median [interquartile range] age was 30 [23-41] months, 55% of the children resided in rural settings with 21% from female-headed households and 47% of mothers had no schooling. The mean ± standard deviation height-for-age z-score (HAZ) was -3.02 ± 0.74, 40% of the children had a positive malaria test and 65% were anaemic (haemoglobin < 110 g/L). One-third had children's books at home, majority (96%) used household objects to play with and most of them (70%) used toys as pretence items like those to mimic cooking. After age, sex, and site adjustments, HAZ (0.24, 95% confidence interval [CI]: 0.14-0.33) and head circumference (0.07, 95% CI: 0.02-0.12) were positive correlates of total MDAT score, whereas weight-for-height z-score (WHZ) was not. Current breastfeeding was associated with 0.41 (95% CI: 0.17-0.65) lower total MDAT score. Children from households with a single income earner had 0.22 (95% CI: 0.06-0.37) lower total MDAT score. Furthermore, severe food insecurity, inflammation and positive malaria test were associated with lower scores for motor development. All family care indicator subscales (FCIs) positively correlated with the total MDAT score and this association was independent of household's socioeconomic status. In conclusion, stunting degree, head circumference, number of household income earners and stimulation by improved FCIs correlate with early child development among stunted children. The negative association with prolonged breastfeeding is likely due to reverse causality. Identified correlates may inform initiatives to support children with stunting attain their development potential.
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Affiliation(s)
- Joseph Mbabazi
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Hannah Pesu
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Rolland Mutumba
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | | | - Christian Ritz
- The National Institute of Public HealthSouthern University of DenmarkCopenhagenDenmark
| | - Suzanne Filteau
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - André Briend
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Tampere Center for Child Health ResearchUniversity of TampereTampereFinland
| | - Ezekiel Mupere
- Department of Paediatrics and Child HealthMakerere UniversityKampalaUganda
| | - Benedikte Grenov
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Friis
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
| | - Mette F. Olsen
- Department of Nutrition, Exercise & SportsUniversity of CopenhagenCopenhagenDenmark
- Department of Infectious DiseasesRigshospitaletCopenhagenDenmark
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Saito A, Kondo M. Continuum of care for maternal and child health and child undernutrition in Angola. BMC Public Health 2024; 24:680. [PMID: 38439029 PMCID: PMC10910721 DOI: 10.1186/s12889-024-18144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status. METHODS We used nationally representative data from the Angola 2015-2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels. RESULTS The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight. CONCLUSIONS The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
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Affiliation(s)
- Akiko Saito
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan
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Anthropometric proxies for child neurodevelopment in low-resource settings: length- or height-for-age, head circumference or both? J Dev Orig Health Dis 2023; 14:61-69. [PMID: 35844103 PMCID: PMC9845425 DOI: 10.1017/s2040174422000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Stunting (<-2 SD of length- or height-for-age on WHO growth curves) is the most used predictor of child neurodevelopmental (ND) risk. Occipitofrontal head circumference (OFC) may be an equally feasible, but more direct and robust predictor. We explored association of the two measurements with ND outcome, separately and combined, and examined if cutoffs are more efficacious than continuous measures in predicting ND risk. Infants and young children in rural Guatemala (n = 642; age range = 0.1-35.9 months) were enrolled in a prospective natural history study, and their ND was tested using the Mullen Scales of Early Learning (MSEL) longitudinally. Length- or height-for-age and OFC-for-age were calculated. We performed age-adjusted multivariable regression analyses to explore the association between 1) length or height and ND, 2) OFC and ND, and 3) both length or height and OFC combined, with ND; concurrently, predictively, and longitudinally, as continuous variables and using WHO z-score cutoffs. Continuous length- or height-for-age and OFC z-scores were more strongly associated with MSEL than the traditional -2 SD WHO cutoff. The combination of height-for-age z-score and OFC z-score was consistently, strongly associated with the MSEL Early Learning Composite concurrently (p-values 0.0004-0.11), predictively (p-value 0.001-0.07), with the exception of the 18-24 months age group which had very few records, and in the longitudinal model (p-value <0.0001-0.004). The combination of continuous length- or height-for-age and OFC shows additional utility in estimating ND risk in infants and young children. Measurement of OFC may improve precision of prediction of ND risk in infants and young children.
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Ntambara J, Zhang W, Qiu A, Cheng Z, Chu M. Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis. Front Nutr 2023; 9:939747. [PMID: 36712519 PMCID: PMC9880174 DOI: 10.3389/fnut.2022.939747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear. Methods In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting. Results Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months. Conclusion The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.
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Amir-ud-Din R, Fawad S, Naz L, Zafar S, Kumar R, Pongpanich S. Nutritional inequalities among under-five children: a geospatial analysis of hotspots and cold spots in 73 low- and middle-income countries. Int J Equity Health 2022; 21:135. [PMID: 36104780 PMCID: PMC9476341 DOI: 10.1186/s12939-022-01733-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Child undernutrition is a severe health problem in the developing world, which affects children’s development in the long term. This study analyses the extent and patterns of under-five child undernutrition using Demographic and Health Surveys (DHS) for 73 low- and middle-income countries (LMICs). Methods First, we mapped the prevalence of undernutrition in the developing world. Second, using the LISA (a local indicator of spatial association) technique, we analyzed the geographical patterns in undernutrition to highlight the localized hotspots (regions with high undernutrition prevalence surrounded by similar other regions), cold spots (regions with low undernutrition prevalence surrounded by similar other regions), and outliers (regions with high undernutrition surrounded by low undernutrition and vice versa). Third, we used Moran’s I to find global patterns in child undernutrition. Results We find that South Asia has the highest under-five child undernutrition rates. The intra-country nutritional inequalities are highest in Burundi (stunting), Kenya (wasting), and Madagascar (underweight). The local indicator of spatial association (LISA) analysis suggests that South Asia, Middle East and North Africa (MENA) region, and Sub-Saharan Africa are undernutrition hotspots and Europe and Central Asia and Latin America, and the Caribbean are undernutrition cold spots (regions with low undernutrition surrounded by similar other regions). Getis Ord-Gi* estimates generally support LISA analysis. Moran’s I and Geary’s C gave similar results about the global patterns of undernutrition. Geographically weighted regressions suggest that several socioeconomic indicators significantly explain child undernutrition. Conclusions We found a significant within and across country variation in stunting, wasting and underweight rates among the under-five children’s population. The geospatial analysis also suggested that stunting, wasting, and underweight patterns exhibit clear regional patterns, underscoring the need for coordinated interventions at the regional level.
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Kodish SR, Farhikhtah A, Mlambo T, Hambayi MN, Jones V, Aburto NJ. Leveraging the Scaling Up Nutrition Movement to Operationalize Stunting Prevention Activities: Implementation Lessons From Rural Malawi. Food Nutr Bull 2021; 43:104-120. [PMID: 34747237 DOI: 10.1177/03795721211046140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rural district of Ntchisi is in the central region of Malawi. Among children aged 6 to 23 months, the stunting prevalence is 40% to 50%. To address this high prevalence, the World Food Programme, with cooperating partners, supported the Government of Malawi to implement an integrated stunting prevention program entitled The Right Foods at the Right Time from 2013 to 2018. OBJECTIVE To provide implementation lessons learned from systematic documentation of how the Scaling Up Nutrition (SUN) movement, combined with other international and national initiatives and policies, was translated into tailored programming. METHODS During program conception, early design, and implementation, this descriptive study systematically documented the process of translating SUN principles and government policies into an operational stunting prevention program in rural Malawi. RESULTS We identified 8 factors that contributed to successful translation of policy into program activities: (1) well-structured National SUN framework, (2) reliable coordination platforms and district ownership, (3) systematic and evidence-informed program design, (4) multiple forms of data used to inform program planning, (5) multisectoral implementation approaches to stunting prevention, (6) innovation in technology to improve overall program efficiency, (7) systematic collaboration among diverse stakeholders, and (8) strong public health nutrition capacity of program team members. CONCLUSIONS Lessons from this nutrition program in Ntchisi, Malawi, provide one case illustrating how the SUN movement, government policies, and global evidence base can be operationalized into tailored programming for improving nutrition.
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Affiliation(s)
- Stephen R Kodish
- United Nations World Food Programme Headquarters, Rome, Italy.,The Pennsylvania State University, University Park, PA, USA
| | - Arghanoon Farhikhtah
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Trust Mlambo
- United Nations World Food Programme, Lilongwe, Malawi
| | | | - Vanessa Jones
- United Nations World Food Programme Headquarters, Rome, Italy
| | - Nancy J Aburto
- United Nations World Food Programme Headquarters, Rome, Italy.,Food and Agriculture Organization of the United Nations, Rome, Italy
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Madhoun LL, Crerand CE, O'Brien M, Baylis AL. Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress. Cleft Palate Craniofac J 2020; 58:470-478. [PMID: 32924577 DOI: 10.1177/1055665620956873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P). DESIGN Cross-sectional. SETTING Pediatric academic medical center in the Midwestern United States. PARTICIPANTS Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments. MAIN OUTCOME MEASURE(S) Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained. RESULTS Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = -0.31, P = .02) and length (r = -0.32, P = .02). CONCLUSIONS Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.
