Postpartum maternal moods and infant size predict performance on a national high school entrance examination.

BACKGROUND: In an earlier series of studies, we documented the effects of feeding practices and postnatal maternal mood on the growth and development of 226 Barbadian children during the first few months of life. In this report, we extend our earlier studies by examining predictive relationships between infant size, feeding practices and postpartum maternal moods and scores on a national high school examination, the Common Entrance Examination (CEE), at 11 to 12 years of age. METHODS: Feeding practices, anthropometry, and maternal moods, using Zung depression and anxiety scales and a morale scale, were assessed at 7 weeks (n = 158), 3 months (n = 168), and 6 months (n = 209) postpartum. Background variables including sociodemographic and home environmental factors were also assessed during infancy. CEE scores on 169 of the children in the original study were obtained from the Ministry of Education of Barbados. RESULTS: In our sample of 86 boys and 83 girls, we found that reduced infant lengths and weights at 3 and 6 months of age were predictive of lower CEE, especially math scores. Children who were smaller at these early ages had significantly lower scores on the examination than did larger children. Postpartum maternal moods, including reports of despair and anxiety, were also found to be significant predictors of lower CEE scores, especially English scores. However, breast-feeding and other feeding practices were not directly associated with the CEE scores. Background variables, which significantly predicted lower CEE scores, included young maternal age at the time of her first pregnancy, more children in the home, less maternal education, and fewer home conveniences. Significant associations between infant anthropometry, maternal moods and CEE scores were all significant even when these background variables were controlled for. CONCLUSIONS: These findings have important implications for developing interventions early in life to improve academic test scores and future opportunities available to children in this setting.

Maternal moods predict breast-feeding in Barbados

This study was designed to identify psychosocial variables affecting early infant feeding practices in Barbados. The sample included 93 healthy women and infants born at the Queen Elizabeth Hospital who were extensively evaluated 7 weeks, 3 months, and 6 months after birth. Maternal moods were assessed with the Zung Depression and Anxiety Scales and the General Adjustment and Morale Scale. Feeding practices were evaluated using a questionnaire developed for this population. The prevalence of mild depression in this population was 16 percent at 7 weeks and increased to 19 percent at 6 months, whereas there were very few cases of moderate-to-severe depression. Disadvantaged environmental conditions, including less information-seeking by the mother, lower family income, and poor maternal health, were closely associated with increased symptoms of depression and anxiety in all women. However, significant predictive relationships between mood and feeding practices remained even when the effects of the home environment were controlled. Specifically, depressive symptoms at 7 weeks postpartum predicted a reduced preference for breastfeeding at current and later infant ages. Conversely, feeding practices did not predict maternal moods at later ages. These findings have important implications for public policy dealing with programs promoting breastfeeding. Early interventions designed to treat mild postnatal depression should be instituted early in the postpartum period to improve the chances for successful breastfeeding.(Au)

Long-term follow-up of infant malnutrition in Barbados studies of glucose tolerance in well-adapted young adults - abstract

Childhood origins of adult disease may be important in the Caribbean, for instance in the later sequelae, if any, of under and malnutrition. Several such hypotheses can be tested for diabetes, including severity of the initial episode(s) leading to pancreatic fibrosis, and weight gain after puberty, causing further B-cell stress. The 1985 WHO criteria defined a malnutrition-related diabetes (MRDM) category, but causal evidence is slim. We examined a series from a chort (N=311) of survivors of infant marasmus (M), Kwashiorkor (K) and age-matched controls (C), all followed since presentation, for over 20 years. Cases were defined on infant weight for age < 2 SDs below expected. Of the first 90 subjects invited, 84 (93 percent) attended for a standardized portocol by trained observers, of a full 2-hour glucose tolerance test and anthropometric measures. (The results are shown in a table). These preliminary results show that average catch-up growth was complete in these previously severely malnourished young adults. While fasting blood glucose (FG) results were similar, following challenge the 2 hr values (2hr G) were significantly higher in female M than respective C(t=3.25, p<0.001) not accounted for by their greater weight, and higher in all M than C (p=0.02). Waist/Hip ratios were no different. Thus, despite these young people being well-adapted in a generally favourable socioeconomic setting, there is some evidence of glucose intolerance following challenge. This could be a prodrome for later development of diabetes. As they are also the first to have responded to the follow-up invitation, those who may not respond may be less well-adapted and hence at even greater risk of glucose intolerance and perhaps other problems (AU)

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination

This one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than health comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition. (AU)

