Nutritional status and correlation with academic performance among primary school children, northwest Ethiopia

Objective

This study aimed to determine the association between nutritional status and academic performance among primary school children in Debre Markos Town, northwest Ethiopia, 2017.

Results

The prevalence of stunting, underweight and wasting were 27.5% (95% CI 23.2–31.9%), 20.4% (95% CI 16.5–24.3%) and 8.7% (95% CI 6.2–11.5%), correspondingly. The low level of educational performance was significantly higher (p < 0.05) among the stunted, underweight and wasted children than that of the normal children. In multivariable logistic regression, age of the child (Adjusted Odds Ratio (AOR) = 0.177, 95% CI 0.07, 0.4), monthly income less < 1000.00 birr (AOR = 0.05, 95% Cl 0.02, 0.15), stunted children (AOR = 0.21, 95% CI 0.10, 0.43) and under-weight (AOR = 0.63, 95% CI 0.26, 0.84) were associated with academic performance. This study revealed that indicators of undernutrition were prevalent among school-age children. Thus, collaboration between the health and education sectors is required to alleviate the problem.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3909-1) contains supplementary material, which is available to authorized users.

Developmental performance of hospitalized severely acutely malnourished under-six children in low- income setting

Background

Retrospective studies show that severe acute malnutrition (SAM) affects child development. However, to what extent SAM affects children of different ages at its acute stage is not well documented. This study was aimed at comparing the developmental performance of severely acutely malnourished children under six with that of age and gender-matched non-malnourished healthy children.

Methods

The developmental performances of 310 children with SAM (male = 155, female = 155); mean age = 30.7 mo; SD = 15.2 mo) admitted to the nutritional rehabilitation unit (NRU) at Jimma University’s Hospital was compared with that of 310 age and gender-matched, non-malnourished healthy children (male = 155, female = 155; mean age = 29.6 mo; SD = 15.4 mo) living in Jimma Town in Ethiopia. Two culturally adapted tools were used: (1) the Denver II-Jimma, to assess the children’s performance on personal social (PS), fine motor (FM) language (LA), gross motor (GM) skills, and (2) the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), to assess social-emotional (SE) skills. Multivariable Poisson regression analysis was conducted to compare the developmental performance scores of SAM and non-malnourished children.

Results

For one-year-old children, SAM delays their developmental performance on GM, FM, PS and LA by 300%, 200%, 140% and 71.4% respectively. For three-years-old children, SAM delays their developmental performance on GM by 80%, on FM and LA by 50% each, and on PS by 28.6%. Of the skills assessed on Denver II-Jimma, GM is the most, and PS is the least affected. Younger SAM children are more affected than older ones on all the domains of development. The delay in FM, GM, LA and PS generally decreases with an increase in age. Social-emotional behavior problems seem to be most pronounced in the very young and older age ranges.

Conclusions

SAM has a differential age effect on the different dimensions of development in children under 6 years of age.

Electronic supplementary material

The online version of this article (10.1186/s12887-017-0950-5) contains supplementary material, which is available to authorized users.

The effect of subclinical infantile thiamine deficiency on motor function in preschool children

We investigated the long-term implications of infantile thiamine (vitamin B1) deficiency on motor function in preschoolers who had been fed during the first 2 years of life with a faulty milk substitute. In this retrospective cohort study, 39 children aged 5-6 years who had been exposed to a thiamine-deficient formula during infancy were compared with 30 age-matched healthy children with unremarkable infant nutritional history. The motor function of the participants was evaluated with The Movement Assessment Battery for Children (M-ABC) and the Zuk Assessment. Both evaluation tools revealed statistically significant differences between the exposed and unexposed groups for gross and fine motor development (p < .001, ball skills p = .01) and grapho-motor development (p = .004). The differences were especially noteworthy on M-ABC testing for balance control functioning (p < .001, OR 5.4; 95% CI 3.4-7.4) and fine motor skills (p < .001, OR 3.2; 95% CI 1.8-4.6). In the exposed group, both assessments concurred on the high rate of children exhibiting motor function difficulties in comparison to unexposed group (M-ABC: 56% vs. 10%, Zuk Assessment: 59% vs. 3%, p < .001). Thiamine deficiency in infancy has long-term implications on gross and fine motor function and balance skills in childhood, thiamine having a crucial role in normal motor development. The study emphasizes the importance of proper infant feeding and regulatory control of breast milk substitutes.