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Affiliation(s)
- Lauren L Madhoun
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Canice E Crerand
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Biobehavioral Health, The Abigail Wexner Research Institute at 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Meghan O'Brien
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
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Chaya BF, Chalhoub R, Jaafar R, Nahhas N, Abu-Sittah G. Prevalence of Stunting in Syrian Refugee Children With Cleft Lip and/or Cleft Palate in Time of Crisis: A Call for Intervention. Cleft Palate Craniofac J 2020; 57:1166-1170. [PMID: 32500735 DOI: 10.1177/1055665620930450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our study aims to compare the prevalence of stunted growth in Syrian refugee children with cleft lip and/or palate (CL±CP) to other children with CL±CP of similar socioeconomic status. DESIGN A retrospective medical chart review. SETTING Center for Cleft and Craniofacial Surgery at a tertiary care hospital in Lebanon in the period between January 2013 and May 2019. PATIENTS, PARTICIPANTS One hundred three Syrian refugee children and 70 Lebanese children <18 years of low socioeconomic status who have CL, CP, or both. INTERVENTIONS These patients underwent cleft repair surgeries at our center. MAIN OUTCOME MEASURE(S) Stunted growth measured by calculating the height-for-age z-score (HAZ). RESULTS Using a confidence interval of 95%, the prevalence of stunting is significantly higher among Syrian refugees (P < .003). The prevalence of stunting and age of presentation were positively correlated (P < .02). There was no difference in stunting between patients with CP and CL (P < .746). There was no difference in stunting between genders. CONCLUSIONS The majority of Syrian refugee patients with CL±CP fall on the malnourished side of the nutritional spectrum as reflected by the high percentage of stunting as well as a mean of -1 for the HAZ.
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Affiliation(s)
- Bachar F Chaya
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Rawad Chalhoub
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Rola Jaafar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Nour Nahhas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
| | - Ghassan Abu-Sittah
- Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, Lebanon
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Lassi ZS, Rind F, Irfan O, Hadi R, Das JK, Bhutta ZA. Impact of Infant and Young Child Feeding (IYCF) Nutrition Interventions on Breastfeeding Practices, Growth and Mortality in Low- and Middle-Income Countries: Systematic Review. Nutrients 2020; 12:E722. [PMID: 32164187 PMCID: PMC7146402 DOI: 10.3390/nu12030722] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/21/2023] Open
Abstract
Undernutrition is associated with 45% of total infant deaths, totalling 2.7 million globally per year. The vast majority of the burden is felt in low- and middle-income countries (LMICs). This review aims to assess the effectiveness of infant and young child feeding (IYCF) interventions. We searched multiple databases including Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE. Title/abstract screening and full-text screening and data extraction filtered 77 studies for inclusion. Breastfeeding education interventions (n = 38) showed 20% increase in rates of early initiation of breastfeeding, 102% increase in exclusive breastfeeding (EBF) at 3 months and 53% increase in EBF at 6 months and 24% decreases in diarrheal diseases. Complementary feeding education intervention (n=12) showed a 0.41 standard deviation (SD) increase in WAZ, and 0.25 SD in HAZ in food secure setting. Complementary food provision with or without education (n=17) showed a 0.14 SD increase in HAZ and 36% decrease in stunting. Supplementary food interventions (n=12) showed a significant 0.15 SD increase in WHZ. Subgroup analyses showed healthcare professional led interventions were largely more effective, especially on breastfeeding outcomes. We believe this is a comprehensive review of the existing literature on IYCF studies in LMICs. Though breastfeeding education is well supported in its effectiveness on breastfeeding practices, limited evidence exists for growth outcomes. Supplementation interventions seem to have better effects at improving growth. However, more research is required to reach more substantial conclusions.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Fahad Rind
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (F.R.); (Z.A.B.)
| | - Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada;
| | - Rabia Hadi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan; (R.H.); (J.K.D.)
| | - Jai K. Das
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan; (R.H.); (J.K.D.)
| | - Zulfiqar A. Bhutta
- Division of Women and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan; (F.R.); (Z.A.B.)
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada;
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East P, Delker E, Blanco E, Encina P, Lozoff B, Gahagan S. Effect of Infant Iron Deficiency on Children's Verbal Abilities: The Roles of Child Affect and Parent Unresponsiveness. Matern Child Health J 2019; 23:1240-1250. [PMID: 31228147 PMCID: PMC6714573 DOI: 10.1007/s10995-019-02764-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Infants who are iron-deficient anemic seek and receive less stimulation from their caregivers, predisposing such children to be functionally isolated. OBJECTIVES To test the sequence whereby iron deficiency in infancy contributes to children's disengagement from the environment, which reduces parent stimulation which, in turn, contributes to children's poor verbal skills. METHODS Chilean children (N = 875, 54% male) were studied, 45% of whom were iron deficient or iron-deficient anemic in infancy. We used structural equation modeling to test the sequence outlined above and to examine the effect of infant iron status on children's verbal performance at ages 5 and 10 years including the roles of child and parent intermediate variables. RESULTS Severity of iron deficiency in infancy was associated with higher levels of children's dull affect and social reticence at 5 years (β = .10, B = .26, SE = .12, p < .05), and these behaviors were associated with parent unresponsiveness (β = .29, B = .13, SE = .03, p < .001), which related to children's lower verbal abilities at age 5 (β = - .29, B = - 2.33, SE = .47, p < .001) and age 10 (β = - .22, B = - 3.04, SE = .75, p < .001). An alternate model where poor iron status related directly to children's verbal ability was tested but not supported. CONCLUSIONS Findings support functional isolation processes resulting from a nutritional deficiency, with iron-deficient anemic infants showing affective and behavioral tendencies that limit developmentally stimulating caregiving which, in turn, hinder children's verbal abilities.
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Affiliation(s)
- Patricia East
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0927, La Jolla, CA, 92093-0927, USA.
| | - Erin Delker
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0927, La Jolla, CA, 92093-0927, USA
| | - Estela Blanco
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0927, La Jolla, CA, 92093-0927, USA
| | - Pamela Encina
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Betsy Lozoff
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, Mail Code 0927, La Jolla, CA, 92093-0927, USA
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Nahar B, Hossain M, Mahfuz M, Islam MM, Hossain MI, Murray-Kolb LE, Seidman JC, Ahmed T. Early childhood development and stunting: Findings from the MAL-ED birth cohort study in Bangladesh. MATERNAL AND CHILD NUTRITION 2019; 16:e12864. [PMID: 31237738 PMCID: PMC7038907 DOI: 10.1111/mcn.12864] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 01/20/2023]
Abstract
Information on the association between stunting and child development is limited from low‐income settings including Bangladesh where 36% of children under‐ 5 are stunted. This study aimed to explore differences in early childhood development (ECD) between stunted (length‐for‐age z‐score [LAZ] < −2) and nonstunted (LAZ ≥ −2) children in Bangladesh. Children (n = 265) aged 6–24 months who participated in the MAL‐ED birth cohort study were evaluated by trained psychologists at 6, 15, and 24 months of age using the Bayley Scales of Infant and Toddler Development‐III; child length and weight were measured using standard procedures. ECD scores (z‐scores derived from cognitive, motor, language and socio‐emotional skills) were compared between stunted, underweight (weight‐for‐age z‐score < −2), and wasted (weight‐for‐length z‐score < −2) children, controlling for child age and sex and maternal age, education, body mass index (BMI), and depressive symptoms. Stunted children had significantly lower ECD scores than their nonstunted peers on cognitive (P = .049), motor (P < .001), language (P < .001) and social–emotional (P = .038) scales where boys had significantly lower fine motor skills compared with girls (P = .027). Mother's schooling and BMI were significant predictors of ECD. Similar to stunting, underweight children had developmental deficits in all domains (cognitive: P = .001; fine motor: P = .039, and P < .001 for both gross motor and total motor; expressive communication: P = .032; total language: P = .013; social–emotional development: P = .017). Wasted children had poor motor skills (P = .006 for the fine motor; P < .001 for both gross motor and total motor development) compared with the nonwasted peers. Early childhood stunting and underweight were associated with poor developmental outcomes in Bangladesh.