The national health and nutrition survey of Barbados, 1981

Reports on a survey carried out to determine the health and nutritional status of Barbadians: establish trends in their health status: and discover whether the results of the health status of a random startified sample of pre-school children would confirm improvements in nutritional status based on hospital statistics. Investoigates the prevalence and association of nutrition-related diseases, such as obesity, diabetes and cardiovascular diseases and to correlate the findings with socio-economic factors while assessing the prevalence ofundernutrition among the vulnerable groups in the population. Recommends the need to implement measures for the prevention and control of diabetes and associated diseases: improving breastfeeding and weaning practices; monitoring child growth; strengthening dental health services and intensifying efforts to increase quantity and nutrient quality of food through home production(AU)

Breast-feeding, nutrition status and socio-economic progress in Barbados - abstract

The object of this study was to examine the breast-feeding performance of mothers in the 1969 and 1981 National Nutrition Surveys and to relate the results to the nutrition status of preschool children against the background of the attendant socio-economic progress. The breast-feeding performance of 126 mothers of infants who were attending health centres during the 1981 survey was compared to that of a similar group of mothers in the 1969 survey. The results showed that by 1981 the knowledge that "breast (feeding) was the best" was successfully imparted to the survey mothers who also stated that they intended to fully breastfeed their infants. This, however, was associated with a negative behavioural change in that the percentage of mothers actually breast-feeding at 6-months, declined significantly from 52 percent (1969) to 17 percent (1981). Notwithstanding this marked decline in breast-feeding, the infant mortality rate improved from 42 per 1000 livebirths (1969) to 17.6 per 1000 (1981), and among the preschool children the percentage of malnourished children declined from 16.5 percent (1969) to 8.8 percent (1981). The economic indicators also showed a marked improvement during the review period but, most importantly, this was not matched with a similar improvement in those social support sytems so necessary for successful breast-feeding. This study in Barbados supports the important relationship between appropriate social support systems and successful breast-feeding in a Third World Country in transition (AU)

Long term behavioural consequences of severe protein-calorie malnutrition - abstract

A study of the long term behavioural consequences of severe nutritional marasmus was undertaken in Barbados, West Indies. The index cases were boys (n=60) and girls (n=36) who had been hospitalized with malnutrition in the first year of life and followed longitudinally by the National Nutrition Centre. At the time of the current study, their ages ranged from four to eleven years. Each index child was matched by age, gender and handedness with a control child from the same school or parish as the index child. Descriptions of the child's behaviour were obtained by interviewing the primary caretaker of each child. Information concerning the social, physical and biological ecology was also gathered since these factors may independently influence behavioural development. Index children had more behavioural problems than their matched controls. Multiple regression analyses were performed to partial out the contribution of nutritional history of the child and economic conditions of the family, which differed in the two groups. These analyses confirmed that the behavioural deficits present among the index children were a consequence of malnutrition and not economic factors. Behavioural deficits persisted even in the older children as compared with their controls. In contrast with the behavioural results, anthropometric measures failed to distinguish between the two groups by ten years of age (AU)

Continuity of care in the management of severe protein-calorie-malnutrition in Barbados: the results of a three-year study - abstract

The purpose of this study is to show that continuity of care in the management of se-reduction in the high case-fatality in hospital and after discharge, frequent relapses and reduction in high case-fatality in hospital and afer discharge, frequent relapse and readmissions, with increased educational benefits to the mothers and at a cost which the country can afford. In the first part of the study, a medical service with continuity of care, integrating hospital and community mangement, and stressing nutrition education without free food supplementation, was provided for 448 malnourished children with complications who were admitted to the Queen Elizabeth Hospital between April 1, 1967 and March 31, 1970, and followed for 1 year after discharge. After 3 years, the re-admission rate was reduced from 25 percent to 3.4 percent, the protein-calorie malnutrition hospital-days were reduced by 36 percent, the protein-calorie-malnutrition case-fatality declined from 12 percent to 2.7 percent in hospital and was 0.5 percent in the community 1 year after discharge. In the second part of the study, 49 cases of Grades II & III protein-calorie-malnutrition without life-threatening complications, discovered by a survey in 1 parish of all children under the age of 2 years, were treated in their homes by nurses under the supervision of a paediatrician. There were no admissions, no deaths and without free food supplementation, we achieved a mean per cent increase in weight-age of 8.4 at the end of 18 months. These increased benefits were achived at a daily cost which was not only a fraction of the annual per capita health expenditure of the Government of Barbados. It is felt that there is a place for commuity as well as hospital management of protein-calorie-malnutrition, but it is important to have continuity of care and integration of the services in order to get maximum benefits (AU)