Relationships between physical growth, mental development and nutritional supplementation in stunted children: the Jamaican study

The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales (AU)

The long term follow up of severely malnourished children who participated in an intervention program

Eighteen severely malnourished children (IM) who participated in a 3-year home-visiting program were compared with 2 other comparison groups comprising 17 severely malnourished (NIM) and 19 adequately nourished children (controls). On enrollment, all the groups were in the same hospital, and both malnourished groups had lower developmental levels than the controls. The IM group received interventioned for 3 years after hospitalization, consisting of weekly or 2 weekly home visits with toy demonstrations. At 7, 8, 9, and 14 years after leaving the hospital, the 3 groups were compared on tests of school achievement and IQ. The NIM group showed no sign of reducing their deficits, and at the 14 year follow up they had markedly lower scores on the WISC verbal and performance scales, the Wide Range Achievement Test (WRAT), and the Peabody Picture Vocabulary Test (PPVT), than the controls. Throughout the follow-up the IM group's scores were intermediate between the NIM and the controls in every test. At the 14-year follow up, their scores were significantly higher than those of the NIM group in the WISC verbal scale, and the difference approached significantly in the WRAT. We conclude that psychosocial intervention should be an integral part of treatment for severly malnourished children (AU)

Risk indicators of childhood undernutrition in Kingston, Jamaica

In Jamaica, early childhood undernutrition remains a problem; however, the health of all children cannot be monitored due to limited resources. Therefore, there is a need for the early identification of children at risk of undernutrition. A simple screening instrument for use by paraprofessionals in the primary health care system was developed. We conducted a case-control study using 649 children, aged 6 to 48 months. The cases were undernourished (weight-for-age less than 80 percent of the reference) and identified from a survey. The children's guardians were given a questionnaire comprising 31 variables thought to be associated with undernutrition and which were present from 6 weeks of age. Nine variables were significantly associated with undernutrition. Multiple logistic regression analysis indicated that low birth weight, short birth spacing, being born at home, poor ante-natal and post-natal clinic attendance, overcrowding and a lack of household possessions were independent predictors of undernutrition. Using these variables, a simple scoring system was developed to identify high risk children. It had a sensitivity and specificity of 56 percent and 76 percent respectively and a positive predictive values of 31 percent. This simple screening instrument should be easy to use in the primary health care system. However, its low sensitivity indicates that it is difficult to identify children who are at risk of undernutrition from 6 weeks of age. Subsequent high morbidity and poor child care which were not measured may account for some of the missed cases. (AU)

Risk indicators of childhood malnutrition in Kingston, Jamaica - abstract

Although childhood malnutrition in early childhood remains a problem in Jamaica, the growth and health of all children cannot be monitored due to economic constraints. In order to target limited resources, a screening tool was developed to identify high-risk children. The tool is intended for use by community health aides: so it was designed to be simple and easy to administer. A survey was conducted, and 649 children, aged 6 to 48 months, were identified.. Anthropometric measurements were taken, and information collected on a comprehensive range of variables. The prevalence of moderate to severe malnutrtion (weight-for-age below 80 percent expected value) in the sample was 17 percent. Odds ratios were calculated to examine associations between variables and malnutrition. Malnutrition was significantly associated with variables (p<0.05). These were then included in logistic regression analyses. The results indicated that low birth spacing of 2 years or less, being born at home, poor antenatal and postnatal clinic attendance, overcrowding and no household possessions were independent predictors of malnutrition. Because of its higher risk, low birth weight was given a score of 2 while the other variables each had a score of 1. A total risk score of 2 or more was found to identify 56 percent of the malnourished children and had a specificity and positive predictive value of 76 and 31 percent, respectively. The risk of malnutrition in these children was 4 times that of children with risk scores of less than 2. We propose that this simple scoring system can be used by community health aides to identify children with a high risk of malnutrition whose progress can then be closely monitored (AU)

Bioelectrical impedence, anthropometry and body composition in stunted and non-stunted children

Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.(AU)

The effects of nutritional supplementation and psychosocial stimulation on the growth and development of stunted children - abstract

Supplementation programmes are used in many countries to reduce the prevalence of undernutrition. However, their effectiveness is uncertain. We have conducted a longitudinal study to determine the effects of nutritional supplementation with or without psychosocial stimulation on the growth of stunted children. Stunted (n = 128) and non-stunted (n = 32) children, aged 9-24 months, were recruited by house-to-house survey of poor areas of Kingston. Stunted children were randomly assigned to four groups: control, nutritional supplementation (1 kg whole milk powder/week providing 750 kcals and 20 gm protein daily), stimulation (structured play sessions) and both interventions. All groups were visited weekly. Length, weight, head (HC) and arm (AC) circumferences, and triceps (TSF) and subscapular (SSF) skinfolds were measured on enrollment and 6 and 12 months later. Multiple regression analysis was used to determine the increases in the measurements attributable to supplementation (Table). The partial regression coefficient B, represents the difference between supplemented and non-supplemented groups controlling for age, sex, initial status and several socioeconomic variables. Supplemented children had significantly increased length, weight, HC and TSF in the first six months. There were no significant effects in the second six months. Weight-for-age and height-for age were increased but not weight-for-height. There was no effect of stimulation and no interaction between the interventions. The timing of the response to supplementation may have implications for the design of future interventions (AU)