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Affiliation(s)
- Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Jessica C Seidman
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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12
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van den Heuvel M, Voskuijl W, Chidzalo K, Kerac M, Reijneveld SA, Bandsma R, Gladstone M. Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross-sectional study. J Glob Health 2018; 7:020416. [PMID: 29302321 PMCID: PMC5735778 DOI: 10.7189/jogh.07.020416] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Early childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe acute malnutrition (SAM). Particularly an important research gap exists in Sub–Saharan Africa where there is a high prevalence of SAM and a high rate of co–occurring HIV (human immune deficiency virus) infection. Our first objective was to assess the prevalence and severity of developmental and behavioural disorders on a cohort of children admitted to an inpatient nutritional rehabilitation centre in Malawi. Our second objective was to compare the developmental and behavioural profiles of children with the two main phenotypes of SAM: kwashiorkor and marasmus. Methods This was a cross–sectional observational study including all children hospitalized with complicated SAM in Blantyre, Malawi over an 8–month period from February to October 2015. At discharge, children were assessed with the well-validated Malawi Developmental Assessment Tool (MDAT) for gross motor, fine motor, language and social development. In children ≥24 months, emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Results 150 children (55% boys) with SAM were recruited; mean age of 27.2 months (standard deviation 17.9), 27 children (18%) had pre–existing neurodisabilities (ND) and 34 (23%) had a co–occurring human immune deficiency virus (HIV) infection. All children with SAM experienced profound delays in the gross and fine motor, language and social domains. Linear regression analysis demonstrated that children with kwashiorkor scored 0.75 standard deviations lower (95% confidence interval –1.43 to –0.07) on language MDAT domain than children with marasmus when adjusted for covariates. The prosocial behaviour score of the SDQ was low in children with SAM, indicating a lack of sensitive behaviour in social interactions. Conclusions Children with SAM have severe developmental delays after a hospital admission. Our results indicate that there might be a significant difference in developmental attainment between children with kwashiorkor and with marasmus. Future studies exploring longer–term outcomes and testing possible intervention strategies are urgently needed.
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Affiliation(s)
- Meta van den Heuvel
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wieger Voskuijl
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Kate Chidzalo
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, United Kingdom
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Robert Bandsma
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.,Centre for Global Health, Hospital for Sick Children Toronto, Ontario, Canada
| | - Melissa Gladstone
- Department of Women and Children's Health, University of Liverpool, Alder Hey Children's Hospital, Liverpool, United Kingdom
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13
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van den Heuvel M, Voskuijl W, Chidzalo K, Kerac M, Reijneveld SA, Bandsma R, Gladstone M. Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross–sectional study. J Glob Health 2017. [DOI: 10.7189/jogh.07.020702416] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Perkins JM, Kim R, Krishna A, McGovern M, Aguayo VM, Subramanian S. Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention. Soc Sci Med 2017; 193:101-109. [DOI: 10.1016/j.socscimed.2017.09.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/01/2017] [Accepted: 09/21/2017] [Indexed: 02/05/2023]
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15
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Hossain M, Choudhury N, Adib Binte Abdullah K, Mondal P, Jackson AA, Walson J, Ahmed T. Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review. Arch Dis Child 2017; 102:903-909. [PMID: 28468870 PMCID: PMC5739821 DOI: 10.1136/archdischild-2016-311050] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/21/2016] [Accepted: 12/02/2016] [Indexed: 12/02/2022]
Abstract
OBJECTIVE We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs). METHODS Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings. FINDINGS Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed. INTERPRETATION For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance. PROSPERO REGISTRATION NUMBER CRD42016043772.
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Affiliation(s)
- Muttaquina Hossain
- Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh
| | - Nuzhat Choudhury
- Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh
| | | | - Prasenjit Mondal
- Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh
| | | | - Judd Walson
- Department of Global Health, University of Washington, Seattle, USA
| | - Tahmeed Ahmed
- Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh
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16
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Undurraga EA, Behrman JR, Emmett SD, Kidd C, Leonard WR, Piantadosi ST, Reyes-García V, Sharma A, Zhang R, Godoy RA. Child stunting is associated with weaker human capital among native Amazonians. Am J Hum Biol 2017; 30. [PMID: 28901592 DOI: 10.1002/ajhb.23059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 06/19/2017] [Accepted: 08/24/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We assessed associations between child stunting, recovery, and faltering with schooling and human capital skills in a native Amazonian society of horticulturalists-foragers (Tsimane'). METHODS We used cross-sectional data (2008) from 1262 children aged 6 to 16 years in 53 villages to assess contemporaneous associations between three height categories: stunted (height-for-age Z score, HAZ<-2), moderately stunted (-2 ≤ HAZ≤-1), and nonstunted (HAZ>-1), and three categories of human capital: completed grades of schooling, test-based academic skills (math, reading, writing), and local plant knowledge. We used annual longitudinal data (2002-2010) from all children (n = 853) in 13 villages to estimate the association between changes in height categories between the first and last years of measure and schooling and academic skills. RESULTS Stunting was associated with 0.4 fewer completed grades of schooling (∼24% less) and with 13-15% lower probability of showing any writing or math skills. Moderate stunting was associated with ∼20% lower scores in local plant knowledge and 9% lower probability of showing writing skills, but was not associated with schooling or math and writing skills. Compared with nonstunted children, children who became stunted had 18-21% and 15-21% lower probabilities of showing math and writing skills, and stunted children had 0.4 fewer completed grades of schooling. Stunted children who recovered showed human capital outcomes that were indistinguishable from nonstunted children. CONCLUSIONS The results confirm adverse associations between child stunting and human capital skills. Predictors of growth recovery and faltering can affect human capital outcomes, even in a remote, economically self-sufficient society.
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Affiliation(s)
- Eduardo A Undurraga
- School of Government, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana 7820436, Chile
| | - Jere R Behrman
- Department of Economics and Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Susan D Emmett
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287.,Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Celeste Kidd
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York 14627-0268
| | - William R Leonard
- Department of Anthropology, Northwestern University, Evanston, Illinois 60208
| | - Steven T Piantadosi
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, New York 14627-0268
| | - Victoria Reyes-García
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08010, Spain.,Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Abhishek Sharma
- Royal Brisbane and Women's Hospital, Brisbane, Queensland 4029, Australia
| | - Rebecca Zhang
- Graduate School of Business, Stanford University, Stanford, California 94305
| | - Ricardo A Godoy
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02453
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17
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Sudfeld CR, McCoy DC, Danaei G, Fink G, Ezzati M, Andrews KG, Fawzi WW. Linear growth and child development in low- and middle-income countries: a meta-analysis. Pediatrics 2015; 135:e1266-75. [PMID: 25847806 DOI: 10.1542/peds.2014-3111] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The initial years of life are critical for physical growth and broader cognitive, motor, and socioemotional development, but the magnitude of the link between these processes remains unclear. Our objective was to produce quantitative estimates of the cross-sectional and prospective association of height-for-age z score (HAZ) with child development. METHODS Observational studies conducted in low- and middle-income countries (LMICs) presenting data on the relationship of linear growth with any measure of child development among children <12 years of age were identified from a systematic search of PubMed, Embase, and PsycINFO. Two reviewers then extracted these data by using a standardized form. RESULTS A total of 68 published studies conducted in 29 LMICs were included in the final database. The pooled adjusted standardized mean difference in cross-sectional cognitive ability per unit increase in HAZ for children ≤ 2 years old was +0.24 (95% confidence interval [CI], 0.14-0.33; I(2) = 53%) and +0.09 for children > 2 years old (95% CI, 0.05-0.12; I(2) = 78%). Prospectively, each unit increase in HAZ for children ≤ 2 years old was associated with a +0.22-SD increase in cognition at 5 to 11 years after multivariate adjustment (95% CI, 0.17-0.27; I(2) = 0%). HAZ was also significantly associated with earlier walking age and better motor scores (P < .05). CONCLUSIONS Observational evidence suggests a robust positive association between linear growth during the first 2 years of life with cognitive and motor development. Effective interventions that reduce linear growth restriction may improve developmental outcomes; however, integration with environmental, educational, and stimulation interventions may produce larger positive effects.