Linking Nutrition and Education: A Cross-Generation Model

Psychosocial influences, such as the family or the school, and biologic influences, such as nutrition or the presence of environmental toxins, can be viewed as elements of a child's overall environment. Family and school influences define dimensions of the child's psychosocial environment whereas nutrition and exposure to toxins define dimensions of the child's bioecologic environment. This paper presents a cross-generation model specifying both the nature and consequences of linkages between the psychosocial and bioecologic environments, with specific reference to schooling, nutrition, and development. Data from two studies done in Egypt and Peru are used to illustrate this model, showing how duration of breastfeeding and quality of the young child's diet are positively associated with higher levels of maternal education and intelligence.

Nutritional deficits and behavioural development

Despite a high incidence level the study of relations between nutritional deficits and children’s behavioural development is a topic that has been relatively neglected by developmental researchers. Such neglect has implications for the generalisability of developmental theories, especially to less developed countries where the majority of the world’s children live and where nutritional deficits are more likely to occur. This paper reviews evidence on the role played by nutritional deficits in children’s development and the mechanisms underlying nutrition → development links. Future directions for collaborative research between clinical, developmental, and nutritional scientists are proposed.

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance

This study investigated the psychometric properties of a number of neuropsychological tests adapted for use in sub-Saharan Africa. A total of 308 school-age children in a predominantly rural community completed the tests. These tests were developed to assess skills similar to those measured by assessments of cognitive development published for use in Western contexts. Culturally appropriate adaptations were made to enhance within-population variability. Internal consistency ranged from .70 to .84. Scores on individual tests were related to various background factors at the level of the child, household, and neighborhood. School experience was the most consistent predictor of outcome, accounting for up to 22.9% of the variance observed. Significant associations were identified to determine salient background characteristics that should be taken into account when measuring the discrete effects of disease exposure in similar sociocultural and economic settings.

Hemoglobin, growth, and attention of infants in southern Ethiopia

Male and female infants from rural Ethiopia were tested to investigate relations among hemoglobin (Hb), anthropometry, and attention. A longitudinal design was used to examine differences in attention performance from 6 (M = 24.9 weeks, n = 89) to 9 months of age (M = 40.6 weeks, n = 85), differences hypothesized to be related to changes in iron status and growth delays. Stunting (length-for-age z scores < -2.0) and attention performance, t(30) = -2.42, p = .022, worsened over time. Growth and Hb predicted attention at 9 months, R(2) = .15, p < .05, but not at 6. The study contributes to the knowledge base concerning the relations among Hb, early growth, and attention.

Models linking nutritional deficiencies to maternal and child mental health

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.

The rise of non-adaptive intelligence in humans under pathogen pressure

Cleverness made our species the most successful primate on Earth, thus claiming that human intelligence is adaptive sounds to be a triviality. Not surprisingly, when establishing long-lasting pair-bonds, humans exhibit mate preferences in favour of clever partners, apparently to increase the chance that their offspring will be as clever as possible. Contrary to this well-established view, here I argue that the adaptive nature of human intelligence has never been proven in a strict evolutionary sense. Furthermore, the exceptional rise of intelligence in our species (and the lack of comparable phenomena in other apes) is best explained within the context of the Hamilton-Zuk Hypothesis. Apparently, humans have been subjected to an exceptionally strong selection pressure exerted by pathogens and parasites, and the human brain is particularly vulnerable to infections, thus cleverness is an ideal character to signal heritable genetic resistance against infections. In this scenario, human preference for intelligent mates is to increase the offspring's resistance against pathogens. Among other phenomena, this hypothesis can explain why humans enjoy wasting most of their intellectual capabilities for totally useless purposes, why prehistoric humans developed brains that made them potentially far more intelligent than required by their physical environment, and why we experience a continuous increase of human intelligence even in modern societies. Briefly, I argue that (1) human sexual selection favours intelligence as a signal of genetic resistance against pathogens, and (2) that intelligence enabled the rise of our species (in terms of population size and distribution) as an accidental side-effect.