Stunting, severe malnutrition and mental development in young children

The association was examined between an episode of severe malnutrition, stunting in length and children's developmental levels. Twenty-nine children aged between 6 and 24 months, who had recently recovered from severe malnutrition, were compared with 29 children matched for age and height who had never had an acute episode, and who came from similar social backgrounds. Both groups were given developmental assessments on the Griffiths Test, and their developmental quotients (DQs) were not significantly different. Both groups' DQs were significantly lower than a third group of 15 non-stunted children. It was concluded that the poor developmental levels usually found in severely malnourished children may be largely explained by factors associated with stunting, rather than the acute episode. (AU)

Parasitism and nutritional status of poor suburban Jamaican toddlers

A survey was conducted on 145 toddlers, 6-36 months of age, in a suburb in Kingston, Jamaica. The aim of the study was to measure the prevalence of and association between parasitism and nutritional status. Forty-two per cent were malnourished (<80 percent of standard weight for age), most commonly (76 percent) in the 12-17 month age group. Thirty-four per cent had one or more parasites, particularly Trichuris trichuria (21 percent) or Ascaris lumbricoides (19 percent). The peak prevalence of parasitism was among the 30-36 month old children (63 percent). Nutritional status did not differ between children with and without parasites. Most of them had light intensities of infection. Therefore, in this sample, there was no association between parasitism and nutritional status (AU)

The relationship between stunting, an episode of severe malnutrition and mental development in young children - abstract

Most studies have found that severe malnutrition, including marasmus, marasmic-kwashiorkor and kwashiorkor, in early childhood is associated with poor mental development several years later. However, the findings from survivors of kwashiorkor are inconsistent. We investigated whether an episode of severe malnutrition, per se, was associated with poor mental development or whether duration, as indicated by height-for-age, was a clinical factor. The study comprised 3 groups of children aged between 6 and 24 months: severely malnourished (n=30), stunted (n=30) and non-stunted (n=15). All severely malnourished children had been admitted to the University Hospital of the West Indies between 1 and 6 months previously. The stunted group were attending an out-patient clinic at the Tropical Metabolism Research Unit, for moderate malnutrition. They were individually matched for height-for-age and age at the time of presentation to hospital, to the severely malnourished children. The non-stunted children were all above minus-1SD of the NCHS standards and came from clinics. All children had developmental assessments on the Griffiths Mental Development Scales by a tester who was unaware of their group. Both the severely malnourished and stunted groups were significantly lower than the non-stunted group in DQs and performance scores. Only the severely malnourished group was significantly lower in hand and eye scores. There was no significant difference between the severely malnourished and stunted group in DQs or subscales. The indications are that factors associated with stunting are responsible for a large part of the deficit in mental development found in children recently recovered from severe malnutrition. Further, classifying children by height-for-age facilitates the identification of functional associations (AU)

Nutritional status of Jamaican children in an economic depression

In Jamaica, between 1979 and 1984 the cost of basic food items increased steeply. It had previously been suggested that many children would rapidly become malnourished in the event of an economic depression. We therefore investigated whether the nutritional status of children in two poor urban neighbourhoods had deteriorated during this period. In both 1979 and 1984, a house to house survey was carried out in the same area using the same methods and sample selection. The sample comprised children between 6 and 48 months, and it included 211 children in 1979 and 227 in 1984. There was no consistent change in the children's mean percentage expected weight-for-age or weight-for-height, nor in the prevalence of moderate or severe malnutrition. There was however an increase in breast feeding. The results suggest that in some populations an increase in malnutrition may be a later manifestation of an economic depression rather than an early one (AU)

Nutritional status of children in two Kingston neighbourhoods over a five-year period of increasing food costs - abstract

Between 1979 and 1984, the cost of basic food items in Jamaica rose steeply, and hospital admissions for malnutrition in children increased. We therfore investigated whether children's nutritional status in 2 poor urban neighbourhoods had changed during the same period. We had surveyed the neighbourhoods in 1979, and the survey was repeated in the same areas using the same methods. The samples comprised all children between 6 and 48 months in the areas, taking only one child from each household. The sample size was 211 in 1979 and 227 in 1984. The children were weighed, their lengths were measured and certain socio-economic details were recorded. There was no consistent change in mean weighed, their lengths were measured and certain socio-economic details were recorded. There was no consistent change in mean weight-for-age, weight-for-height and height-for-age over the five-year period. There was an increase in the height-for-age of 12 to 23 month-old children only. The prevalence of severe and moderate malnutrition as diagnosed by the Wellcome (1970) and Waterlow (1976) classifications remained similar (14 percent, 12 percent wt/age; 7 percent ht/age; 3 percent wt/ht for 1979 and 1984 respectively). In both surveys, the nutritional status deteriorated as the children got older. In 1984, associations were found between poor weight-for-age and older children, poorer toilet facilities and increased crowding, and between height-for-age and older children, boys, non-working mothers and increased crowding. It is concluded that although socio-economic conditions are associated with children's nutritional status, national economic problems do not necessarily impact on a community's status. This lack of impact had also been reported from Brazil (Gross, 1986). This suggests that a decline in children's nutritonal status may be a late, rather than an early, manifestatioin of economic reversal (AU)