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Affiliation(s)
| | - Dana Charles McCoy
- Center on the Developing Child, Schools of Education and Public Health, Harvard University, Cambridge, Massachusetts; and
| | - Goodarz Danaei
- Departments of Global Health and Population, Epidemiology, and
| | | | - Majid Ezzati
- Departments of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | | | - Wafaie W Fawzi
- Departments of Global Health and Population, Epidemiology, and Nutrition, Harvard School of Public Health, Boston, Massachusetts
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18
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Kristjansson E, Francis DK, Liberato S, Benkhalti Jandu M, Welch V, Batal M, Greenhalgh T, Rader T, Noonan E, Shea B, Janzen L, Wells GA, Petticrew M. Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Cochrane Database Syst Rev 2015; 2015:CD009924. [PMID: 25739460 PMCID: PMC6885042 DOI: 10.1002/14651858.cd009924.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Undernutrition contributes to five million deaths of children under five each year. Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection, poor cognitive functioning, chronic disease, and mortality. It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children. OBJECTIVES Primary objective1. To assess the effectiveness of supplementary feeding interventions, alone or with co-intervention, for improving the physical and psychosocial health of disadvantaged children aged three months to five years.Secondary objectives1. To assess the potential of such programmes to reduce socio-economic inequalities in undernutrition.2. To evaluate implementation and to understand how this may impact on outcomes.3. To determine whether there are any adverse effects of supplementary feeding. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, PsycINFO, and seven other databases for all available years up to January 2014. We also searched ClinicalTrials.gov and several sources of grey literature. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished trials. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that provided supplementary food (with or without co-intervention) to children aged three months to five years, from all countries. Adjunctive treatments, such as nutrition education, were allowed. Controls had to be untreated. DATA COLLECTION AND ANALYSIS Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data, and assessed risk of bias. We conducted meta-analyses for continuous data using the mean difference (MD) or the standardised mean difference (SMD) with a 95% confidence interval (CI), correcting for clustering if necessary. We analysed studies from low- and middle-income countries and from high-income countries separately, and RCTs separately from CBAs. We conducted a process evaluation to understand which factors impact on effectiveness. MAIN RESULTS We included 32 studies (21 RCTs and 11 CBAs); 26 of these (16 RCTs and 10 CBAs) were in meta-analyses. More than 50% of the RCTs were judged to have low risk of bias for random selection and incomplete outcome assessment. We judged most RCTS to be unclear for allocation concealment, blinding of outcome assessment, and selective outcome reporting. Because children and parents knew that they were given food, we judged blinding of participants and personnel to be at high risk for all studies.Growth. Supplementary feeding had positive effects on growth in low- and middle-income countries. Meta-analysis of the RCTs showed that supplemented children gained an average of 0.12 kg more than controls over six months (95% confidence interval (CI) 0.05 to 0.18, 9 trials, 1057 participants, moderate quality evidence). In the CBAs, the effect was similar; 0.24 kg over a year (95% CI 0.09 to 0.39, 1784 participants, very low quality evidence). In high-income countries, one RCT found no difference in weight, but in a CBA with 116 Aboriginal children in Australia, the effect on weight was 0.95 kg (95% CI 0.58 to 1.33). For height, meta-analysis of nine RCTs revealed that supplemented children grew an average of 0.27 cm more over six months than those who were not supplemented (95% CI 0.07 to 0.48, 1463 participants, moderate quality evidence). Meta-analysis of seven CBAs showed no evidence of an effect (mean difference (MD) 0.52 cm, 95% CI -0.07 to 1.10, 7 trials, 1782 participants, very low quality evidence). Meta-analyses of the RCTs demonstrated benefits for weight-for-age z-scores (WAZ) (MD 0.15, 95% CI 0.05 to 0.24, 8 trials, 1565 participants, moderate quality evidence), and height-for-age z-scores (HAZ) (MD 0.15, 95% CI 0.06 to 0.24, 9 trials, 4638 participants, moderate quality evidence), but not for weight-for-height z-scores MD 0.10 (95% CI -0.02 to 0.22, 7 trials, 4176 participants, moderate quality evidence). Meta-analyses of the CBAs showed no effects on WAZ, HAZ, or WHZ (very low quality evidence). We found moderate positive effects for haemoglobin (SMD 0.49, 95% CI 0.07 to 0.91, 5 trials, 300 participants) in a meta-analysis of the RCTs.Psychosocial outcomes. Eight RCTs in low- and middle-income countries assessed psychosocial outcomes. Our meta-analysis of two studies showed moderate positive effects of feeding on psychomotor development (SMD 0.41, 95% CI 0.10 to 0.72, 178 participants). The evidence of effects on cognitive development was sparse and mixed.We found evidence of substantial leakage. When feeding was given at home, children benefited from only 36% of the energy in the supplement. However, when the supplementary food was given in day cares or feeding centres, there was less leakage; children took in 85% of the energy provided in the supplement. Supplementary food was generally more effective for younger children (less than two years of age) and for those who were poorer/ less well-nourished. Results for sex were equivocal. Our results also suggested that feeding programmes which were given in day-care/feeding centres and those which provided a moderate-to-high proportion of the recommended daily intake (% RDI) for energy were more effective. AUTHORS' CONCLUSIONS Feeding programmes for young children in low- and middle-income countries can work, but good implementation is key.
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Affiliation(s)
- Elizabeth Kristjansson
- University of OttawaSchool of Psychology, Faculty of Social SciencesRoom 407C, Montpetit Hall125 UniversityOttawaCanadaK1N 6N5
| | - Damian K Francis
- University of West IndiesEpidemiology Research UnitMona Kingston 7Jamaica
| | - Selma Liberato
- Menzies School of Health Research, Charles Darwin UniversityNutrition Research TeamPO Box 41096DarwinAustralia0811
| | - Maria Benkhalti Jandu
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart StreetOttawaCanadaK1N 6N5
| | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaCanadaK1N 5C8
| | - Malek Batal
- University of MontrealWHO Collaborating Centre on Nutrition Changes and Development (TRANSNUT), Nutrition Department, Faculty of MedicinePavillon Liliane de Stewart2405, Chemin de la Côte‐Sainte‐Catherine l MontréalQuebecCanadaH3C 3J7
| | - Trish Greenhalgh
- Barts and the London School of Medicine and DentistryCentre for Primary Care and Public Health58 Turner StWhitechapelLondonUKE1 2AB
| | - Tamara Rader
- Cochrane Musculoskeletal GroupOttawa Hospital Research Institute501 Smyth RoadOttawaCanadaK1H 8L6
| | - Eamonn Noonan
- Norwegian Knowledge Centre for the Health ServicesPO Box 7004St Olavs plassOsloNorwayN‐0130
| | - Beverley Shea
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaCanadaK1H 8L6
| | - Laura Janzen
- The Hospital for Sick ChildrenDepartment of Psychology & Division of Haematology/Oncology555 University AvenueTorontoCanadaM5G 1X8
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaCanadaK1H 8L6
| | - Mark Petticrew
- London School of Hygiene and Tropical MedicineDepartment of Social & Environmental Health Research, Faculty of Public Health & Policy15‐17 Tavistock PlaceLondonUKWC1H 9SH
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Dose of early intervention treatment during children's first 36 months of life is associated with developmental outcomes: an observational cohort study in three low/low-middle income countries. BMC Pediatr 2014; 14:281. [PMID: 25344731 PMCID: PMC4288653 DOI: 10.1186/1471-2431-14-281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The positive effects of early developmental intervention (EDI) on early child development have been reported in numerous controlled trials in a variety of countries. An important aspect to determining the efficacy of EDI is the degree to which dosage is linked to outcomes. However, few studies of EDI have conducted such analyses. This observational cohort study examined the association between treatment dose and children's development when EDI was implemented in three low and low-middle income countries as well as demographic and child health factors associated with treatment dose. METHODS Infants (78 males, 67 females) born in rural communities in India, Pakistan, and Zambia received a parent-implemented EDI delivered through biweekly home visits by trainers during the first 36 months of life. Outcome was measured at age 36 months with the Mental (MDI) and Psychomotor (PDI) Development Indices of the Bayley Scales of Infant Development-II. Treatment dose was measured by number of home visits completed and parent-reported implementation of assigned developmental stimulation activities between visits. Sociodemographic, prenatal, perinatal, and child health variables were measures as correlates. RESULTS Average home visits dose exceeded 91% and mothers engaged the children in activities on average 62.5% of days. Higher home visits dose was significantly associated with higher MDI (mean for dose quintiles 1-2 combined = 97.8, quintiles 3-5 combined = 103.4, p = 0.0017). Higher treatment dose was also generally associated with greater mean PDI, but the relationships were non-linear. Location, sociodemographic, and child health variables were associated with treatment dose. CONCLUSIONS Receiving a higher dose of EDI during the first 36 months of life is generally associated with better developmental outcomes. The higher benefit appears when receiving ≥91% of biweekly home visits and program activities on ≥67% of days over 3 years. It is important to ensure that EDI is implemented with a sufficiently high dose to achieve desired effect. To this end groups at risk for receiving lower dose can be identified and may require special attention to ensure adequate effect.
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Abstract
Linear growth failure is the most common form of undernutrition globally. With an estimated 165 million children below 5 years of age affected, stunting has been identified as a major public health priority, and there are ambitious targets to reduce the prevalence of stunting by 40% between 2010 and 2025. We view this condition as a 'stunting syndrome' in which multiple pathological changes marked by linear growth retardation in early life are associated with increased morbidity and mortality, reduced physical, neurodevelopmental and economic capacity and an elevated risk of metabolic disease into adulthood. Stunting is a cyclical process because women who were themselves stunted in childhood tend to have stunted offspring, creating an intergenerational cycle of poverty and reduced human capital that is difficult to break. In this review, the mechanisms underlying linear growth failure at different ages are described, the short-, medium- and long-term consequences of stunting are discussed, and the evidence for windows of opportunity during the life cycle to target interventions at the stunting syndrome are evaluated.