Economic and nutritional analyses offer substantial synergies for understanding human nutrition

There is growing recognition that interventions designed to improve human nutritional status have, in addition to their intrinsic value, instrumental value in terms of economic outcomes. In many cases, productivity gains alone provide sufficient economic returns to justify investments using benefit and cost criteria. The often-held belief that nutrition programs are welfare interventions that divert resources that could be better used in other ways to raise national incomes is incorrect. Many investments in nutrition are in fact very good economic investments. This recognition has developed out of work that integrates insights from nutrition and economics. Further exploration of this interface is the focus of this article, which seeks: 1) to outline recent contributions that integrate research results from both economics and nutrition, particularly in the context of poor countries; and 2) to describe some areas in which enhanced collaboration is likely to have substantial payoffs in terms of both improved knowledge and more informed policy choices. Collaborative cross-disciplinary research on the topics described here is likely to have substantial payoffs, not only in terms of our understanding of nutritional and economic issues, but also in the improved design of programs and policies that seek to benefit nutritional-related outcomes.

Child development: risk factors for adverse outcomes in developing countries

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.

Maternal education and intelligence predict offspring diet and nutritional status

The traditional assumption that children's nutritional deficiencies are essentially due either to overall food scarcity or to a lack of family resources to purchase available food has been increasingly questioned. Parental characteristics represent 1 type of noneconomic factor that may be related to variability in children's diets and nutritional status. We report evidence on the relation of 2 parental characteristics, maternal education level and maternal intelligence, to infant and toddler diet and nutritional status. Our sample consisted of 241 low-income Peruvian mothers and their infants assessed from 3 to 12 mo, with a further follow-up of 104 of these infants at 18 mo of age. Using a nonexperimental design, we related measures of level of maternal education, maternal intelligence, and family socioeconomic status to infant anthropometry, duration of exclusive breast-feeding, adequacy of dietary intake, and iron status. Results indicated unique positive relations between maternal education level and the extent of exclusive breast-feeding. Significant relations between maternal education and offspring length were partially mediated by maternal height. There also were unique positive relations between maternal intelligence and quality of offspring diet and hemoglobin level. All findings remained significant even after controlling for family socioeconomic characteristics. This pattern of results illustrates the importance of parental characteristics in structuring the adequacy of offspring diet. Maternal education and intelligence appear to have unique influences upon different aspects of the diet and nutritional status of offspring.

Relation of neonatal iron status to individual variability in neonatal temperament

The relation between indices of neonatal iron status and individual differences in neonatal temperament were investigated in a sample of 148 low-income Peruvian women and their newborn infants. Using cord blood, at birth we obtained measures of neonatal ferritin, serum iron, and hemoglobin. While neonates were still in the hospital, their behavior during a structured anthropometry examination was videotaped and subsequently coded on four temperament dimensions: activity level, negative emotionality, alertness, and soothability. The same dimensions were coded using a videotape obtained during a subsequent visit to the neonates' homes. Results indicated that lower levels of neonatal hemoglobin and serum iron were related to higher levels of negative emotionality and to lower levels of alertness and soothability. A similar pattern was found for ferritin, but only for females. For the most part, relations between neonatal iron measures and neonatal temperament were linear, operating across the full range of iron values. Our pattern of iron-temperament results could not be attributed to variation in family demographics, low birth weight, gestational age, maternal dietary intake, or markers of neonatal illness and maternal diabetes. Our findings are consistent with prior research with older infants relating iron deficiency to temperament. These results support the importance of increased research on the early functional-behavioral consequences of individual differences in iron status as well as on the mechanisms that underlie such consequences.