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Affiliation(s)
- Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, UK,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Boo FL, Palloni G, Urzua S. Cost-benefit analysis of a micronutrient supplementation and early childhood stimulation program in Nicaragua. Ann N Y Acad Sci 2014; 1308:139-148. [PMID: 24571215 DOI: 10.1111/nyas.12368] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This paper estimates the cost-benefit ratio for an integrated early childhood development program in Nicaragua (PAININ). Using longitudinal data, we estimate the average treatment effects of PAININ including micronutrient sprinkles on the prevalence of anemia and hemoglobin levels among disadvantaged children aged 6-36 months. We also estimate the effects of PAININ excluding sprinkles on cognitive outcomes among children aged 2.5-5 years. In the younger age group the program reduced anemia by 4 percentage points after 8 months and nearly 6 percentage points after 1 year; the latter is a 26% decrease in anemia. In the older age group, the program improved verbal and numeric memory after a year and a half, but the effects were modest (0.13 SD). When analyzing its potential impact on earnings, we conclude that the discounted annual costs of the program per child are less than the discounted annual increase in beneficiary earnings. Specifically, we estimate a cost-benefit ratio of 1.50 from the PAININ plus sprinkles package. Our sensitivity analysis suggests a range for this ratio between 1.30 and 2.30.
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Affiliation(s)
| | - Giordano Palloni
- Department of Economics, The University of Maryland, College Park, Maryland
| | - Sergio Urzua
- Department of Economics, The University of Maryland, College Park, Maryland
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Dercon S, Sánchez A. Height in mid childhood and psychosocial competencies in late childhood: evidence from four developing countries. ECONOMICS AND HUMAN BIOLOGY 2013; 11:426-432. [PMID: 23669463 DOI: 10.1016/j.ehb.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
We use longitudinal data from children growing up in four developing countries (Peru, India, Vietnam, Ethiopia) to study the relationship between height at the age of 7-8 and a set of psychosocial competencies measured at the age of 11-12 that are known to be correlated with earnings during adulthood: self-efficacy, self-esteem and aspirations. Results show that a one standard deviation increase in height-for-age tends to increase self-efficacy, self-esteem and aspirations by 10.4%, 6.4% and 5.1%, respectively. We argue that these findings are likely to be informing of an underlying relationship between undernutrition and the formation of non-cognitive skills.
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Affiliation(s)
- Stefan Dercon
- Department of International Development, University of Oxford, OX1 3TB, United Kingdom
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23
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Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382:427-451. [PMID: 23746772 DOI: 10.1016/s0140-6736(13)60937-x] [Citation(s) in RCA: 4184] [Impact Index Per Article: 380.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups.
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Affiliation(s)
- Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Cesar G Victora
- Universidade Federal de Pelotas, Pelotas, Rio Grande do Sol, Brazil
| | - Susan P Walker
- The University of the West Indies, Tropical Medicine Research Institute, Mona Campus, Kingston, Jamaica
| | - Zulfiqar A Bhutta
- The Aga Khan University and Medical Center, Department of Pediatrics, Karachi, Pakistan
| | - Parul Christian
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mercedes de Onis
- World Health Organization, Department of Nutrition for Health and Development, Geneva, Switzerland
| | - Majid Ezzati
- Imperial College of London, St Mary's Campus, School of Public Health, MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, London, UK
| | - Sally Grantham-McGregor
- Institute of Child Health, University College London, London, UK; The University of the West Indies, Mona, Jamaica
| | - Joanne Katz
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ricardo Uauy
- London School of Hygiene and Tropical Medicine, London, UK
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Phuka JC, Gladstone M, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Developmental outcomes among 18-month-old Malawians after a year of complementary feeding with lipid-based nutrient supplements or corn-soy flour. MATERNAL & CHILD NUTRITION 2012; 8:239-48. [PMID: 21342456 PMCID: PMC6860816 DOI: 10.1111/j.1740-8709.2011.00294.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The major aim of this trial was to compare the development of 18-month-old infants who received complementary feeding for 1 year either with lipid-based nutrient supplements or micronutrient fortified corn-soy porridge. Our secondary aim was to determine the socio-economic factors associated with developmental outcomes in the same population. A total of 163 six-month-old rural Malawian children were enrolled in a randomized controlled trial where the control population received daily supplementation with 71 g corn-soy flour [Likuni Phala (LP)] (282 kcal) and individuals in the intervention groups received daily either 50 g of lipid-based nutrient supplement (FS50) (264 kcal) or 25 g of lipid-based nutrient supplement (FS25) (130 kcal). The main outcome measures were Griffiths' developmental scores at 0-2 years. Independent comparison of study groups was carried out using analysis of variance (ANOVA) statistics where mean raw scores, quotients, or mental ages were compared. Association of developmental outcome with predictor variables were examined using multiple regression. At 18 months of chronological age, the mean ± standard deviation (SD) mental ages in the LP, FS50, and FS25 groups were 17.9 ± 1.3, 17.9 ± 1.3, and 17.9 ± 1.2 (P > 0.99), respectively. Likewise, the mean raw developmental scores and mean developmental quotients did not differ significantly. Length-for-age z-score gain during the intervention period, and maternal education were associated with developmental outcome at 18 months (P = 0.03 and P = 0.04; respectively). In conclusion, rural Malawian infants receiving 12-month daily supplementation of their diet either with the tested lipid-based nutrient supplements or fortified corn-soy flour have comparable development outcomes by 18 months of age.
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Affiliation(s)
- John C Phuka
- College of Medicine, University of Malawi, Blantyre, Malawi.
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Simkiss DE, Blackburn CM, Mukoro FO, Read JM, Spencer NJ. Childhood disability and socio-economic circumstances in low and middle income countries: systematic review. BMC Pediatr 2011; 11:119. [PMID: 22188700 PMCID: PMC3259053 DOI: 10.1186/1471-2431-11-119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 12/21/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The majority of children with disability live in low and middle income (LAMI) countries. Although a number of important reviews of childhood disability in LAMI countries have been published, these have not, to our knowledge, addressed the association between childhood disability and the home socio-economic circumstances (SEC). The objective of this study is to establish the current state of knowledge on the SECs of children with disability and their households in LAMI countries through a systematic review and quality assessment of existing research. METHODS Electronic databases (MEDLINE; EMBASE; PUBMED; Web of Knowledge; PsycInfo; ASSIA; Virtual Health Library; POPLINE; Google scholar) were searched using terms specific to childhood disability and SECs in LAMI countries. Publications from organisations including the World Bank, UNICEF, International Monetary Fund were searched for. Primary studies and reviews from 1990 onwards were included. Studies were assessed for inclusion, categorisation and quality by 2 researchers. RESULTS 24 primary studies and 13 reviews were identified. Evidence from the available literature on the association between childhood disability and SECs was inconsistent and inconclusive. Potential mechanisms by which poverty and low household SEC may be both a cause and consequence of disability are outlined in the reviews and the qualitative studies. The association of poor SECs with learning disability and behaviour problems was the most consistent finding and these studies had low/medium risk of bias. Where overall disability was the outcome of interest, findings were divergent and many studies had a high/medium risk of bias. Qualitative studies were methodologically weak. CONCLUSIONS This review indicates that, despite socially and biologically plausible mechanisms underlying the association of low household SEC with childhood disability in LAMI countries, the empirical evidence from quantitative studies is inconsistent and contradictory. There is evidence for a bidirectional association of low household SEC and disability and longitudinal data is needed to clarify the nature of this association.
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Affiliation(s)
- Douglas E Simkiss
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, (Gibbet Hill Road), Coventry, (CV4 7AL), UK
| | - Clare M Blackburn
- School of Health and Social Studies, University of Warwick, (Gibbet Hill Road), Coventry, (CV47 1GN), UK
| | - Felix O Mukoro
- NHS Kidney Care, New Croft House, (Market Street East), Newcastle upon Tyne, (NE1 6ND), UK
| | - Janet M Read
- School of Health and Social Studies, University of Warwick, (Gibbet Hill Road), Coventry, (CV47 1GN), UK
| | - Nicholas J Spencer
- School of Health and Social Studies, University of Warwick, (Gibbet Hill Road), Coventry, (CV47 1GN), UK
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Wachs TD, Posada G, Carbonell OA, Creed-Kanashiro H, Gurkas P. Infant Nutrition and 12 and 18 Months Secure Base Behavior: An Exploratory Study. INFANCY 2011; 16:91-111. [PMID: 32693480 DOI: 10.1111/j.1532-7078.2010.00040.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A notable omission in studies of developmental links to early nutritional deficiencies is infant attachment. In those few studies investigating associations between infant nutrition and attachment, nutrition was defined solely by physical growth, and infants had moderate-severe growth retardation. In this study, we utilized multiple markers of infant nutrition. Our sample consisted of 172 12-month-old Peruvian infants and their mothers from low-income families, with a follow-up assessment on 77 infants at 18 months. Infants were not severely malnourished, but did have micronutrient deficiencies. Anthropometry, dietary intake, and iron status were used as measures of infant nutrition. Based on infant behavior in a structured laboratory situation, Q-sort techniques were used to rate three attachment markers: infant secure base behavior, interaction quality, and negative emotionality with mother. At 12 months, infant weight was positively related to interaction quality. At 18 months, infant iron status was positively related to secure base behavior. This pattern of findings remained even after statistically controlling for family socioeconomic status and maternal education. Our findings indicate that infant nutritional status is associated with markers of infant attachment and these associations are not restricted just to severely malnourished infants.
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Affiliation(s)
| | - German Posada
- Department of Child Development and Family Studies Purdue University
| | | | | | - Pinar Gurkas
- Department of Psychology & Sociology Columbus State University
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Wallander JL, McClure E, Biasini F, Goudar SS, Pasha O, Chomba E, Shearer D, Wright L, Thorsten V, Chakraborty H, Dhaded SM, Mahantshetti NS, Bellad RM, Abbasi Z, Carlo W. Brain research to ameliorate impaired neurodevelopment--home-based intervention trial (BRAIN-HIT). BMC Pediatr 2010; 10:27. [PMID: 20433740 PMCID: PMC2873519 DOI: 10.1186/1471-2431-10-27] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low- and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low- and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality and morbidity from birth asphyxia disproportionately affect more infants in low- and low-middle-income countries, particularly those from the lowest socioeconomic groups. There is evidence that relatively inexpensive programs of early developmental intervention, delivered during home visit by parent trainers, are capable of improving neurodevelopment in infants following brain insult due to birth asphyxia. METHODS/DESIGN This trial is a block-randomized controlled trial that has enrolled 174 children with birth asphyxia and 257 without perinatal complications, comparing early developmental intervention plus health and safety counseling to the control intervention receiving health and safety counseling only, in sites in India, Pakistan, and Zambia. The interventions are delivered in home visits every two weeks by parent trainers from 2 weeks after birth until age 36 months. The primary outcome of the trial is cognitive development, and secondary outcomes include social-emotional and motor development. Child, parent, and family characteristics and number of home visits completed are evaluated as moderating factors. DISCUSSION The trial is supervised by a trial steering committee, and an independent data monitoring committee monitors the trial. Findings from this trial have the potential to inform about strategies for reducing neurodevelopmental disabilities in at-risk young children in low and middle income countries.
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Affiliation(s)
- Jan L Wallander
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 Lake Road, Merced, CA 95343, USA
| | - Elizabeth McClure
- Department of Statistics and Epidemiology, RTI International, 3040 Cornwallis Road, Durham, NC 27709, USA
| | - Fred Biasini
- Department of Psychology, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294, USA
| | - Shivaprasad S Goudar
- Departments of Physiology and Medical Education, J N Medical College, Belgaum, 590 010 Karnataka, India
| | - Omrana Pasha
- Departments of Community Health Sciences and Family Medicine, Aga Kahn University, Stadium Road, Karachi 74800, Pakistan
| | - Elwyn Chomba
- University Teaching Hospital, Private Bag RW1X, Lusaka, Zambia
| | - Darlene Shearer
- Department of Public Health, Western Kentucky University, 1906 College Heights Blvd, AC 129A, Bowling Green, KY 42101, USA
| | - Linda Wright
- Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 4B05J, Rockville, MD 20852, USA
| | - Vanessa Thorsten
- Department of Statistics and Epidemiology, RTI International, 3040 Cornwallis Road, Durham, NC 27709, USA
| | - Hrishikesh Chakraborty
- Department of Statistics and Epidemiology, RTI International, 3040 Cornwallis Road, Durham, NC 27709, USA
| | - Sangappa M Dhaded
- Department of Pediatrics, J. N. Medical College, Belgaum, 590 010 Karnataka, India
| | | | - Roopa M Bellad
- Department of Pediatrics, J. N. Medical College, Belgaum, 590 010 Karnataka, India
| | - Zahid Abbasi
- Departments of Community Health Sciences and Family Medicine, Aga Kahn University, Stadium Road, Karachi 74800, Pakistan
| | - Waldemar Carlo
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, 619 South 20th Street, Birmingham, AL 35233-7335, USA
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Aburto NJ, Ramirez-Zea M, Neufeld LM, Flores-Ayala R. The effect of nutritional supplementation on physical activity and exploratory behavior of Mexican infants aged 8–12 months. Eur J Clin Nutr 2010; 64:644-51. [DOI: 10.1038/ejcn.2010.52] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Baker-Henningham H, Hamadani JD, Huda SN, Grantham-McGregor SM. Undernourished children have different temperaments than better-nourished children in rural Bangladesh. J Nutr 2009; 139:1765-71. [PMID: 19605526 DOI: 10.3945/jn.109.106294] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Undernutrition in early childhood is associated with poor cognitive development and some changes in behavior. However, there is little information on their temperament. Our objective in this study was to determine whether undernourished children aged 6-24 mo had different temperament traits than better-nourished children. Two hundred and twelve undernourished children (weight for age < -2 Z-scores) attending community nutrition centers in 20 villages in rural Bangladesh and 108 better-nourished children (weight-for-age > or = -2 Z-scores) matched for age, sex, and village participated in the study. Temperament was assessed through an interviewer-administered maternal questionnaire consisting of 7 subscales: manageability, activity, emotionality, sociability, attention, soothability, and fear. After adjusting for significant covariates, the undernourished children were less sociable [regression coefficient (B) = -0.96; 95% CI = -0.04, -1.88], less attentive (B = -0.94; 95% CI = -0.19, -1.69), more fearful (B = 1.43; 95% CI = 2.44, 0.42), and had more negative emotionality (B = -1.08; 95% CI = 0.006, -2.16). In conclusion, these undernourished children had comprehensive differences in temperament traits, which may increase their risk of developing behavioral and mental health problems in later childhood.
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30
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Aburto NJ, Ramirez-Zea M, Neufeld LM, Flores-Ayala R. Some indicators of nutritional status are associated with activity and exploration in infants at risk for vitamin and mineral deficiencies. J Nutr 2009; 139:1751-7. [PMID: 19640971 DOI: 10.3945/jn.108.100487] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Severe malnutrition, both protein-energy and micronutrient deficiency, results in decreased activity, but the results regarding mild-to-moderate malnutrition are equivocal. Our objective in this investigation was to describe the activity and exploratory behavior of Mexican infants and describe the relationship among nutritional status, activity, and exploration in this population at high risk for mild-to-moderate micronutrient deficiency, but at low risk for severe malnutrition. The participants were infants, 4-12 mo old, of low socioeconomic status from 3 states in southern Mexico. We measured anthropometrics using standard techniques. We measured hemoglobin (Hb) concentration in the field and adjusted values for altitude before analysis. We measured activity and exploration by direct observation during 15 min of individual play in a novel environment. Cluster analysis generated mutually exclusive activity clusters and exploration clusters based on patterns of bodily movement and exploratory behavior, respectively. We categorized the clusters as higher or lower activity or higher or lower exploration. A higher Hb concentration and height-for-age Z-score (HAZ) significantly increased the odds of being in the high-activity cluster. Iron deficiency, stunting, and wasting significantly decreased the odds of being in the high-activity cluster. Higher HAZ and weight-for-age Z-score significantly increased the odds of being in a higher exploration cluster. In Mexican infants at risk for mild-to-moderate micronutrient deficiency but at low risk of severe malnutrition, some indicators of nutritional status were related to increased activity and exploration.
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Affiliation(s)
- Nancy J Aburto
- Division of Nutrition, Physical Activity and Obesity, CDC, Atlanta, GA 30341, USA.
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31
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Eickmann SH, Maciel AMS, Lira PIC, Lima MDC. Fatores associados ao desenvolvimento mental e motor de crianças de quatro creches públicas de Recife, Brasil. REVISTA PAULISTA DE PEDIATRIA 2009. [DOI: 10.1590/s0103-05822009000300008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Identificar os fatores associados aos índices de desenvolvimento mental e motor em lactentes que frequentam creches da rede municipal em Recife. MÉTODOS: Estudo de corte transversal realizado entre fevereiro e abril de 2005 em uma amostra de 108 crianças com idade entre quatro e 24 meses, pertencentes a quatro creches municipais do Recife. O desenvolvimento mental e motor foi avaliado pela Escala de Desenvolvimento Infantil de Bayley II. Por meio de entrevistas às mães, foram obtidas informações sobre as condições socioeconômicas e demográficas das famílias e as características biológicas das crianças ao nascer (peso, sexo e idade gestacional). O estado nutricional foi avaliado através dos índices peso/idade, comprimento/idade, peso/comprimento e da concentração de hemoglobina. RESULTADOS: As médias dos índices de desenvolvimento mental e motor foram 88±11 e 95±12 pontos, respectivamente. A idade gestacional apresentou associação significativa com o desenvolvimento mental e motor e o peso ao nascer e o estado nutricional atual, avaliado pelo índice peso/comprimento, se associaram ao desenvolvimento motor. CONCLUSÕES: As crianças analisadas apresentaram desenvolvimento neuropsicomotor ainda na faixa de normalidade, mas aquém do esperado para a idade, comparado a populações de referência em países desenvolvidos. Os fatores associados ao baixo desempenho do desenvolvimento nessa população estão relacionados aos fatores biológicos, destacando-se os déficits nutricionais, cuja redução deve ser uma prioridade para gestores em saúde e educação.
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Hadley C, Tegegn A, Tessema F, Asefa M, Galea S. Parental symptoms of common mental disorders and children's social, motor, and language development in sub-Saharan Africa. Ann Hum Biol 2009; 35:259-75. [DOI: 10.1080/03014460802043624] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wachs TD. Models linking nutritional deficiencies to maternal and child mental health. Am J Clin Nutr 2009; 89:935S-939S. [PMID: 19176736 DOI: 10.3945/ajcn.2008.26692b] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The primary goal of this article was to illustrate how nutritional deficiencies can translate into adult or child mental health problems. Whereas brain development and function play an essential role in the etiology and maintenance of mental health problems, what is required are models that go beyond nutrition-brain relations and integrate the contributions of nutritionally related contextual and behavioral characteristics. Four such models are presented. The multiple risks model derives from evidence showing covariance between nutritional deficiencies and other life stressors. Given that poorly nourished adults may be less able to actively cope with stressors, nutritional deficiencies may accentuate the negative impact of stress exposure on mental health. The cross-generational model is based on evidence showing less adequate patterns of mother-child interactions when mothers are poorly nourished. Impairments in mother-child interactions increase the likelihood of child mental health problems and the risk of subsequent child nutritional deficiencies. The attachment model derives from evidence showing that poorly nourished infants may be less likely to elicit the types of maternal child-rearing patterns that translate into secure infant-mother attachments. Insecure attachments in infancy are associated with an increased risk of both short-term and long-term child mental health problems. The temperament model is based on evidence documenting that certain patterns of infant temperament are related to an increased risk of later behavioral problems. Infant nutritional deficiencies can influence the development of temperament, and certain temperament patterns can contribute to an increased risk of infant nutritional deficiencies.
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Affiliation(s)
- Theodore D Wachs
- Department of Psychological Sciences, Purdue University, West Lafayette, IN 47907, USA.
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Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P. Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Am J Clin Nutr 2009; 89:382-90. [PMID: 19056572 DOI: 10.3945/ajcn.2008.26483] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Therapeutic feeding with micronutrient-fortified lipid-based nutrient supplements (LNSs) has proven useful in the rehabilitation of severely malnourished children. We recently reported that complementary feeding of 6-18-mo-old infants with an LNS known as FS50 was associated with improved linear growth and a reduction in the incidence of severe stunting during the supplementation period. OBJECTIVE Our objective was to assess whether a reduction in stunting seen with 12-mo LNS supplementation was sustained over a subsequent 2-y nonintervention period. DESIGN One hundred eighty-two 6-mo-old healthy rural Malawian infants were randomly assigned to receive daily supplementation for 12 mo with 71 g of maize-soy flour [likuni phala (LP); control group, 282 kcal] or either 50 g of FS50 (264 kcal; main intervention group), or 25 g of FS25 (130 kcal). Main outcome measures were incidence of severe stunting and mean z score changes in weight-for-age, length-for-age, and weight-for-length during a 36-mo follow-up period. RESULTS The cumulative 36-mo incidence of severe stunting was 19.6% in LP, 3.6% in FS50, and 10.3% in FS25 groups (P = 0.03). Mean weight-for-age changes were -1.09, -0.76, and -1.22 (P = 0.04); mean length-for-age changes were -0.47, -0.37, and -0.71 (P = 0.10); and mean weight-for-length changes were -1.52, -1.18, and -1.48 (P = 0.27). All differences were more marked among individuals with baseline length-for-age below the median. Differences in length developed during the intervention at age 10-18 mo, whereas weight differences continued to increase after the intervention. CONCLUSIONS Twelve-month-long complementary feeding with 50 g/d FS50 is likely to have a positive and sustained impact on the incidence of severe stunting in rural Malawi. Half-dose intervention may not have the same effect. This trial was registered at (clinicaltrials.gov) as NCT00131209.
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Affiliation(s)
- John C Phuka
- College of Medicine, University of Malawi, Blantyre, Malawi.
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35
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Abubakar A, Van de Vijver F, Van Baar A, Mbonani L, Kalu R, Newton C, Holding P. Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study. Early Hum Dev 2008; 84:613-21. [PMID: 18499363 PMCID: PMC4825882 DOI: 10.1016/j.earlhumdev.2008.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 01/21/2008] [Accepted: 02/21/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome. AIM To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings. STUDY DESIGN A cross-sectional study design was used. SUBJECTS A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months). OUTCOME MEASURE Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory. RESULTS A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect. CONCLUSION Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.
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Affiliation(s)
- Amina Abubakar
- Centre for Geographic Medicine Research-Coast, KEMRI/ Wellcome Trust Research Programme, Kenya.
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36
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Olney DK, Pollitt E, Kariger PK, Khalfan SS, Ali NS, Tielsch JM, Sazawal S, Black R, Mast D, Allen LH, Stoltzfus RJ. Young Zanzibari children with iron deficiency, iron deficiency anemia, stunting, or malaria have lower motor activity scores and spend less time in locomotion. J Nutr 2007; 137:2756-62. [PMID: 18029495 DOI: 10.1093/jn/137.12.2756] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Motor activity improves cognitive and social-emotional development through a child's exploration of his or her physical and social environment. This study assessed anemia, iron deficiency, hemoglobin (Hb), length-for-age Z-score (LAZ), and malaria infection as predictors of motor activity in 771 children aged 5-19 mo. Trained observers conducted 2- to 4-h observations of children's motor activity in and around their homes. Binary logistic regression assessed the predictors of any locomotion. Children who did not locomote during the observation (nonmovers) were excluded from further analyses. Linear regression evaluated the predictors of total motor activity (TMA) and time spent in locomotion for all children who locomoted during the observation combined (movers) and then separately for crawlers and walkers. Iron deficiency (77.0%), anemia (58.9%), malaria infection (33.9%), and stunting (34.6%) were prevalent. Iron deficiency with and without anemia, Hb, LAZ, and malaria infection significantly predicted TMA and locomotion in all movers. Malaria infection significantly predicted less TMA and locomotion in crawlers. In walkers, iron deficiency anemia predicted less activity and locomotion, whereas higher Hb and LAZ significantly predicted more activity and locomotion, even after controlling for attained milestone. Improvements in iron status and growth and prevention or effective treatment of malaria may improve children's motor, cognitive, and social-emotional development either directly or through improvements in motor activity. However, the relative importance of these factors is dependent on motor development, with malaria being important for the younger, less developmentally advanced children and Hb and LAZ becoming important as children begin to attain walking skills.
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Affiliation(s)
- Deanna K Olney
- Program in International and Community Nutrition, University of California, Davis, CA 95616, USA.
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Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 2007; 137:2464-9. [PMID: 17951486 DOI: 10.1093/jn/137.11.2464] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.
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Affiliation(s)
- Susan P Walker
- Epidemiology Research Unit, University of the West Indies, Kingston 7, Jamaica.
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Stewart RC. Maternal depression and infant growth: a review of recent evidence. MATERNAL AND CHILD NUTRITION 2007; 3:94-107. [PMID: 17355442 PMCID: PMC6860855 DOI: 10.1111/j.1740-8709.2007.00088.x] [Citation(s) in RCA: 197] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Depressive disorder occurring during pregnancy and the post-natal period (maternal depression) is common in both developed and developing countries. It can cause functional impairment at a time when the mother is performing tasks vital to her infant's growth and development. This article reviews recent research investigating whether there is an association between maternal depression and infant growth impairment. A search was made using Medline for articles published in the last 10 years, and the results were scrutinized for relevance and quality. Eight studies from developing countries, and three from the UK, are described. Cohort studies from both India and Pakistan provide evidence that maternal depression is an independent risk factor for poor infant growth. However, studies from other developing countries are limited and conflicting in their findings. The UK-based research suggests that such an association occurs in mothers/infants living in conditions of socio-economic deprivation. This review discusses the potential mechanisms by which the relationship between maternal depression and infant growth outcomes may be explained: the effect of infant growth 'failure' upon maternal mood; the impact of maternal depression upon health-seeking behaviours, breastfeeding and mother-child interaction; the relationship between antenatal depression and low infant birthweight; and economic, socio-cultural and confounding factors that may explain the variation between results from different settings.
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Affiliation(s)
- Robert C Stewart
- Department of Community Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
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Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, Carter JA. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 369:145-57. [PMID: 17223478 DOI: 10.1016/s0140-6736(07)60076-2] [Citation(s) in RCA: 1054] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifiable biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine deficiency, and iron deficiency anaemia. The evidence is also sufficient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the effect of other potential risk factors on child development. The prevalence of the risk factors and their effect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse effects on the development of the world's poorest children.
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Affiliation(s)
- Susan P Walker
- Epidemiology Research Unit, The University of the West Indies, Mona, Jamaica.
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40
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Grantham-McGregor S, Baker-Henningham H. Review of the evidence linking protein and energy to mental development. Public Health Nutr 2007; 8:1191-201. [PMID: 16277829 DOI: 10.1079/phn2005805] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo examine the evidence as to whether the relationship between undernutrition and poor child development is causal.DesignSelected studies from developing countries were discussed. Observational studies were first considered then experimental studies of preventative and remedial supplementation. The type of functions affected, the presence of sensitive periods and the role of protein and energy versus that of micronutrients were reviewed.ResultsChildhood undernutrition is generally associated with concurrent and longer term deficits in cognition, behaviour and motor skills, although the relationship is likely to be confounded by socio-economic factors. Supplementation trials have had many design problems. However, those beginning at any age from pregnancy up to 24 months have consistently had concurrent benefits suggesting a causal relationship. Supplement begun in older children had little or no effect, albeit there are too few studies to conclude with confidence. The limited evidence suggests that benefits are more likely to be sustained if supplementation begins in late pregnancy or at birth and is continued until the child is at least 24 months old.Deficits in cognition tend to be global and there is insufficient evidence of specific deficits. There is some evidence that the first 2 years of life are most sensitive to the effects of undernutrition. Most studies have failed to separate the effects of energy and protein from those of micronutrients. One study showed that energy and/or protein affects children's development. Psychosocial stimulation has had consistent benefits on undernourished childrens' developmentConclusionsPublic health nutrition programmes should include a component in which children who are at risk are targeted during the first 2 years of life with combined interventions involving nutrition, health care and early stimulation.
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Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. BMJ 2006; 333:472. [PMID: 16877454 PMCID: PMC1557928 DOI: 10.1136/bmj.38897.555208.2f] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether dietary supplementation or psychosocial stimulation given to growth retarded (stunted) children age 9-24 months has long term benefits for their psychosocial functioning in late adolescence. DESIGN Sixteen year follow-up study of a randomised controlled trial. SETTING Poor neighbourhoods in Kingston, Jamaica. PARTICIPANTS Of 129 stunted children identified at age 9-24 months, 103 adolescents aged 17-18 were followed up. INTERVENTION Supplementation with 1 kg milk based formula each week or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years. MAIN OUTCOME MEASURES Anxiety, depression, self esteem, and antisocial behaviour assessed by questionnaires administered by interviewers; attention deficit, hyperactivity, and oppositional behaviour assessed by interviews with parents. RESULTS Primary analysis indicated that participants who received stimulation had significantly different overall scores from those who did not (F = 2.047, P = 0.049). Supplementation had no significant effect (F = 1.505, P = 0.17). Participants who received stimulation reported less anxiety (mean difference - 2.81, 95% confidence interval - 5.02 to - 0.61), less depression (- 0.43, - 0.78 to - 0.07), and higher self esteem (1.55, 0.08 to 3.02) and parents reported fewer attention problems (- 3.34, - 6.48 to - 0.19). These differences are equivalent to effect sizes of 0.40-0.49 standard deviations. CONCLUSIONS Stimulation in early childhood has sustained benefits to stunted children's emotional outcomes and attention.
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Affiliation(s)
- Susan P Walker
- Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica.
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Kurpad AV, Muthayya S, Vaz M. Consequences of inadequate food energy and negative energy balance in humans. Public Health Nutr 2006; 8:1053-76. [PMID: 16277820 DOI: 10.1079/phn2005796] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Energy deficiency is probably best measured in adults by the body mass index (BMI). Acute energy deficiency (AED) is associated with body weight loss, along with changes in body composition, as well as a reduced BMR and physical activity. Chronic energy deficiency (CED) is an inadequacy in food to which individuals adapt, at some cost. Individuals with this have never 'lost' weight: they have simply grown less. They adapt to the decreased food energy by reductions in their total energy expenditure (TEE), linked mainly to a lower body size, and to their physical activity. It seems unlikely that enhanced metabolic efficiency contributes substantially to energy saving in CED. Supplementation of energy deficient individuals is accompanied by significant fat deposition; this may have deleterious consequences. Women in many developing countries achieve a successful outcome to pregnancy in spite of being chronically undernourished. Reductions in basal metabolism and behavioural changes in the form of diminished physical activity could meet most of the extra energy needed for pregnancy. Milk energy output is maintained within the expected range in undernourished lactating mothers. Energy deficiency in children is best measured by height-for-age for stunting, and weight-for-height for wasting. Deficits in behavioural and functional parameters in children exist with undernutrition, and can be reduced by early nutritional supplementation along with the appropriate environment.
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Affiliation(s)
- A V Kurpad
- Division of Nutrition, Institute of Population Health and Clinical Research, St. John's National Academy of Health Sciences, Bangalore 560 034, India.
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Lima MC, Eickmann SH, Lima ACV, Guerra MQ, Lira PIC, Huttly SRA, Ashworth A. Determinants of mental and motor development at 12 months in a low income population: a cohort study in northeast Brazil. Acta Paediatr 2004; 93:969-75. [PMID: 15303815 DOI: 10.1111/j.1651-2227.2004.tb18257.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To identify biological and environmental factors associated with poorer mental and motor development at age 12 mo in urban communities in northeast Brazil. METHODS A cohort of 245 infants born during January August 1998 in six hospitals in the interior of Pernambuco was followed twice weekly from birth until 12 mo of age. Socio-economic, demographic and environmental data were collected, together with daily information on morbidity and feeding patterns. Gestational age, birth anthropometry and nutritional status at 12 mo were measured. Multiple linear regression analysis was used to identify variables that had independent effects on mental and motor development assessed at 12 mo of age with the Bayley Scales of Infant Development. RESULTS Environmental factors explained about 21% and 19% of the variance in mental and motor development, respectively. Of these, the most important were poverty-related. Significant biological factors associated with mental development were birthweight and infant sex. For motor development, the biological factors were weight-for-age and haemoglobin concentration. Biological factors explained only 6% and 5% of the variance in mental and motor development, respectively. CONCLUSION Of the variables examined, environmental factors had a greater detrimental effect on child development than biological factors in this population. Interventions that enhance social capital and alleviate poverty are advocated.
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Affiliation(s)
- M C Lima
- Federal University of Pernambuco, Recife, Brazil
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Wachs TD. Expanding Our View of Context: The Bio-ecological Environment and Development. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2004; 31:363-409. [PMID: 14528666 DOI: 10.1016/s0065-2407(03)31009-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Theodore D Wachs
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana 47907, USA
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Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S. Mothers of undernourished Jamaican children have poorer psychosocial functioning and this is associated with stimulation provided in the home. Eur J Clin Nutr 2003; 57:786-92. [PMID: 12792663 DOI: 10.1038/sj.ejcn.1601611] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare mothers of undernourished children with mothers of adequately nourished children on maternal depression, parenting self-esteem, social support and exposure to stressors and to determine if these variables are independently related to undernutrition and stimulation provided in the home after controlling for socio-economic status. DESIGN A case control study. SETTING Children and their mothers were recruited from 18 government health centres in the Kingston, St Andrew and St Catherine parishes of Jamaica. SUBJECTS One hundred and thirty-nine mothers of undernourished children (WAZ< or =-1.5z scores) aged 9 - 30 months and 71 mothers of adequately nourished children (WAZ > -1z scores) matched for sex and age group were enrolled into the study. RESULTS Mothers of undernourished children came from poorer homes but had similar social support to mothers of adequately nourished children. They were more depressed, had lower levels of parenting self-esteem (both P<0.01), reported higher levels of economic stress (P<0.001) and provided a less stimulating home environment (P<0.05). However, after controlling for social background variables there was no independent relationship between either psychosocial function or home stimulation and nutritional status. Undernutrition was found to be mainly explained by economic factors. The mothers' self-esteem was independently associated with the level of stimulation provided to the child. CONCLUSIONS When caring for undernourished children attention should be paid to the psychosocial status of the mother as well as the physical condition of the child. SPONSORSHIP Thrasher Research Fund; Campus Research and Publication Fund, UWI, Jamaica.
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Affiliation(s)
- H Baker-Henningham
- Centre of International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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